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Is the energy crisis the UK’s next public health emergency?

Public health
Alex Turnbull looks at the impact that skyrocketing fuel bills is having on the nation’s health

The winter is always a period of intense pressures for the NHS, particularly this year as the health service faces a ‘twindemic’ of flu and Covid. But the greatest challenge this year could be caused by the energy crisis. Skyrocketing prices for gas and electricity are being linked to worsening public health, exacerbating a whole range of mental and physical health conditions, particularly in children and the elderly.

According to the NHS Confederation, household energy bills are set to rise to over £4,200 per year from January 2023. Even taking into account the £400 cost-of-living rebate promised by the government, this will push over two thirds of UK households into fuel poverty, exacerbating health inequalities that were already widened during the pandemic.

‘This winter has already been bleak and next year is set to be even worse. With Government support being reduced and energy bills spiralling yet again in April, one in three households will be in fuel poverty,’ said Adam Scorer, chief executive of National Energy Action (NEA), a charity which campaigns to eradicate fuel poverty1.

‘That means many of them will be forced to bed wearing coats, rationing showers and hot water, it means running up huge debts or self-disconnecting and going cold. Millions of the most vulnerable – carers, people with disabilities, those on low incomes and living in inefficient homes – are already bearing the brunt this winter. The situation will continue to get worse next year. The effects of this are devastating on both physical and mental health.

‘Make no mistake, cold homes can kill. Government intervention must prioritise the most vulnerable in 2023 and beyond.’

National Energy Action’s figures show that the number of households in fuel poverty will increase from 4.5 million UK households last October to 8.4 million. The research also shows, from April, that 1.8 million carers; 5.9 million low-income and financially vulnerable households; 3.6 million people with a disability; and 1.6 million households in off-gas homes will be in fuel poverty.

‘For too long we have known cold homes cost lives. On average, about 80 people per day die during the winter months due to a cold home. The wider physical and mental health impacts are devastating, praying on the most vulnerable in our society – often striking those with the worst existing health conditions or in the most fragile mental states, the hardest,’ added Mr Scorer.

The health impact of fuel poverty

The impact of fuel poverty is severe, and is thought to add as much as £1.3 billion onto the NHS bill each year.

Children growing up in cold, damp homes are more than twice as likely to suffer from respiratory conditions than their classmates in warm homes. Respiratory conditions such as asthma can require lifelong treatment and often begin in childhood. If a child is diagnosed at the age of six with asthma, they could require as many as 75 years of treatment. Research shows that cold housing is bad for children’s attainment at school, their emotional wellbeing and their resilience. The same is true for teenagers: adolescents living in cold housing are five times more likely to suffer from multiple mental health problems.

‘The physical and mental impacts on children are exceptionally harrowing; cold, damp homes and poor nutrition often go hand in hand. This means babies struggle to gain weight, at the same time or later in the child’s development there is the increasing risk of serious breathing problems. In adolescents social isolation or worse, extreme anxiety, is all too common. These impacts often last a lifetime. As well as misery, this all puts immense, unwelcome strain on our already overstretched health service,’ added Mr Scorer.

‘Unlike many other health conditions, the impacts of cold homes are however entirely preventable. We have known for years that by taking action to boost incomes, reduce prices and enhance the quality of homes; everyone can live in a warm, safe home.’

Older people are also particularly vulnerable to the effects of a cold winter with no heating at home. Because the heart has to work harder to keep the body warm when it’s cold, cold homes increase blood pressure, causing heart attacks and stroke in adults and older people.

In addition, cold homes reduce dexterity, which increases the risk of falls - a common cause of injury, loss of independence and even death for older people. Falls are estimated to cost the UK £4.4 billion each year, which includes £1.1 billion social care costs.

This comes at a time when the social care sector can ill afford any further increases in demand for its services. In January 2022, two thirds of care home providers had to refuse new requests for home care because staff shortages have drastically reduced capacity in the sector

‘Demand for frontline care is sky rocketing, waiting time standards are deteriorating despite the sterling efforts of NHS staff, and the winter months look to be very bleak and the busiest on record,’ said Matthew Taylor, chief executive of the NHS Confederation.

‘The cost-of-living crisis is threatening to have a real and long-lasting impact on the health and well-being of our communities up and down the country, something which the new government must urgently address.’

The already heavy demand for NHS services is further being affected by the energy crisis. NHS trusts are concerned they will have to make critical choices on staff levels and the services they provide in order to keep operating, with energy costs predicted to be as much as three times higher than a year ago. The problem is not limited to hospitals, as recent RCGP research showed that 75% of general practice staff thought their practices were a risk to health.

‘We’re working in a 1950s tin roof health centre…our ability to meet patient expectations and political promises is impossible unless significant investment in infrastructure is made,’ said a primary care clinical director in the south-east cited by the NHS Confederation.

‘It is like promising the public a safe, effective, modern car and when they go to collect it, they find a 1970s Ford Escort, with rusting roof, wheezy engine, designed to take four people, but being required to carry 10, and with no one to service it or drive it.’

Impact on nurses

The fuel crisis is also affecting the ability of nurses to carry out their work. According to a recent survey by the NHS Confederation, nine in ten NHS leaders of services provided in the community say they are either extremely or moderately concerned about their organisation’s ability to deliver all services due to staff shortages related to recent increases in the cost of fuel.

Over two-thirds of NHS community health services leaders are extremely concerned about the impact of increased fuel costs on their ability to recruit new staff and retain existing staff.

‘We are concerned about the number of staff who are putting this down as their main reason for leaving and moving into an acute or a setting closer to home. [We] have now had to assist some staff with advances on salary to help them fuel their cars to come to work. We know sickness has gone up as a way of deflecting from the problem as people do not want to be honest about their financial issue and not being able to fund their car,’ said a senior community nurse cited in the survey.

Concern has also been raised that this is preventing already understaffed roles such as district nurses and health visitors from hiring.

‘Vacancies for health visitors and district nurses are high already, and soaring fuel costs risk driving away staff we can ill afford to lose. Without community staff keeping people well in the community, more demand will be placed on other parts of the health and care system which are already under pressure at a level never seen before,’ said Saffron Cordery, interim chief executive of NHS Providers.

‘Many local NHS community service providers have taken the lead to support staff, including funding increased mileage rates from their own already stretched budgets. But this is only a temporary sticking plaster; the problem needs a national, properly funded and coordinated solution.’


1. The Government uses the Low Income Low Energy Efficiency (LILEE) definition for fuel poverty in England (Scotland, Wales and Northern Ireland use different definitions). Under the LILEE indicator, a household is considered to be fuel poor if:they are living in a property with a fuel poverty energy efficiency rating of band D or belowand when they spend the required amount to heat their home, they are left with a residual income below the official poverty line. (Source: