Intended for healthcare professionals


GPs should identify and visit people at risk from cold homes, says NICE

BMJ 2015; 350 doi: (Published 05 March 2015) Cite this as: BMJ 2015;350:h1183
  1. Zosia Kmietowicz
  1. 1The BMJ

GPs should identify people who live in cold or hard to heat homes and should visit them once a year to assess their heating needs, the National Institute for Health and Care Excellence (NICE) has recommended.1

Year round planning and action by many sectors is needed to combat problems related to cold homes and fuel poverty, NICE has said, as they can affect a range of groups including people with cardiovascular and respiratory problems, people with mental health conditions, those with disabilities, older people, and households with young children and low incomes.

People who are discharged from hospital or social care homes should also have their homes assessed to check that they will be warm enough, NICE recommended. Part of the planned discharge could include simple measures such as turning on the heating before discharge and providing advice on the ill effects of cold on health—although more complex advice about replacing boilers may also be needed, said the guidance.

Anyone whose health and wellbeing are at risk because of a cold home should have an assessment of how the situation can be improved, NICE said, with referrals to responsible local agencies such as the health and housing service at health and wellbeing boards, which should have the expertise to bring homes up to minimum standards of heating and insulation.

Every year about 24 000 excess winter deaths occur in England and Wales—not generally from hypothermia but mainly from respiratory and cardiovascular problems when outdoor temperatures drop below 5-8°C. Most excess winter deaths occur during these periods of “normal” winter temperatures rather than in periods of severe cold when temperatures drop further.

Three times as many excess winter deaths have been estimated to occur in the coldest quarter of housing as in those in the warmest quarter. In England a household is said to be “fuel poor” if its members live below the official poverty line and have higher than average energy costs.

Gillian Leng, deputy chief executive of NICE, said, “Deaths and illnesses linked to living in a cold home are preventable. NICE recommends that health and wellbeing boards should ensure that a single-point-of-contact health and housing referral service is commissioned to help vulnerable people who live in cold homes.

“Anyone who comes into contact with vulnerable groups should be able to refer people to the service, including health and social care staff, safety services staff, and workers from charities and voluntary organisations. Properly using this huge number of contact opportunities can make a big difference in preventing illness and saving lives.”

She added, “We must stop the revolving door scenario where people are made ill by living in a cold home, they go into hospital for treatment, but then are discharged back to the cold home which continues to damage their health. What help the person needs should be assessed well before plans are made for discharge so they can get home without delay, and even simple actions like asking someone to switch the heating on before a person returns home can make a difference.

“This guideline can help break that cycle and instead get support to people whose health is at risk because they live in a cold home.”


Cite this as: BMJ 2015;350:h1183


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