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Inaction on social isolation will hit frontline NHS – Mervyn Kohler

Age UK’s External Affairs Adviser explains why there must be a full response to helping the elderly this winter:

Loneliness seems to be rising.

More older people cite loneliness as part of their lives; more surveys indicate the scale of its incidence.

The latest, from Age UK, shows that 60% of over 65s won’t find much festive happiness with their families over Christmas, and its ‘No-one should have no-one at Christmas’ campaign highlights that over a million older people say they haven’t spoken to a friend, neighbour or family member for over a month.

The reasons are not hard to see. Families are more geographically scattered than ever before due to factors such as increasing divorce rates and the changing job market; working families live busy, hectic lives; and as more of us use electronic communications, older people risk being isolated from conversation channels.

Yet loneliness is a serious health hazard, and is closely linked to depression, self-neglect and mental illness.

The cold winter months are a particularly difficult time for older people and Britain’s appalling record on ‘excess winter deaths’ is a national disgrace. Yet in addition to these deaths are shoals of illness and preventable misery, exacerbating circulatory and respiratory conditions, and aggravating the pain of arthritis sufferers and those with varicose veins.

The medical links between cold temperatures and related illness, particularly in older people, are well-attested and presented alongside the Government’s annual Cold Weather Plan and in its supporting material, Making the Case.

An important shift of emphasis in this year’s Cold Weather Plan is its stress that ‘normal cold’ is the danger. Negative health impacts begin to appear when the temperature drops below 6 degrees, which even in London is the average January high temperature – with lows under 5 degrees for the three months of winter. So we can expect and predict ‘normal cold’ conditions for several weeks every year.

Now, combine the hazards of loneliness with the known health challenges of a normally cold winter, and we have a really spikey cocktail.

We can spice it up further – let’s imagine the possible behavioural reactions of lonely older people sitting in a cold home. They could be feeling anxious about the high costs of energy, and choosing to keep their heating off rather than risk running up an unpredictable and worrying bill. They may have mobility problems, and sit still too long in a cold room, reading, dozing or watching television – at the risk of feeling giddy when they stand up and potentially fall over risking damaging an arm or a leg. There may be no-one to make them a hot drink, or encourage them to prepare and eat a nourishing warm meal.   They feel neglected and abandoned.

NICE came forward this Spring with the practical guideline that there needs to be a local referral agency sign-posting and delivering advice and home improvements and adaptations which can make a house more affordably warm. All health professionals, making the mantra of ‘make every contact count’ really work, should be encouraged to refer people they suspect are living in cold temperatures to this agency. There is no standard template for what they do or what they might be called, but there are models of this kind in a number of local areas.

And the current campaign from NHS England and Public Health England, ‘Stay Well This Winter’, which raises awareness of a range of simple actions the public can take to help keep well over the colder months, works to engage the public in this very issue, encouraging people to check in on their elderly friends, neighbours or relatives to help alleviate loneliness and also to ensure they are keeping well.

A full response to the challenge of cold and loneliness must involve getting the co-operation and support of the local voluntary and community sector on board. This could draw in befriending schemes, local advice lines, and bring people to local centres where they could find hot meals and human company.   They might provide benefit checks, helping people to boost their incomes and check their eligibility for heating schemes where the gateway is receipt of certain benefits. They could identify other issues – such as mobility – where other local services might exist with possible support options to offer.

The alternative is to accept and try to manage the consequences of inaction. This task will ultimately fall on front-line GPs and community health services, and on A&E departments and the ambulance service taking people there.

Even counting the most obvious and straightforward of consequences, we can see that this presents the NHS with an annual bill of well over a billion pounds. The human cost is impossible to calculate.

In an ageing society, these costs will ramp up much more, unless we take deliberate steps to address these two demons – cold and loneliness – which threaten our health and wellbeing.


Image od Mervyn Kohler, External Affairs Adviser at Age UKMervyn Kohler is External Affairs Adviser at Age UK, having been Head of Public Affairs at Help the Aged since 1984.

His original role was to manage the Charity’s links with Parliament, Government and the outside world, and to develop the policy positions of Help the Aged.

As the political and social agenda involving older people has mushroomed, Mervyn has increasingly focussed on cross-cutting issues and new developments in policy and practice whilst retaining an overview of the broad policy field, and a long-standing interest in fuel poverty and the issue of keeping adequately warm in winter.

This, with his (nearly) thirty years of long service, means he plays a part too as the public face of the Charity, at conferences, seminars and in the media.

He is, and has been, on the trustee board of a number of charities and on several public bodies, and currently serves on the Fuel Poverty Advisory Group.

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