This research sought to understand carbon monoxide (CO) knowledge, behaviour and practices amongst low income households. Results from a Department of Health study in 2011 suggested that one-fifth of lower-income households could regularly be exposed to CO levels above WHO guidance.
There are recognised shortcomings in existing data on CO exposure levels. Recorded deaths and injuries attributable to CO poisoning have occurred across different tenancy types and socio-economic groups. However, it may be safely assumed that there is a reasonable overlap between those households qualifying for Priority Services Register assistance and CO exposure risk.
Actions to help prevent CO poisoning in the home include the regular maintenance and servicing of appliances, as well as the correct use of fuel-burning appliances (and the installation of audible CO alarms). These activities are not cost-free, and are unlikely to be prioritised by households with limited budget. Priority Services Register households are frequently those that are privately rented. There is some evidence to suggest that these tenures are higher risk than others.
Despite clear legal responsibilities to their tenants, data from the Gas Safe Register indicates that many landlords fail to provide tenants with an assurance of the safety of their gas appliances. In a poll of privately rented homes, only half received an up-to-date gas safety record when moving in and 75 per cent were left without a valid record for their entire tenancy.
Households qualifying for Priority Services Register-based assistance are also likely to qualify for a range of other forms of assistance that could improve their health and welfare. However, for unknown reasons, these services are not yet being utilised. Organisations visiting Priority Services Register households are in a good position to identify such households and refer them on for further assistance.

Recommendations
Join up fuel poverty and gas safety initiatives
Government energy efficiency programmes such as ECO replace old and inefficient boilers and install first-time boilers and central heating in low income households in order to alleviate fuel poverty. This is welcomed. However, CO risk will not necessarily be addressed in these households if occupants continue to use and rely on older room heaters such as gas fires. This research has shown it is not always correct to assume that households with modern boilers will favour them over other heating systems.
Instead, amongst occupants vulnerable to fuel poverty, combustion room heaters may be preferred for cost reasons. Alternatively, both primary and secondary appliances will be run concurrently in an attempt to achieve adequate warmth.
Consideration should therefore be given to supporting households replace or maintain appliances such as gas fires. Equally, it is critical that households are educated on their central heating systems and occupants on low incomes are supported to optimise use of these systems without compromising on energy affordability. A key role is required for frontline service providers such as local authorities and community organisations, who are already reaching and protecting households in need.
These agencies should be supported to deliver integrated fuel poverty and CO safety initiatives, including providing measures such as CO alarms to fuel poor households. There is a clear role here for gas distribution network companies to support these agencies. The gas networks have existing obligations on fuel poverty and CO awareness under the regulator Ofgem’s RIIO-GD1 price control model. Ofgem should further incentivise the gas networks to join up action on fuel poverty and CO awareness in the next price control period (after 2021).
Support non-gas households to replace old and risky boilers
Historically, non-gas homes have disproportionately missed out on heating measures under ECO. This study shows rural households with boilers not fuelled by mains gas are disproportionally older, riskier and inefficient models. Rural off-gas homes are at increased risk of living in severe fuel poverty. They are also not served by free safety checks of gas appliances offered to low income owner-occupants under the Priority Services Register (PSR).
For both energy affordability and safety reasons, these households must be targeted in future government energy efficiency programmes. Specifically, NEA recommends a minimum target for installation of first time central heating systems under the next iteration of ECO (from October 2018) and that this target is aligned to Ofgem’s scheme to provide free connections to the mains gas network for fuel poor non-gas homes.
Promote the PSR as a pathway to free gas safety checks
Gas suppliers are required to offer free gas safety checks for low income and vulnerable households. However, the volume of these checks has historically been very low. This is unfortunate because this service can help to address CO risk in low income owner-occupant households who may be neglecting to service appliances for cost reasons. These households may also be more susceptible to adverse effects from CO exposure for reasons of age or ill health.
The gas industry (suppliers and network distributors) must improve efforts to sign-up low income and vulnerable customers to the PSR and passport eligible households into annual free servicing plans.
Improve public awareness about the CO risks of combustion appliances beyond gas boilers
Households servicing gas boilers are not always extending this behaviour to include other gas appliances in the home. For example, gas cookers in particular are perceived to pose a low CO risk relative to boilers and households are largely unaware that such appliances require maintenance.
Gas safety messages should be made clearer to communicate about the risks posed by different gas appliances and advised on their proper installation, use and maintenance. Gas fires and gas cookers should be prioritised in such messages and catch-all and ambiguous terms such as ‘appliance’ should be avoided.
Target and tailor CO safety messages to account for different household, appliance and fuel types
Safety may not always be the most effective message to prompt households to check their appliances. Instead, an understanding of the appliance and household type should inform CO campaigns.
For example, emphasising reliability and comfort may help drive boiler servicing, particularly in older age households susceptible to the cold. While a focus on safety may be more suitable for appliances such as cookers. Amongst low income families and working-age households, integrated CO and fuel poverty interventions should be considered (elevated CO levels and lower mean temperatures were observed in these homes).
Clear messaging about landlord and tenant responsibilities is also critical, particularly in social rented housing where appliances are more likely to be owned by tenants and not covered by landlord gas safety checks. Households not on mains gas should be targeted with bespoke campaigns addressing servicing of oil, solid fuel and LPG appliances.
Our research partners

University of Hertfordshire

University College London

St George's University Hospitals

Queen Mary University of London

Sheffield Hallam University

Public Health England

Newcastle University

NPIS

NEA

London Fire Brigade

Université de Lausanne

Imperial College London

Liverpool John Moore University

Lancaster University

Improving Practice in Performance

East of England Ambulance Service

IGEM

Brunel University London

Cranfield University

Aintree University Hospital

Frimley Health

University of Surrey