Investing in warmer housing could save the NHS billions

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Bitterly cold.
Ruslan Guzov/Shutterstock

Dr Nathan Bray, Bangor University; Eira Winrow, Bangor University, and Rhiannon Tudor Edwards, Bangor University

British weather isn’t much to write home about. The temperate maritime climate makes for summers which are relatively warm and winters which are relatively cold. But despite rarely experiencing extremely cold weather, the UK has a problem with significantly more people dying during the winter compared to the rest of the year. In fact, 2.6m excess winter deaths have occurred since records began in 1950 – that’s equivalent to the entire population of Manchester.

Although the government has been collecting data on excess winter deaths – that is, the difference between the number of deaths that occur from December to March compared to the rest of the year – for almost 70 years, the annual statistics are still shocking. In the winter of 2014/15, there were a staggering 43,900 excess deaths, the highest recorded figure since 1999/2000. In the last 10 years, there has only been one winter where less than 20,000 excess deaths occurred: 2013/14. Although excess winter deaths have been steadily declining since records began, in the winter of 2015/16 there were still 24,300.

According to official statistics, respiratory disease is the underlying cause for over a third of excess winter deaths, predominantly due to pneumonia and influenza. About three-quarters of these excess respiratory deaths occur in people aged 75 or over. Unsurprisingly, cold homes (particularly those below 16°C) cause a substantially increased risk of respiratory disease and older people are significantly more likely to have difficulty heating their homes.

Health and homes

The UK is currently in the midst of a housing crisis – and not just due to a lack of homes. According to a 2017 government report, a fifth of all homes in England fail to meet the Decent Homes Standard – which is aimed at bringing all council and housing association homes up to a minimum level. Despite the explicit guidelines, an astonishing 16% of private rented homes and 12% of housing association homes still have no form of central heating.

Even when people have adequate housing, the cost of energy and fuel can be a major issue. Government schemes, such as the affordable warmth grant, have been implemented to help low income households increase indoor warmth and energy efficiency. However, approximately 2.5m households in England (about one in nine) are still in fuel poverty – struggling to keep their homes adequately warm due to the cost of energy and fuel – and this figure is rising.

Poor housing costs the NHS a whopping £1.4 billion every year. Reports indicate that the health impact of poor housing is almost on a par with that of smoking and alcohol. Clearly, significant public health gains could be made through high quality, cost-effective home improvements, particulalrly for social housing. Take insulation, for example: evidence shows that properly fitted and safe insulation can increase indoor warmth, reduce damp, and improve respiratory health, which in turn reduces work and school absenteeism, and use of health services.

Warmth on prescription

In our recent research, we examined whether warmer social housing could improve population health and reduce use of NHS services in the northeast of England. To do this, we analysed the costs and outcomes associated with retrofitting social housing with new combi-boilers and double glazed windows.

After the housing improvements had been installed, NHS service use costs reduced by 16% per household – equating to an estimated NHS cost reduction of over £20,000 in just six months for the full cohort of 228 households. This reduction was offset by the initial expense of the housing improvements (around £3,725 per household), but if these results could be replicated and sustained, the NHS could eventually save millions of pounds over the lifetime of the new boilers and windows.

The benefits were not confined to NHS savings. We also found that the overall health status and financial satisfaction of main tenants significantly improved. Furthermore, over a third of households were no longer exhibiting signs of fuel poverty – households were subsequently able to heat all rooms in the home, where previously most had left one room unheated due to energy costs.

Perhaps it is time to think beyond medicines and surgery when we consider the remit of the NHS for improving health, and start looking into more projects like this. NHS-provided “boilers on prescription” have already been trialled in Sunderland with positive results. This sort of cross-government thinking promotes a nuanced approach to health and social care.

The ConversationWe don’t need to assume that the NHS should foot the bill entirely for ill health related to housing, for instance the Treasury could establish a cross-government approach by investing in housing to simultaneously save NHS money. A £10 billion investment into better housing could pay for itself in just seven years through NHS cost savings. With a growing need to prevent ill health and avoidable death, maybe it’s time for the government to think creatively right across the public sector, and adopt a new slogan: improving health by any means necessary.

Dr Nathan Bray, Research Officer in Health Economics, Bangor University; Eira Winrow, PhD Research Candidate and Research Project Support Officer, Bangor University, and Rhiannon Tudor Edwards, Professor of Health Economics, Bangor University

This article was originally published on The Conversation. Read the original article.

Underpaid, overworked and drowning in debt: you wonder why young people are voting again?

