The Health Housing and Fuel Poverty Forum is an initiative from the Partnership's Health Sub Group which was set up on behalf of the group by the UK Public Health Association in 2005, and funded to date by the Partnership. This article provides an update on the progress the Forum has made so far as well as details of activities going forward.

Origins of the Health Housing and Fuel Poverty Forum

In March 2005 the Health Housing and Fuel Poverty Forum (HHFPF) was launched at the Royal Horticultural Halls in London . The HHFPF was set up by the UK Public Health Association on behalf of the Partnership?s Health Sub Group, with the aim of optimising the contribution which the health sector makes in helping vulnerable people living in cold damp homes to gain maximum benefit from energy efficiency grants and programmes. The need to dramatically reduce the shocking excess winter mortality (40,000 extra deaths a year) and the illness and suffering caused by living in cold damp homes is the key motivational force which drives the HHFPF.

The 2005 launch event created a Core Group within the HHFPF, bringing together influential people in the public health, primary care, voluntary, energy and public sectors to work at a strategic level, identifying priorities for meeting the HHFPF's aim and leading the engagement with the wider community of practitioners and activist workings working to help those suffering from living in cold damp homes. The Core Group met throughout 2005 and early 2006 and identified three strategic priorities to achieve the aim.

• promote efficient and simple processes to enable health and social care practitioners to identify and refer vulnerable clients in cold homes to schemes that provide improvement to housing;
• streamline the delivery of energy efficiency and related measures and make better use of resources already within the system; and
• influence the effective implementation of the Health Housing and Safety Rating System.

Developing the Action Plan for the HHFPF

In March 2006 the HHFPF re-convened to:

• Learn from the results of the latest research into the Health Impact of Warm Front led by Professor Geoff Green from Sheffield Hallam University.
• Explore how the HHSRS could be used to tackle fuel poverty
• Consider how the Single Assessment Process could be developed to include issues of fuel poverty.
• Identify a model for delivery to vulnerable people

The Warm Front Research

The Health Impact Evaluation of the Warm Front programme showed measured increases in average living room temperatures of 1.6ºC and bedroom temperatures of 2.8ºC, taking them above recommended thresholds. The research predicted that this level of improvement will reduce excess winter deaths in the UK and estimated that the average cost per life year saved ranged from £4,000 for insulation to £21,000 for heating plus insulation over a 20 year horizon. It was found that higher temperatures, satisfaction with the heating system and less difficulty paying heating bills are all associated with better mental health and well-being as is more resident control over their homes, less insecurity, and a greater feeling of safety.

The Housing Health and Safety Rating System

The Health Housing and Safety Rating System (HHSRS):

• Replaces the Housing Fitness Standard from the 6th April 2006.
• Formally considers the potential risks to health and safety in residential accommodation arising from hazards in the home.
• Requires the Local Authority to act upon referrals/reports to perform assessments of dwellings.

Implications of the HHSRS for Health, Housing and Fuel Poverty.

• Health workers have a formal route to report suspected poor housing.
• Local Authorities are now statutorily required to act upon reports.
• Interventions to improve housing conditions can be more strategic than before. Different hazards can be compared (prioritisation).
• Allows a proactive and preventative approach (targeting resources at the most in need).

The Single Assessment Process

The purpose of the Single Assessment Process (SAP) is to ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals regardless of health and social care boundaries. It has the potential therefore to be a powerful too, in the armoury of health workers seeking to help the elderly vulnerable living in cold damp homes

The Elderly Vulnerable

Because the elderly vulnerable constitute the largest group at risk from death and disease associated with living in cold damp homes, and because the HHSRS and SAP, described above, offer unique opportunities to address the needs of this group, the Core Group of the HHFPF have identified the Link-Age Plus programme as a possible opportunity for fast-tracking the lessons learned and delivery models developed through the work of the Group over the previous year.

There are many agencies in public, voluntary and private sectors with an interest in improving cold homes for older people. There are significant resources available to provide energy efficiency improvements, but in many areas the available resources aren?t reaching the most vulnerable people who need it most. It is hoped that by joining forces with Link-Age that addressing fuel poverty in the elderly can be prioritised at the very outset of the initiative.

The Link-Age Plus Programme

The Link-Age Plus is a programme developed by the Social Exclusion Unit, now being led by the Department of Work and Pensions (DWP) which is currently ?going live?.  Eight geographical areas have successfully bid to be part of the Link-Age programme, which emphasises developing more ?joined up? services for older people. It aims to create a ?one stop shop? for older people?s services: The areas which have bid successfully to pilot the Link-Age approach are Devon County Council, Gateshead Metropolitan Council, Gloucestershire County Council, Lancaster City Council, London Borough of Tower Hamlets, Nottinghamshire County Council Salford City Council and Leeds City Council.

Joint working with the Link-Age Plus Programme

It is envisaged that action based on collaborative working with the Link-Age programme will:

• create more streamlined  services to deliver energy efficiency and related improvements, geared to the needs of older low-income owner occupiers and private rented tenants (especially those with greatest health vulnerability).
• develop a simplified prioritisation, identification and referral system (involving, among others, community and public health, social care and environmental health).
• do this in a defined geographical area, with an agreed plan to capture learning from the process in order to transfer lessons more widely, to contribute to the ?mainstreaming? of  more effective systems, delivering a service better geared to the needs of vulnerable people.

Discussion with the DWP leads has resulted in a commitment by the HHFPF to work in two Link-Age Plus areas to:

• Identify who are most at risk from the adverse health effects of cold homes in their areas
• Consider what different sectors can contribute  (using real examples)
• Consider and develop the HHFPF ?Model?
• Define aspects of the model they wish to strengthen in their pilot area
• Discuss how to involve older people in developing good practice and monitoring progress

Lessons learned and partnerships formed through this collaborative working  will inform and develop the work of the HHFPF and lead to the exchange of learning throughout the HHFPF networks locally, regionally and nationally, and particularly though the HHFPF website  www.warmerhealthyhomes.org.uk