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House of Commons Hansard
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Excess Winter Deaths
06 June 2016
Volume 611

Motion made, and Question proposed, That this House do now adjourn.—(Guy Opperman.)

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I am sure that colleagues who—unaccountably—are leaving the Chamber will do so quickly and quietly, so that the hon. Gentleman who has the Adjournment debate can make his case and be heard with courtesy and attentiveness.

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I am grateful to have secured this opportunity to raise the important subject of excess winter deaths again in this House. I first raised the issue with the Prime Minister some four years ago. Since then, tragically, 117,000 people have died unnecessarily because of the cold—43,000 in the winter of 2014-15 alone. I think we can all agree that it is simply unacceptable that each year tens of thousands of people are dying unnecessarily. I am not going to pretend that this is an easy problem to solve or that any one Government are to blame. Tonight I intend to outline where I believe the Government’s approach can be improved and, in a constructive manner, offer suggestions of steps that I believe should be taken to address this national scandal, because while today was a very warm day, now—during the summer months—is precisely the time when we should be preparing for the winter.

The majority of those who are dying are elderly. We know that the demographic group most affected by excess winter deaths is women aged over 85, yet we also know from the evidence across Europe that more people are dying unnecessarily here than is the case elsewhere. Scandinavian countries including Norway, Denmark, Finland and Sweden all have significantly lower rates of excess winter deaths than the UK, despite all of those countries being considerably colder. One of the reasons for that is that, in policy terms, Scandinavian countries tend to be better prepared. As former director general of Age UK Michelle Mitchell put it,

“excess winter deaths are much lower because they take staying warm seriously and prepare for the cold weather.”

We know that that preparation is key, and I will outline several areas where preparation in our country could be improved.

The first is public health. The Office for National Statistics analysis of the most recent excess winter deaths figures highlights flu as an important factor in mortality levels, so I have to say to the Minister that I was concerned to be left waiting this spring for the Government’s flu plan for the upcoming winter. It was published just before recess, but that was some two months later than last year. Will the Minister say why the Government’s flu preparations are behind compared with a year ago?

Secondly, we know that cold homes are a major cause of excess winter deaths. They are also a burden on our public finances. Former chief medical officer Liam Donaldson has estimated that cold homes cost the NHS £850 million each year. Unfortunately, many elderly people live in fuel poverty—people like Lynne from Cumbria, who to keep warm in winter has to put on several layers of clothing and heat a hot water bottle, because she cannot afford to have the heating on when she needs to. For people like Lynne energy prices are a big issue. I welcome the fact that energy prices are falling, but they are not falling in line with wholesale prices, and too many energy customers find themselves on tariffs that lead to them paying more than they should. What discussions has the Minister had with her colleagues at the Department of Energy and Climate Change about alleviating fuel poverty to help to prevent excess winter deaths?

In addition, more can and should be done about home insulation. Although neither programme was perfect, I thought the green deal and energy company obligation were steps in the right direction. However, the green deal has now expired and the energy company obligation expires next year. We have been told that it will be reformed and renewed but, as yet, no timeline has been set out by the Government for doing so. May I ask the Minister what discussions she has had with fellow Ministers at the Department of Energy and Climate Change about ensuring that home insulation is increased?

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I thank the hon. Gentleman for bringing an important issue to the House in this Adjournment debate. In the period from July 2014 to August 2015, there were 870 excess winter deaths in Northern Ireland—the highest figure since 2009-10. It is unbelievable that the figure is so high in a developed nation such as ours. Does he agree that we need to do more to eradicate winter deaths, not just reduce them? In other words, it should be target zero.

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I am grateful to the hon. Gentleman for his intervention. He is absolutely right to draw attention to the heavy costs that his part of the world has borne. He is right to point out that in a prosperous, wealthy nation—yes, of course we have challenges—it is simply unacceptable that anyone should die as a result of the cold. The numbers that he has outlined in Northern Ireland and the national numbers that I outlined are simply unacceptable. As I said, this not the fault of any single Government—this is an issue that has challenged successive Governments. The Prime Minister recently said to me that these figures act as a standing rebuke to all Governments. The issue for us in the House tonight is what practical measures and action the Government can take to reduce the numbers and get to the point, as the hon. Gentleman suggested, where no one dies in this country as a result of the cold.

I was outlining some of those practical measures and was asking the Minister about the conversations that I hoped she would have with her colleagues at DECC on home insulation. Any measures that the Government seek to take should be targeted at those groups such as the elderly who are the most vulnerable to the cold. That brings me to a crucial point about the importance of cross-government working. Excess winter deaths are clearly an issue that requires a cross-government approach, but despite the fact that nearly 44,000 people died unnecessarily in the most recent winter for which we have figures, there is not a joined-up cross-government plan to reduce excess winter deaths.