Paul Whiteley, University of Essex

The 2017 general election was highly unusual as far as the youth vote was concerned. The Labour party won 65% – the lion’s share – of the youth vote. The nearest comparisons are with 1964 and 1997. In both those years, Labour took 53% of the youth vote. In the 2015 election, just two years earlier, the party had won just 38% of the youth vote.

How the under-30s vote

Tracking the youth vote between 1964 and 2017.
Paul Whiteley, Author provided

The contrast between the youth vote in the 2010 and 2017 shows how radically youth voting patterns have changed. During this period, their turnout rose by 19%. This change in youth participation, combined with a massive swing to Labour, has unsurprisingly led some to talk of a “youthquake”.

What could have brought this about? Political and cultural drivers are clearly at work. That includes youth support for remaining in the EU and their preference for Jeremy Corbyn over Theresa May. Only a quarter of 18-to-25s voted to leave in the EU referendum compared with two-thirds of those over 65.

But economic drivers also played a crucial role. Young people, put simply, have lost out both in the economy and government policy making. Since 2010 the British government has been preoccupied with shoring up its political support among middle aged and retired voters. It has largely ignored the concerns of the young, very often dismissing them because, in the past, most young people did not vote. That all changed in 2017.

Paying for education

One obvious driver of youth voting is the rapid increase in student debt imposed by a government which sought to privatise higher education during the austerity years. Tuition fees were originally introduced in 1998 and had reached £3,000 per year by 2006-7. At the time, it was widely accepted that the considerable graduate premium which existed in lifetime earnings justified a contribution to the costs of higher education by the beneficiaries.

But things radically changed in 2010 when the coalition government introduced a fees cap of £9,000. Ironically, this increased privatisation of the costs of higher education was accompanied by ever-increasing regulation, so that the less the state supports higher education the more it wants to control it. This trend culminated in a 2016 proposal to scrap maintenance grants and raise fees to £9,250 while at the same time charging interest rates of 6.1% on student loans at a time when the Bank of England base rate was 0.25%.

Such a reckless disregard for the interests of more than 40% of the under-25s is quite hard to understand, particularly in light of the fate of the Liberal Democrats following their u-turn on tuition fees after they joined the coalition in 2010.

The bias against youth was not confined to university students. In April 2016, the minimum wage was raised to £7.50 an hour, but this change only applied to employed workers over the age of 25. The minimum wage for apprentices under the age of 19 was a meagre £3.50 and hour and this did not change. Young people were essentially ignored.

Another aspect of the same issue relates to the self-employed, none of whom receive the minimum wage. Historically, self-employed workers have been older than the workforce average age – but, in recent years, self-employment has grown faster among the under 25s than any other group with the exception of 40-year-olds. Between 2008 and 2015 the number of self-employed people in the UK increased from 3.8 million to 4.6 million people with part-time self-employment, often synonymous with under-employment, increasing by 88%. Thus young people have lost out on the increases in minimum wages, with many of them being underemployed and working part-time for wages that are well below average.

Are you even listening?

It was, therefore, no surprise that when the pollsters YouGov recently asked citizens to rank their priorities for the country, 46% of 18-24 year olds selected increasing the minimum wage to approximately £9 per hour. That compared to a national figure of 28% (and 19% among pensioners).

In our panel survey of the electorate conducted immediately before the 2017 general election, we asked respondents if they agreed or disagreed with the following statement: “The government treats people like yourself fairly”. We found that 18% of the under-25s agreed with this statement compared with 28% of the over-65s. In contrast, 49% of the under-25s disagreed with it compared with 32% of the over-65s. Youth have not only been left behind but many of them are aware of this fact and have a sense of grievance arising from it. The stark difference in the responses of youth and pensioners to this statement is related to the differences in the government’s treatment of them.

The so called “triple lock” on pensions was introduced by the coalition government in 2010. It was a guarantee to increase the state pension every year by the rate of inflation, average earnings or by a minimum of 2.5% whichever was the highest. By 2016 it produced a situation in which retired people had average incomes £2,500 higher than in 2007/8, while those who were not retired earned an average of £300 less over this period. The latter reflects the fact that real wages have been flat-lining for more than a decade.

Given all this it is no surprise that the 2017 election was a case of youth striking back.

The ConversationThis article is based on research by Paul Whiteley, Harold Clarke, Matthew Goodwin and Marianne Stewart. Paul Whiteley is speaking at Youthquake 2017! Can young voters transform the UK’s political landscape? a joint event between The Conversation and The British Academy on October 9, 2017.

Paul Whiteley, Professor, Department of Government, University of Essex

This article was originally published on The Conversation. Read the original article.

Bare cupboards and nobody to help buy food: the forgotten welfare gap in older age


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Poverty and isolation is leading to nutritional problems for older people.
via shutterstock.com

Kingsley Purdam, University of Manchester

Welfare reform and austerity in the UK has led to reductions in public spending on services that support older people. Age UK has highlighted how nearly one million older people have unmet social care needs. This is of particular concern as the winter months approach.

In ongoing research on food insecurity in older age, my colleagues and I have analysed survey data and interviewed older people who use foodbanks. We’re finding that many older people are at risk of under-nutrition because of poverty, or because they don’t get the support they need to shop, cook and eat.

While many older people have been less affected by the recent recession than other age groups, in part because of the triple lock protection for pensions, poverty can persist in old age. Data from 2015 shows that 1.6m pensioners live below the relative poverty line, and 8% of pensioners are in persistent poverty – defined as having spent three years out of any four-year period in a household with below 60% of median income.

Poverty and social isolation

Around 20% of older people have little or no private pension, housing or material wealth and retiring with debt is also a growing problem. There are 3.8m people aged 65 and older living alone in the UK and evidence from Age UK suggests that nearly one million people in this age group always or often feel lonely.

Older people living alone tend to eat less. This can lead to under-nutrition – a major cause of functional decline among older people. It can lead to poorer health outcomes, falls, delays in recovery from illness and longer periods in hospital, including delayed operations.

Evidence from the National Nutrition Screening Survey suggests that an estimated 1.3m people aged over 65 in the UK are not getting adequate protein or energy in their diet. On admission to hospital, 33% of people in this age group are identified as being at risk of under-nutrition.


Read more: Huge cuts have made elder care today look like a relic of the Poor Law


Data we are analysing from the 2014 English Longitudinal Study of Ageing suggests that for around 10% of people aged 50 and over “too little money stops them buying their first choice of food items” and this has increased consistently since 2004. Evidence from the Poverty and Social Exclusion Survey in 2012 found that 12% of people aged over 65 had often or sometimes: “skimped on food so others in the household would have enough to eat”.

Embarrassment and stigma

The Health Survey of England consistently highlights the issue of unmet need among some older people. For example, 6% of people aged over 65 reported that they had not received help from anyone with shopping for food in the last month. In addition, 19% of this age group reported needing help to leave their home.

Evidence suggests that as food insecurity has increased in the UK, many older people have become reliant on food banks. In 2016, the food redistribution charity FareShare said that 13% of its clients were aged over 65.

Our interviews with older people using food banks have highlighted the challenges many older people can face. Some were having food parcels delivered by the food banks as they were unable to go themselves or did not want to be seen going.

Embarrassment and stigma were also a concern for one 69-year-old man who told us how he preferred coming to the food bank than asking family or friends for help. “I don’t believe in asking others, I don’t want to upset people,” he said. Another 65-year-old man told us: “My family would help but I don’t like to ask them, they have their own families to look after.” Others, however are either unable or too embarrassed to visit a food bank.

Food or warmth

One 54-year-old man said: “I can go for a couple of days without food… the gas is cut off and I get hot water from the kettle to wash.” There was also evidence that some older people were not fully recognising their nutritional needs. As one 60-year-old woman said: “When you are on your own… sometimes I don’t cook, depends how I feel.” Another 65-year-old man revealed his poor diet, stating how when he had no food he would: “Just eat cornflakes.”

Counting the pennies.
Kingsley Purdam, Author provided

Other people chose to cut back on food during the winter due to the costs of heating their home – suffering the cold as a result. As one 72-year-old woman stated: “Sometimes I just go without putting the heating on.”

An increasing number of older people are constrained in their spending on food, many are skipping meals and are not getting the social care support they need. Emergency food parcels are an inadequate and unsustainable way of addressing the issue of food insecurity.

There are currently 10m people in the UK aged over 65, but this is expected to increase to 19m by 2050 – that’s one in every four people.

The ConversationAs the size of the older population continues to grow, the reductions in local authority spending on social care raise concerns about their long-term welfare. Given the follow-on costs to the public purse, including in terms of healthcare, the government must do more to combat food insecurity amongst older people.

Kingsley Purdam, Senior Lecturer, University of Manchester

This article was originally published on The Conversation. Read the original article.