Nottinghamshire Insight

Joint strategic needs assessment

Winter Warmth and Excess Winter Deaths (2014)

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Topic title Winter Warmth and Excess Winter Deaths (2014)
Topic owner Mary Corcoran
Topic author(s) Sue Coleman
Topic quality reviewed Kristina McCormick
Topic endorsed by OPICG
Topic approved by HWIG 26th March 2014
Current version Final 26.03.14
Replaces version Final Draft 14.03.14
Linked JSNA topics

Executive summary


England and Wales experienced approximately 31,100 more deaths in the winter months than 2012-2013, at a level that surpasses that experienced by other colder, Northern European countries.[i]  This suggests that many of these deaths could be prevented.  In Nottinghamshire in 2011/12 a figure of 340 excess winter deaths was recorded.

The majority of excess winter deaths occur in people aged 75 years or older, with women (18,000 deaths nationally) more affected than men (13,100).  Reasons for this are multifactorial; including the increased amount of time spent indoors, a higher prevalence of fuel poverty, a reduction in fat to retain body heat and an increased likelihood of having underlying health conditions.[ii]

The majority of excess winter deaths are due to cardiovascular disease and respiratory illness (accounting for approximately 40% and 33% of excess winter deaths respectively).[iii]  Flu is an important factor.   Exposure to cold causes thickening of the blood which increases the risk of coronary thrombosis and stroke, and also produces an increase in blood pressure and causes the blood vessels around the heart to spasm.  For every 1 degree Celsius decrease in average winter temperature there is a resultant 8,000 additional deaths in England.ii

This section considers the health and social care needs of winter warmth, with a particular focus on the issue of excess winter deaths among older people.  Cold homes present a health risk to all, and exposure of young children can result in a life time of ill health with the contracting of respiratory related illness such as asthma.  Other relevant links within the JSNA are to sections on housing and children’s health. 

Winter warmth is a local and national issue of concern.  Two significant policy documents: the 2009 Annual Report of the Chief Medical Officer chapter ‘winter kills’ and the National Cold Weather Plan (2013)  (please see the links below).

[i] Office for National Statistics. (2013) Excess Winter Mortality in England and Wales, 2012/13 (provisional) and 2011/12 (final)

[ii] Department of Health (2011) Cold Weather Plan for England: Making the case – why cold weather planning is essential to health and wellbeing

[iii] Department of Health (2009) Annual Report of the Chief Medical Officer, 2009

Unmet needs and gaps

Overall across the County strategic multi-agency approaches are required to decrease the number of people in fuel poverty.  This will require the on-going support for households to access home heating and insulation improvements, awareness raising of the key winter warmth messages and quality information on home energy efficiency savings and approaches for secure fuel at the lowest costs.  A small emergency provision, also, has proven valuable in enabling the District council housing officers to offer support when vulnerable people are suddenly put at risk due to boiler and heating system failures.  The winter flu clinics in GP surgeries provide a valuable venue to communicating the messages and support available.

Within these overall needs the following points are key :

  • Identifying approaches for ensuring the most vulnerable of residents are able to access support and home heating insulation grants successfully.
  • Promoting referral pathways to ensure the on-going identification of those people who are able to benefit from the home heating and insulation grants and finance schemes available.
  • Establishing support for people wishing to ‘make the move’ in situations where their home is no longer a good match to their needs.
  • Developing local knowledge of the relationships between excess winter deaths and ill-health and health inequalities.

Recommendations for consideration by commissioners

Winter warmth is a health and social care issue in Nottinghamshire.  The causes are structural in terms of quality within the local building stock, economic in terms of personal household budgets, and educational due to the poor understanding of the winter warmth messages and the potential assistance available among many residents.  The challenge, is also being able to identifying and have suitable support in place to assist the most vulnerable.

EWD measures used to present the local picture here represent the extreme, the ‘tip of the iceberg’. Cold homes and fuel poverty impacts on many people’s health in a wide variety of ways which is difficult to capture fully through the presentation of established statistics.

In Nottinghamshire the work established through the ‘Warm Homes, Healthy People’ initiative drawing on national funding developed a comprehensive framework and strategic approach for achieving winter warmth improvements in 2012.  Over the two subsequent winters local initiatives have been scaled back to reflect budget availability rather than the health need.  The opportunity presented with this detailed review on winter warmth here is the renewed developed of a local winter warmth strategy and the establishment of defined actions and funding allocations for its implementation.

Key contacts

Sue Coleman, Public Health and Commissioning Manager

This is an online synopsis of the topic which shows the executive summary and key contacts sections. To view the full document, please download it.

Full report »