A number of Departments, including the Department of Health, the Department of Energy and Climate Change, the Department for Work and Pensions, the Cabinet Office and the Department for Communities and Local Government, have policies which could contribute to reducing excess winter deaths. As yet, there is no overarching cross-government strategy to join up those policies and ensure that they contribute in the best possible way to reducing excess winter deaths. It is often left to local authorities to develop their own approach to reducing excess winter deaths. In Barnsley, we are fortunate that our local authority takes this issue very seriously. The council is making a concerted effort to ensure that vulnerable and elderly people live in heated homes.

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The hon. Gentleman is making a powerful speech. Does he agree that it is not just about the responsibility of Government or of local authorities? Fuel companies have a duty to ensure that as wholesale prices come down so too do the bills that people, including the most vulnerable people in our society, pay.

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I agree, and it is important that we seek to have a debate with the energy companies about what practical measures they would be prepared to take to reduce fuel poverty, particularly for the most elderly and vulnerable members of the community. I recently had the great privilege of engaging in a webchat on Mumsnet, and this was an issue that many people raised. What practical measures are energy and utility companies prepared to take? That is partly a matter for the regulator, and it is partly a matter for Government, but it is also, as the hon. Gentleman pointed out, a matter for the energy companies. I hope that they will look and listen carefully to the content of our debate. It is not in their interests for elderly people to freeze to death, and I look forward to having a constructive dialogue with them ahead of the winter months to see what measures can be taken to reduce the number of deaths this winter.

I was talking about the work that is taking place locally. My local authority is making a concerted effort to ensure that the vulnerable and the elderly live in warmer homes. The most recent practical example was the council securing funding for a warm homes programme, which offers free central heating replacements for people on low incomes who have no gas central heating system. I recently met one of my constituents, John Key, who had benefited from the scheme. At 84 years old, he had never had gas central heating and had never been able to heat the top floor of his home. Now, thanks to Barnsley Council, he is able to do that.

However, as I frequently say, not everyone is lucky enough to live in Barnsley, and I fear that what we have developing across the country is a patchwork approach to preventing excess winter deaths. That may well explain why there is substantial regional variation in the national figures, with the excess winter death rate in the south-west almost 20% higher than the rate in Yorkshire and the Humber.

Tonight, therefore, I am calling for the Government to bring forward a national strategy to reduce excess winter deaths. The strategy should be cross-government and should incorporate the following elements: a clear plan for reducing the number of excess winter deaths, with regular assessments to review the plan’s success; an independent assessment of what additional policies would help to reduce excess winter deaths; and a cross-departmental working group to co-ordinate current policy efforts to reduce excess winter deaths.

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The hon. Gentleman is outlining a plan of action. Does he feel that there is a role that the Salvation Army and church groups, whose congregations are normally elderly people, could play in the Government’s strategy?

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I absolutely do believe that there is a role for the charitable sector and for a range of organisations that make hugely significant contributions. However, the point I am trying to make concerns the means by which we draw those contributions together—the practical co-ordination measures that can be taken at a local level, led by directors of public health, to ensure that we have the most effective response and bring together all the different agencies locally, including the local authority, the clinical commissioning group, the local hospital, the GPs practices and the organisations the hon. Gentleman rightly referred to.

Before drawing to a conclusion, I want to take the opportunity to tell the House that I have started a petition today on Parliament’s petition website so that people across the country can join me in calling for a national strategy. I am pleased to say that, despite the fact that the petition launched only a few hours ago, it has already received a signature from one of the Minister’s own constituents—I hope she will welcome that contribution.

To conclude, the way in which a society cares for the most vulnerable is an important metric by which any society should seek to be judged. At the moment, given the numbers of people who are dying each year, we as a country are failing that test. Reducing excess winter deaths is an issue Members on both sides of the House can work together on. I look forward to the Minister’s response. I know she treats these matters with the concern they rightly deserve. I hope that tonight will not be the end of the discussion but the beginning and that she will go away and consult colleagues across the Government to see what more can be done so that, this winter and in winters to come, we can prevent people from dying unnecessarily.

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I congratulate the hon. Member for Barnsley Central (Dan Jarvis) on securing the debate. As he says, this is an important issue, and I appreciate his consistent interest in it. I hope I have responses to some of the points he made, but equally, I am happy at the outset to accept his challenge and give the issue more thought, and to make this an ongoing dialogue, because, as he said, this is an important issue.

