Excess winter deaths
Cold weather and associated seasonal illnesses such as flu complicate existing long-term conditions such as circulatory and respiratory diseases. This leads to peaks in mortality in winter months where the majority of deaths occur amongst the older population. Government recognises that many of these deaths are preventable where responsibility lies at national level the Cold Weather Plan for England seeks to reduce and avoid winter deaths by putting in place a range of preventative measures. Whilst individuals must also take responsibility for their health and wellbeing at this time, it must be recognised that not everyone is well equipped to cope with the drop in temperature and may have limited or restricted income for heating. Some factors are beyond their control such as inadequate heating, poorly insulated homes, and fluctuating fuel prices.
Key inequalities and risk factors
The Department of Health Cold Winter Plan Equality Analysis 2013 states a range of people people and groups are particularly at risk in the event of severe cold weather. These include:
- people over 75 years old
- otherwise “frail” older people
- children under the age of five
- people with pre-existing chronic medical conditions such as heart disease, stroke or TIA, asthma, COPD or diabetes
- people with mental ill-health that reduces individual’s ability to self-care
- people with dementia
- people with learning difficulties
- those assessed as being at risk of or has had recurrent falls
- people who are housebound or otherwise have low mobility
- people living in deprived circumstances
- people living in houses with mould
- those who are fuel poor (i.e. those who have a low income but have high energy costs)
- elderly people who live alone and do not have additional social services support
- homeless or people sleeping rough
The Department for Engery and Climate Change links fuel poverty with excess winter deaths. Published data from 2013 shows this affects those from a lower socio-economic background and older people. Flu vaccinations are part of a wider preventative and winter preparation programme to reduce winter deaths. A review of evidence with regard to take up in people aged 65+ suggests the 65-74 age groups experiences lower take up than other older age groups. Raising awareness of relevance to this group would therefore be beneficial. A number of clinical risk groups who should receive influenza immunisation are set out in the Green Book and include people with chronic respiratory, heart, kidney, liver or neurological disease (e.g. Stroke, transient ischaemic attack (TIA), diabetes, immunosuppression (due to disease or treatment), asplenia or dysfunction of the spleen, pregnant women and those who are morbidly obese.
Facts, figures and trends
Office for National Statistics provisional analysis (2015/16) highlights:
- excess winter mortality significantly decreased to 24,300 in 2015/16 from the uncommonly high number of 43,900 in 2014/15 which was the highest number since 1999/00
- 15% more people dies in the winter months compared with the non-winter months (27% om 2014/15)
- there were similar levels of excess winter mortality across all age groups, with those aged 0 to 64 affected more than in previous years and those aged 85 and over affected less than previous years.
- following the pattern of previous years there were more excess winter deaths in females than males in 2015/16. Excess winter deaths for both sexes decreased from the 2014/15 period
- more than one-third of all excess winter deaths were caused by respiratory diseases in England and Wales in 2015/16
- there is no clear geographical pattern in excess winter mortality over time, however, in 2015/16 Wales had the highest excess winter mortality index at 17% and East of England had the lowest excess winter mortality index at 13%
Excess winter deaths
Excess winter deaths Index (EWD Index) is the excess winter deaths measured as the ratio of extra deaths from all causes that occur in the winter months compared with the expected number of deaths, based on the average of the number of non-winter deaths. This index shows a significant decrease in Bracknell Forest in the latest available year of data (2015).
The council’s Sustainable Energy Officer will give information, advice and signpost occupiers to any available funding to improve heating and insulation within their homes. Call 01344 352000 for more.
At the last census (2011), 1.2% of households in Bracknell Forest did not have central heating, with the highest proportion of these households in Hanworth ward (2.5%). This compares to 2.7% in England overall. This is relevant because Hanworth and Harmans Water are wards with older populations. Source: LGA Inform Plus (accessed 4 July 2016)
A household is considered to be in fuel poverty if their income does not cover the cost of keeping their home heated. Low temperatures are strongly linked to the worsening of long-term conditions and illnesses such as respiratory disease and heart conditions. The factors that determine fuel poverty are: income, fuel prices and rate of fuel consumption. Homes that are harder to heat increase the rate of fuel consumption and older people, who tend to have fixed, pension, incomes cannot always respond to an increase in fuel prices and fuel consumption.
Data from the Departmetn of Energy and Climate Change shows Bracknell Forest in respect of fuel poverty shows 5.8% of residents are found to be in fuel poverty. Figures for Bracknell Forest are lower than national and south east averages, but all areas show slight rises year on year.
Winter fuel payments
Winter Fuel Payments were introduced by government to tackle the income element of fuel poverty. The payment is a tax free sum to help people of pension age born on or before 5 May 1953 to their pay heating bills and is targetted at pensioners who are particularly vulnerable to the effects of cold weather during the winter months and are more likely to be on fixed, pension, incomes. Data recorded until 2012 shows the percentage of people aged 60+ in receipt of winter fuel payments in Bracknell Forest is significantly higher than the national average.
A key driver of the higher number of deaths in winter months is seasonal flu. Excess winter mortality reports conclude that excess deaths were found predominantly in older people and in deaths coded as resulting from respiratory causes. Their analysis showed influenza (the flu) to be a major explanatory factor. For most healthy people, flu is an unpleasant but usually self limiting disease with recovery generally within a week. However, the following people are at particular risk of severe illness if they catch flu.
