Excess Winter Deaths

Jane Ellison Excerpts

Monday 6th June 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

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.