The causes of excess winter deaths are complex; I will try to draw out a little bit of that complexity in my remarks. They are linked to various factors, including, as the hon. Gentleman said, the impact of cold temperatures on the body leading to issues such as heart attacks. Circulating infections such as the flu are also significant, particularly in winter. I will look at that in a bit more detail. The Government have put in place a range of measures to address those issues and ensure that we protect the most vulnerable, including by providing financial support to keep homes warm and by working to keep people well and out of hospital.

The hon. Gentleman made a good point about the need for more cross-Government work on the issue. I agree that there is always room for closer working between Departments. He also rightly draws on the fact that there is often close working between departments at a local government level. In fact, just this evening, as I was preparing for this debate, one of my colleagues from Cornwall, my hon. Friend the Member for Truro and Falmouth (Sarah Newton), told me that the very bodies that the hon. Gentleman has listed—all the different health bodies and initiatives—are brought together in her local area to form that combined plan. [Interruption.] My hon. Friend the Member for Hexham (Guy Opperman) says from a sedentary position that the same thing is happening in Northumberland. There is some excellent local practice. As we head towards even more local powers and devolution, it is important to say that, for those local areas that can do that really well, it is probably the single most important thing that they can do.

As a Health Minister, I will focus a little bit more on the health points, but I give the hon. Member for Barnsley Central an undertaking that we will take up those questions of his that it would be more appropriate for the Department of Energy and Climate Change to answer, and we will make sure that he gets a response.

Let me return to the flu. I want to address the hon. Gentleman’s point about the high number of excess winter deaths in 2014-15. The principal reason that excess mortality was higher that winter than in previous seasons is that the main strain of flu circulating in 2014-15, which was AH3N2, was one to which older people were particularly vulnerable. Flu affects different groups of people in different years. For example, the strain circulating in the season just gone, namely 2015-16, had more impact on children and younger people. The impact of the 2014-15 strain on older people unfortunately resulted in a large number of flu outbreaks in care homes, and higher than expected numbers of admissions to hospital and intensive care for flu. Cold snaps and other respiratory infections may also have contributed to an increase in excess mortality. The situation was not unique to the UK; 14 other European countries also reported an increase in excess mortality due to the same circulating strain of flu.

The hon. Gentleman will recall, I am sure, media reports on the effectiveness of the 2014-15 flu vaccine. There is a complex system behind understanding what goes into the vaccine, and there is a long lead time in preparing it in the required quantities. It is based on the World Health Organisation’s analysis of the circulating strains, but occasionally, for technical reasons, we do not get the match we are looking for. Although the interim mid-season figures caused concern, I am pleased to report that the final findings showed that the vaccine provided some protection against the primary strain, and good protection against the B strain that circulated later in the season. Nevertheless, it was a very difficult strain of the flu that affected older people in particular. Initial findings indicate that the vaccine for the season just gone, namely 2015-16, was well matched to the predominant circulating strain.

Vaccination remains the best protection against flu. The seasonal flu vaccination is offered free of charge to those people in whom flu can be more serious and even fatal. I urge those Members present to encourage their constituents—I am sure that the hon. Gentleman does this—to get the free vaccines. Despite the fact that they are free and that a lot of effort goes into promoting people’s eligibility, it is surprising that there is still a large number of people who do not take advantage of them. It is something with which we ask constituency Members to assist. I have always felt that our surgeries, where we may see some of the most vulnerable members of our community, give us an opportunity to do that. I am always looking for ways to promote this through Members of the House.

In September 2013, we rolled out a new programme offering children flu vaccination. This programme aims to protect children and reduce the transmission of infection in the wider population. We know that the programme works, because it reduced flu levels among children who received the vaccine and among the wider community. It is important to explain that this is why we focus on children so much. In 2014-15, GP consultations for flu-like illnesses were 59% lower in the pilot areas where the vaccine was offered to primary school children than in other areas. Those results are important, and they demonstrate why the child flu programme is essential to protect not only children but the whole community. Some commissioners refer to small children as “super-spreaders”; older members of their family and of the community are especially vulnerable.

I turn to the cold weather plan, which is at the core of what the hon. Gentleman called for. As he is aware, in addition to the flu programme, Public Health England annually publishes a cold weather plan for England, which is a collaboration between the Department of Health, NHS England and the Local Government Association. That plan provides guidance on how to keep warm in the winter and information on where support is available. That is underpinned by a cold weather alert service provided by the Met Office. The plan is aligned with additional guidance from the National Institute for Health and Care Excellence on reducing excess winter mortality and morbidity and the health risks associated with cold homes. We are trying to draw together all the key strands of the health system and local government.

