Health, Cold Weather and Fuel Poverty
Submitting InstitutionSheffield Hallam University
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
This case study presents the impact of the Health and Temperature
Research Group (HTRG) at Sheffield Hallam University, led by Professor
Tod. The group generates novel, collaborative, translational,
interdisciplinary (e.g. health, housing and environment, energy and
welfare) research with a focus on cold related ill health. The research
impact is illustrated here by The Keeping Warm in Later Life Project
(KWILLT). KWILLT findings provide a unique understanding of the complex
environment and multiple factors influencing older people keeping warm and
well in winter. Beneficiaries include NHS, local and national policy
makers, and practice organisations.
The HTRG research group focuses on the health impacts of temperature. The
underpinning research commenced in 2009 with KWILLT, the focus of this
case study. KWILLT generated findings demonstrating an improved
understanding of health behaviour and inequalities in groups vulnerable to
cold related illness and death (References 1-3). Translational outputs
were developed for applied use in policy and practice across the related
academic and practice disciplines including health, housing and
environment, energy and welfare. Research in HTRG has expanded to include
work on households with children, environment interventions, temperature
measurement and links between temperature and clinical conditions.
Professor Tod (at SHU since 2006) has led the research, working with staff
across the Centre for Health and Social Care Research including Dr
Lusambili (Research assistant 2009-2011), Dr Allmark (Principal Research
Fellow (2009-present), Dr Cronin de Chavez (Research Fellow, 2012 to
present) and Catherine Homer (Research Assistant 2011-present). New
members of the group include Dr Kelly (Reader, 2013-present) and Professor
Childs (2012-present). The group now includes one PhD student and one
Professional Doctorate student (co-funded by CLAHRC-SY).
KWILLT was funded by a National Institute for Health Research (NIHR)
Research for Patient Benefit (RfPB) Grant of £232382 from 01/09/2009 to
30/11/2011. The study was highlighted as one of two RfPB exemplars in the
2010/11 NIHR Annual Report (Reference 4). Conducted in partnership with
NHS Rotherham, the study was adopted by the health inequalities theme of
the NIHR South Yorkshire Collaboration for Leadership in Applied Health
Research and Care (CLAHRC-SY) which enabled and enhanced dissemination and
KWILLT is a unique behavioural health study generating research findings
and outputs in relation to the Department of Health Cold Weather plan and
associated policy and practice. Through robust qualitative inquiry with a
sample of older people and staff, alongside objective temperature
measurement, KWILLT has generated findings in four main areas.
First, it identified the complex and varied influences on vulnerable
older people's decision-making regarding heating and cold at home. A range
of contextual factors, attitudes and values, as well as barriers, was
identified as important (References 1 and 3).
Second, KWILLT revealed that, in order to access help, vulnerable people
have to navigate a system that is fragmented, with findings illustrating
how this conspires against older people keeping warm and well (References
1, 2 and 3).
Third, KWILLT generated an understanding of the barriers health and
social care staff encounter in identifying, assessing and intervening in
the lives of older people at risk of cold related ill health. The findings
illustrate how staff attitudes and assumptions can prevent vulnerable
people from receiving the care they need. Through qualitative and social
marketing analysis techniques a segmentation model was developed
describing six groups of older people vulnerable to being cold, and their
core characteristics (Reference 1). The model identified how staff and
systems can be developed to address problems identified
(http://kwillt.org/index.php/pen-portraits).The segmentation model
informed the development of six pen portraits. These helped public and
voluntary sector organisations identify vulnerable populations, e.g.
Health and Wellbeing Boards.
Finally, the HTRG has analysed KWILLT findings alongside existing
evidence to address policy implementation, e.g. the Cold Weather Plan
(Reference 1) and Nudge (Reference 3). During the conduct of KWILLT the
Department of Health launched its first Cold Weather Plan, highlighting
evidence gaps about the identification of those vulnerable to the cold and
developing appropriate interventions to reduce temperature related
illness. The latter stages of KWILLT (e.g. segmentation model) and further
work of the HTRG aim to address this evidence gap.
