Background

In order for people to reach their potential they need all of the right ‘building blocks’ in place: including stable jobs, good pay, safe and stable housing and good education, however both nationally and locally, many of these ‘blocks’ are missing for some people (5).

Affordable, warm, and safe housing is a cornerstone of good health, however, many people in the UK are living in homes that do not meet basic health and safety standards, triggering ill health such as respiratory conditions and chronic stress, ultimately cutting lives short.

This profile pack explores the role and impact of fuel poverty as one of the building blocks of health providing recommendations for further action and research.

National Context

Fuel poverty relates to households that cannot meet their energy needs at a reasonable cost. In England, the Low-Income Low Energy Efficiency (LILEE) definition for fuel poverty is used, meaning a household is fuel poor if:

• They are living in a property with a fuel poverty energy efficiency rating of band D or below; and
• They spend the required amount to heat their home, they are left with a residual income below the official poverty line.

While the Low-Income High Cost (LIHC) indicator is used to measure the extent of fuel poverty, the fuel poverty gap is used to measure its depth. The fuel poverty gap is the reduction in fuel costs that would be necessary to lift a household out of fuel poverty. In the UK, the average fuel poverty gap rose by 33% between 2021 and 2022 due to rising energy prices, with the average fuel poverty gap in the East Midlands around £263.

Certain households are also more likely to be in fuel poverty, including low-income households, households with dependent children, households home to people living with disabilities, households where the age of the oldest member is between 16 and 24, and minority ethnic households, with single parent households the household most likely to be fuel poor.

Fuel poverty is driven by 3 main factors: household income, high or unmanageable energy costs and the energy efficiency of a home.

The ‘cost of living crisis’ in the UK has caused ‘real’ disposable income to fall. Despite median disposable income increasing by 1.6% to £66,000 for the richest fifth of people, median disposable income for the poorest fifth of the population decreased by 3.8% to £14,500 in 2022. In 2022, around 28% of households in England were found to be low-income households, an increase of 818,000 (13.5%) since 2019.

Global energy prices have also risen significantly in recent years, with the price of gas in January 2022 almost four times higher than in early 2021. The typical cost of energy in April 2023 reached about 2.5 times pre-crisis costs. Rises in the cost of energy are down to several factors, including:

• The increase in global energy demand as Covid-19 lockdowns were lifted.
• Gas supply disruption following military action in Ukraine.
• Across Europe, warmer weather during summer 2022 increased the demand of energy for cooling, while also decreasing energy supplies due to drought and the subsequent reduction in the supply of hydropower.

Additionally, there are several factors associated with the energy efficiency of housing, including property type, tenure, and its construction date. The median energy efficiency score for households in England was 66 up to March 2021, equivalent to band D, highlighting the poor energy efficiency of a large proportion of households in England.

Around 47.2% of all low-income households live in a property with a fuel poverty energy efficiency rating of band D or worse. For the least efficient properties (band F/G), fuel costs are nearly three times as high compared to costs for the most efficient properties (band A-C) in 2022.

Cold homes can cause issues such as damp and mould and can have severe impacts on physical and mental health if the household cannot afford the heating costs.

According to the English Housing Survey, around 904,000 homes in England had damp problems in 2021 with 11% of these in the private rented sector. An estimated 653,000 households in England also lived with a ‘category 1 hazard’ of excess cold – i.e., a home with poor energy efficiency that could lead to cold conditions posing a serious risk to health and safety.

Homes that are cold due to fuel poverty exacerbate health inequalities with groups who are more vulnerable to health problems associated with cold homes and/or who may have less contact with health service such as people on low income or people over 65. Specifically looking at low-income households, in 2020, around 7% of households on the lowest incomes were estimated to have damp problems at home, compared with around 2% of households on the highest incomes.

In 2019 it was estimated the NHS spends at least £2.5 billion per year on treating illnesses that are directly linked to cold, damp, and dangerous homes.

The combination of these factors has resulted in increases to national fuel poverty, with National Energy Action’s figures showing that the number of households in fuel poverty will increase from 4.5 million UK households from October 2022 to 8.4 million in October 2023.

Local Context

Around 13.6% of households in Nottinghamshire are living in fuel poverty. Across Nottinghamshire, Mansfield has the highest percentage of fuel poor households (16.2%) which is higher than both the England and Nottinghamshire average.

Areas in Mansfield featured 5 times out of the 10 Middle Layer Super Output Areas (MSOA) with the highest percentage of fuel poor households, with the area with the highest percentage located in Bassetlaw (24.3%).

Mansfield also has the highest number of households with a prepayment meter, followed by Ashfield, with households with pre-payment meters installed more likely to be living in fuel poverty.

Out of the 10 MSOA with the highest number of households with a prepayment meter, areas in Ashfield featured 4 times, with the area with the highest number located in Mansfield (1113).

Energy Performance Certificates (EPCs) tell you how energy efficient a building is and give it a rating from A (very efficient) to G (inefficient). In Nottinghamshire, Broxtowe has the highest proportion of households rated with an EPC of below C (69.1%), with Rushcliffe having the least (58.5%).

When looking at the 10 MSOA with the highest number of households with an energy performance certificate rating of D-G, areas in Ashfield featured 4 times, with the area with the highest number of D-G certified households also located in Ashfield (5172). The MSOA with the highest percentage of households with an energy performance certificate rating of D-G was Tuxford, Markham & Rampton (81.7%), located in Bassetlaw.

Unmet Needs and Service Gaps – What we Still Need to Improve

• There are high and growing levels of fuel poverty across Nottinghamshire and further support is required to address the drivers of fuel poverty, particularly in the areas most in need previously highlighted.
• The energy efficiency of a household is one of the three main fuel poverty drivers. Local intelligence highlights that many households in Nottinghamshire have a poor energy efficiency.
• There is a lack of insight into the housing stock conditions of private sector housing in Nottinghamshire. Currently much of this data is either incomplete or out of date.

Recommendations for Consideration

Carol Ford                                                                                           
Senior Public Health and Commissioning Manager
Carol.Ford@nottscc.gov.uk

Dawn Jenkin 
Consultant in Public Health                                      
dawn1.jenkin@nottscc.gov.uk