Each year the NHS prepares for the unpredictability of flu. The flu programme is a coordinated and evidence based approach to planning for the demands of flu across England and can change from year to year. The flu plan for 2016/17 also recommends vaccination for people in long-stay residential care homes and carers. Increasing the uptake of flu vaccine among these high risk groups should contribute to easing winter pressure on primary care services and hospital admissions. Flu vaccination uptake against the Department of Health target of 75% is measured by Public Health England for adults aged 65 and over and at risk individuals aged 6 months to 65 years (excluding pregnant women):
Most recently, the percentage of adults aged 65+ in receipt of the flu vaccine is higher than the England average, however, the rate is still lower than the national 75% target. Work is under way to ensure that uptake of the ful vaccine is maximised.
Recommendations and current action
Preventing excess winter deaths and illness associated with cold homes (NICE, 2016) – makes recommendations on how to reduce the risk of death and ill health associated with living in a cold home. The aim is to help meet a range of public health and other goals. The recommendations are set out below.
- develop a strategy
- ensure there is a single‑point‑of‑contact health and housing referral service for people living in cold homes
- provide tailored solutions via the single‑ point‑of‑contact health and housing referral service for people living in cold homes
- identify people at risk of ill health from living in a cold home
- make every contact count by assessing the heating needs of people who use primary health and home care services
- non-health and social care workers who visit people at home should assess their heating needs
- discharge vulnerable people from health or social care settings to a warm home
- train health and social care practitioners to help people whose homes may be too cold
- train housing professionals and faith and voluntary sector workers to help people whose homes may be too cold for their health and well being
- train heating engineers, meter installers and those providing building insulation to help vulnerable people at home
- raise awareness among practitioners and the public about how to keep warm at home
- ensure buildings meet ventilation and other building and trading standards
The following summary of current action shows that we are well on the way to meeting all of these recommendations. However, more work is required in some areas.
The council has an overarching Housing Strategy which aims to “enable Bracknell Forest residents to live in a comfortable home in a community they want to live in”. The strategy has 4 priorities to achieve that aim:
i. supporting a vibrant housing market
ii. providing affordable housing
iii. providing the right homes for vulnerable people
iv. contributing to sustainable communities.
The Strategy to improve the existing housing stock under pins these priorities and seeks to deliver services which support residents to remain in their own homes, where that is the best option for them, reduce fuel poverty, enable affordable warmth and ensure good standards of property condition and management.
At the moment, 38% of properties in Brackenll Forest at EPC rating in band A, B and C. Officers within Regulatory Services and Housing will refer to the Sustainable Energy Officer if energy advice is needed or if enforcement action is being considered to improve cold homes.
Home visits are undertaken by the Sustainable Energy Officer or Environmental Health officers regarding adequate ventilation and heating, if appropriate such visits may lead to improvement works to ensure that homes meet the current minimum standard. Trading Standards currently involved with EPC legislation Provision of tailored solutions via the single‑point‑of‑contact health and housing referral service for people living in cold homes is undertaken depending upon the tenure and the situation, for example, if necessary enforcement action can be taken to improve cold homes in the private rented sector, or through signposting persons to appropriate energy improvement schemes.
We have recently completed £1.8 million energy improvement programme including insulation to 65 park homes. People at risk of ill health from living in a cold home are highlighted by identifying properties with a poor energy performance (E,F, and G rated properties). The council is able to target any applicable funding towards those homes. This has recently included external wall insulation works to Park homes with 65 completed up to March 2016.
Ongoing work is being undertaken to develop closer working with primary health care providers and home care services as part of the ‘Making Every Contact Count’ initiative. This also includes work to increase uptake of flu vaccination.
In addition, vulnerable people discharged from health or social care settings to a warm home referred to the Sustainable Energy Officer to give advice and signpost to further services as appropriate. Awareness raising and training work with Health & Social Care professionals, as well as with the faith and voluntary sector is planned. A lot of work also goes into raising awareness among the public about how to keep warm at home and the need for energy efficiency. This has included articles in our residents’ magazine ‘Town & Country’ as well as information on our website and local parish newsletters.
Want to know more?
Cold Weather Plan for England (Public Health England, 2015 updated 2016) – The Cold Weather Plan for England is a framework intended to protect the population from harm to health from cold weather. It aims to prevent the major avoidable effects on health during periods of cold weather in England by alerting people to the negative health effects of cold weather, and enabling them to prepare and respond appropriately.
Cutting the cost of keeping warm – a fuel poverty strategy for England (HM Government, 2015) – sets out who is vulnerable, the legal framework for tackling fuel poverty and how the government target of ensuring all homes reach a minimum energy efficiency rating of Band C by 2030 will be achieved.
Flu plan 2016/17 (Public Health England, 2016) – sets out a co-ordinated approach to planning for and responding to the demands of flu across England, building up lessons learnt during previous flu seasons. It is intended to help the development of robust and flexible operational plans by local organisations and emergency planners within the NHS and local government.
Reducing harm from cold weather (Local Government Association, 2013) – a framework for co-ordinated multi-agency long term planning and commissioning throughout the year, to protect people and infrastructure against the harmful effects of cold weather.
Local Action on Health Inequalities: Tackling fuel poverty and cold home-related health problems (Public Health England, 2014) – a summary of evidence about the impact of fuel poverty and cold homes on health and wellheing and potential actions that could be taken by local authotities.
Safe, warm, decent housing for older people – why it really matters (Housing LIN, 2014) – Establishes the argument for a ‘joined up strategy’ around older people’s housing to future proofing housing for an ageing society, engaging older people in the planning and design of new homes & neighbourhoods, promoting greater choice of specialist and general housing for older people and integrating housing as an issue into the planning of health and care services.
This page was created on 27 February 2014 and updated in August 2017. Next review April 2018.
Cite this page: Bracknell Forest Council. (2016). JSNA – Excess Winter Deaths. Available at: jsna.bracknell-forest.gov.uk/ageing-well/keeping-well/excess-winter-deaths. (Accessed dd mmm yyyy)
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