References to the research
Peer review journal articles
1. Tod AM, Lusambili A, Homer C, Abbott J, Cooke JM, Stocks AJ, McDaid
KA. (2012) Understanding factors influencing vulnerable older people
keeping warm and well in winter: a qualitative study using social
marketing BMJ Open 2012;2:e000922 doi:10.1136/bmjopen-2012- 000922
2. Allmark A. Tod AM. Can a nudge keep you warm? Using nudges to reduce
excess winter deaths: insight from the Keeping Warm in Later Life Project
(KWILLT) Journal of Public Health. doi: 10.1093/pubmed/fdt067
Quality indicators of the research
01/09/2009-30/11/2011 Keeping warm at home in later life: a study to
develop social marketing interventions that promote engagement of older
people in keeping warm behaviour and access to anti-fuel poverty services.
NIHR, Research for Patient Benefit. (Grant Reference Number PB-PG-
0408-16041) £232382, Prinicipal Investigator Prof Tod.
01/03/2012 - 31/12/2013 Warm Well Families Joint funding by NIHR
Flexibility and Sustainability funding, NHS Rotherham, NHS Doncaster, and
Consumer Focus Energy. £150000, Principal Investigator Prof Tod.
Details of the impact
To facilitate the impact of KWILLT on policy and practice, creative,
applied outputs were developed (e.g. DVDs, videos and e-learning
materials) based on KWILLT data and the segmentation model (Sources 1, 2
and 3). The outputs are available on the KWILLT website (101030 hits at
31/7/2013). The impact of KWILLT is rooted in its contribution to enhance
evidence through which to inform policy and practice related to avoidable
cold related illness and death. The prime example of impact relates to the
Department of Health Cold Weather Plan (CWP). The CWP called for NHS staff
and organisations, alongside collaborative institutions, to plan for
winter to avoid the negative impact of cold weather (Source 10). This
requires identifying and assessing those at risk, alongside delivering
interventions including flu jabs, referral to affordable warmth schemes,
home improvement agencies and welfare and debt advice. In addition, the
Department of Energy and Climate Change (DECC) is tasked with implementing
the Green Deal and Energy Company Obligation (ECO). This places a premium
on identifying homes vulnerable to cold related harm and also householders
who would benefit from energy efficiency measures. As KWILLT indicates,
those most at risk often do not access such policy initiatives. KWILLT
findings and outputs have provided evidence to inform relevant
organisations on how to respond to the challenges and obligations laid
down in such policy. Evidence of impacts is summarised below.
- Influence in national policy was realised through the 2012/13
Department of Health Cold Weather Plan where it is recommended to
stakeholder groups as a toolkit for practice and cited as key evidence
(Souces 5, 6, 10). Also the DECC Fuel Poverty Team has used the
electronic KWILLT outputs to increase understanding of factors
influencing older people to think about ways of overcoming these
barriers, and to stimulate thinking on how the DECC fuel poverty policy
and ECO reaches vulnerable householders (Email communication from Senior
Policy Advisor for Green Deal, DECC) (Source 9).
- Impact has also been demonstrated through evidence contribution to
national consultations, primarily the Hills Fuel Poverty review (Source
- KWILLT informed the development of Winter Warmth England (WWE) (Source
3), this being a web based communications and information resource that
used KWILLT findings to develop the content and target audiences. This
was supported by Department of Health Warm Homes: Warm Families funding
to facilitate delivery of the Cold Weather Plan. How KWILLT findings
were used in practice are detailed in the WWE evaluation report (Source
4). Examples include using KWILLT findings to develop and deliver clear,
consistent, accurate and accessible messages to staff and the public on
the health impact of cold and reducing health risk.