Those most at risk of excess deaths include the elderly, those with long-term and severe illness and young children. To protect those who are most vulnerable, NHS England and PHE last winter ran an integrated marketing campaign, “Stay Well This Winter”. The campaign encouraged people particularly at risk of being admitted to hospital during the winter to take actions to help them stay well. Those actions included: getting a flu jab, keeping houses warm, seeking advice from a pharmacist at the first sign of feeling unwell, getting prescriptions before the Christmas period and taking prescribed medicine as directed.

We targeted the campaign at helping those with long-term health conditions. Last year, we enlisted charities that cater for people with particular conditions, because a lot of people with long-term health conditions do not realise that they are eligible for that free support. We also targeted those aged 65 or over, pregnant women and parents of under-fives. We had very positive feedback from the campaign, in the light of which we are planning to run it again this winter for a longer period.

I turn to the issue of cold homes, which the hon. Gentleman focused on to a large extent, and to the Government’s work to reduce the number of cold homes, as he rightly challenges us to do. There must be more that we can do, and it is vital to keep asking ourselves what more can be done. There has been significant progress, although too many homes are cold in the winter months, and excess winter deaths in the coldest quarter of homes are almost three times as high as in the warmest quarter. To address this, the Department of Energy and Climate Change has published a fuel poverty strategy for England with clear targets to improve housing. The Government have also made grants and sources of advice available to help people to make their homes more energy-efficient, which can improve home heating as well as helping with bills. For example, the warm home discount provides a one-off £140 discount on electricity bills for 2 million households, including 1.3 million of the poorest pensioners. The extension of the warm home discount to 2020-21 will help households who are at most risk of fuel poverty with their energy bills.

The Government also dedicate £2 billion a year to helping pensioners with their energy bills, which means that some of the most vulnerable in our society each receive up to £300 every winter. On top of that, we are ensuring that the poorest in our society get £140 off their energy bills every year, and we are requiring energy companies to help us to make 1 million homes warmer by 2020. I heard the challenge from my hon. Friend the Member for Cheltenham (Alex Chalk) to energy companies to do more, and he is quite right to make that challenge. There is more that can be done all round on this.

Last year, we invested £1 million in nine existing local schemes through the fuel poverty and health booster fund. That is about ensuring that people who are ill as a result of living in a cold home can get something done about the root cause of their illness. In addition, the Department of Health has introduced indicators for excess winter deaths and fuel poverty in the public health outcomes framework. That is what brings all those strands together at local government level to make sure that local authorities have a view of the whole system, and they are judged on that plan.

The hon. Member for Barnsley Central was right to praise his constituency for some of its initiatives. I am always happy to praise Barnsley. He may know that I stood for election in Barnsley twice, in 1996 and 1997, and I have extremely fond memories of it. He drew attention to the issues facing people in his constituency. I know that the council, together with local partners, has a range of programmes in place to help improve home energy efficiency and reduce fuel poverty. For example, a consortium that includes the district council—he referred to the consortium in his speech—received a Government central heating fund grant totalling £1,763,775. As he said, the money will be used to provide first-time central heating systems for up to 150 properties that are in fuel poverty. Barnsley Council is also running a warm homes campaign, which provides energy efficiency and fuel poverty training for front-line staff who are in contact with vulnerable people.

I know from work in my constituency that the most vulnerable people are often those who really need somebody to talk to them and guide them through the process. None of us, whether we are Ministers or Members of the House, would say that dealing with complex energy matters is the easiest thing to do. The Government want to make it easier, but there is no doubt that training to enable front-line staff to hand-hold people through the process, particularly if they are vulnerable, is really important.

I hope that I have given the hon. Gentleman some sense of the things that are going on. We are continuing to invest time and effort in learning, through an iterative process, about what has worked previously. I stress the fact that we were particularly affected by that strain of flu and the nature of the vaccine’s match to it, and it was not only the UK that was affected in that way. Nevertheless, I take his central point that we must all look at what more we can do to bear down on this problem. I am very happy to take away the points that he raised, and to bring them up with ministerial colleagues with responsibility for energy. I am sure that he will return to this subject, and I am happy to discuss it further with him outside the House and, no doubt, at some point in the future, on the Floor of the House again. I thank him for bringing this vital topic to the House’s attention this evening, and I thank all colleagues who have stayed for this late but important debate.

Question put and agreed to.

House adjourned.