- A number of national organisations have used KWILLT findings and
outputs for media, campaigns and training. For example, National Energy
Action (NEA) used the findings within a national programme of seminars
for over 150 organisations involved in delivering on ECO, and a national
strategy seminar on Achieving Public Health Outcomes on Fuel Poverty and
Excess Winter Deaths (28 Feb 2013).
- KWILLT highlighted the need for partnership and cross sector working
to overcome existing barriers to action. KWILLT materials have
facilitated collaboration at a strategic and policy level such as local
Joint Strategic Needs Assessments, and also health and housing policies
in Local Authorities, for example Rotherham (Source 8). Findings have
helped Local Government Yorkshire and Humber identify areas with
vulnerable populations and target interventions accordingly e.g. flu
jabs and energy efficiency schemes such as Green Deal and ECO (Sources 4
- In public and policy debate at a local level KWILLT findings have been
used to discuss and influence local preparedness for winter, for example
at Local Area Assemblies. Findings were presented at Local Area
Assemblies in Rotherham to inform local neighbourhood responses to the
Cold Weather Plan, e.g. promoting neighbour checks on vulnerable
households. At a national level this is evidenced by invitations to
present at two Department of Health seminars on the CWP, by the DECC
fuel poverty team, and other forums where key stakeholders discuss
organisational responses to current policy, e.g. being an invited
speaker at the NEA Annual National Conferences (2009, 2011 & 2012).
NEA also used the KWILLT pen portraits as materials for policy debate on
the introduction of the Green Deal and in their training events with MPs
and key stakeholders regarding implementation of the Green Deal
- Impact is illustrated through integration of KWILLT findings into
staff training, e.g. in the NHS into Making Every Contact Count training
to health and social care staff, in Local Authorities into training with
housing department gas contractors and within the voluntary sector with
the training of volunteer Energy Champions (NEA). Partnership
interventions such as South Yorkshire Hotspots have also used KWILLT
findings and outputs in their staff training.
- Whilst it can be difficult to establish a direct influence of research
findings on practice, the impact of KWILLT on public health and NHS
staff practice is evidenced from the evaluation of the effectiveness of
the Winter Warmth England (WWE) web based Toolkit (Source 3), a resource
based on KWILLT findings. An evaluation of WWE indicates the website had
10475 page views and 792 people have visited the Kwillt videos on WWE up
to February 2013 (Source 4. p7). The evaluation provides examples of how
the KWILLT evidence was used to change practice including: helping
public health managers develop action plans for winter, informing
development of public campaign materials and public health
communications over winter, developing practice partnerships across
sectors, e.g. housing, energy and health, deliver keeping warm
interventions, e.g. Barnsley case study on p37 of the evaluation report.
This impact is reinforced by the CLAHRC-SY in their case study
collection (Source 8).
Sources to corroborate the impact
Keeping Warm in Later Life projecT (KWILLT) website. Full
details of outputs, conference presentations and publications.
National Institute for Health Research Annual Report 2010-2011.
p14 Research for Patient Benefit Research Highlights.
Winter Warmth England. http://www.winterwarmthengland.co.uk/
Evaluation of the Winter Warmth England Toolkit Stocks A.
McDaid K. Homer C. (2013) Winter warmth, Preparation for Winter.
Evaluation and reported effectiveness of the Winter Warmth England
Department of Health Cold Weather Plan 2012/13
p41 and p45
Health Protection Agency Evaluation Report Warm Homes, Healthy
People Fund 2011/12
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317136356595 p15 / p16
Department of Energy and Climate Change (2012) Getting the
measure of fuel poverty
Rotherham Joint Strategic Needs Assessment p38. KWILLT has
helped inform strategic response to fuel poverty, excess winter deaths
and preventable negative effects of cold weather. p38 Plus contact from
Health and Wellbeing Board Chair
- Senior Policy Advisor at the Department of Energy and Climate Change
- Senior contact at Public Health England Extreme Events and Health