The impact of winter pressures on different population groups in Great Britain: 18 October 2023 to 1 January 2024

The following results cover the latest pooled period (18 October 2023 to 1 January 2024).

• Just under 1 in 5 (19%) adults reported they were occasionally, hardly ever, or never, able to keep comfortably warm in their home; this is lower than late autumn and winter 2022 (24%).

• Around 1 in 25 adults (4%) said that they had run out of food and could not afford to buy more in the past two weeks; this is similar to late autumn and winter 2022 (5%).

• A high proportion of adults who reported difficulties with their ability to keep warm in their home also experienced difficulties with paying their energy bills (76%), affording food (14%) or affording housing payments (59%).

• With 3% of adults experiencing both heating and food insecurities, those more likely to report both measures included those with moderate-to-severe depressive symptoms (10%), those economically inactive for reasons other than retirement (8%), those living in the most deprived areas in England (7%), and disabled adults (6%).

• Around 1 in 4 adults (24%) said that having to cut back on energy use at home in the past month had a negative impact on their mental health; a similar proportion (24%) reported that waiting too long for a GP or hospital appointment had a negative impact on their mental health.

Our latest Public opinions and social trends bulletin (4 to 14 January 2024) shows how increases in the cost of living have affected adults across Great Britain. Around half of adults (52%) reported an increase in their cost of living compared with one month ago.

When asked why their cost of living had increased over the last month, the most common reasons reported were:

• the price of food shopping increasing (90%)

• gas or electricity bills increasing (85%)

• the price of fuel increasing (41%)

As the weather gets colder, the cost of people heating and lighting their homes more can increase financial pressures.

In this article, we have used a pooled dataset covering 18 October 2023 to 1 January 2024 to examine how different population groups are being affected by current winter pressures, including increases in the cost of living and health.

We provide an update to our Impact of winter pressures articles from last winter, comparing data both overall and across population groups. Data collected between 22 November to 18 December 2022 will be referred to as "late autumn and winter 2022" and data collected between 15 to 26 February 2023 will be referred to as "February 2023". For more information, please see our The impact of winter pressures on different population groups in Great Britain articles.

This article reports differences between groups where these are statistically significant. See Section 10: Data sources and quality for more information.

The increased cost of living affects what people can buy throughout the year. However, during the winter, the increased use of energy to keep warm can add additional strain on the affordability of basic needs such as the ability to acquire enough food and the ability to afford rent or mortgage payments.

Energy insecurity

Around 4 in 10 (39%) adults reported finding it very or somewhat difficult to afford their energy bills; this is similar to February 2023 (42%).

Those more likely to report finding it very or somewhat difficult to afford their energy bills include:

• those experiencing moderate-to-severe depressive symptoms (61%), compared with 35% among adults with no or mild depressive symptoms

• those who are economically inactive for reasons other than retirement (54%) or those who are unemployed (54%), compared with 40% of adults who were employed or self-employed

• disabled adults (49%), compared with 34% of non-disabled adults

Food insecurity

Among all adults, around 1 in 25 (4%) reported that in the past two weeks they or their household had run out of food and could not afford to buy more. This is similar to late autumn and winter 2022 (5%).

Adults who were significantly more likely to report running out of food and could not afford to buy more included those:

• experiencing moderate-to-severe depressive symptoms (14%), compared with 2% of adults with no or mild depressive symptoms

• who are economically inactive because of reasons other than retirement (12%), compared with 3% of adults who were employed or self-employed

• living in the most deprived areas in England (9%), compared with 2% of adults living in the least deprived areas

Housing insecurity

Among adults currently paying rent or mortgage payments, just over one third (35%) reported finding it very or somewhat difficult to afford their rent or mortgage payments.

Those more likely to report finding it very or somewhat difficult to afford their rent or mortgage payments included:

• Black, African, Caribbean or Black British adults (55%), or Asian or Asian British adults (54%), compared with 33% of White adults
• adults experiencing moderate-to-severe depressive symptoms (45%), compared with 33% of adults with no or mild depressive symptoms
• disabled adults (39%), compared with 33% of non-disabled adults

Figure 1: Adults experiencing moderate-to-severe depressive symptoms and disabled adults were more likely to experience energy, food or housing insecurity

Proportion of adults experiencing energy, food or housing insecurity, Great Britain, 18 October 2023 to 1 January 2024

Notes

1. Questions: "How easy or difficult is it to afford your energy bills?”, “In the past two weeks, have you or your household run out of food and could not afford to buy more?”, “How easy or difficult is it to afford your rent or mortgage payments?"

2. Base: adults who pay energy bills (energy insecurity), all adults (food insecurity), adults who are currently paying rent or mortgage payments (housing insecurity).

3. For further breakdowns and all response options, see our accompanying dataset.

Energy, food and housing insecurities, along with the colder weather during late autumn and winter, can affect people's ability to keep warm in their home. Some groups are affected more than others.

In the latest pooled period, just under 1 in 5 (19%) reported they were occasionally, hardly ever, or never, able to keep comfortably warm in their home in the past two weeks (12% occasionally, 5% hardly ever, 2% never). This was a statistically significant drop since late autumn and winter 2022 (24%).

Adults who were more likely to report being occasionally, hardly ever, or never, able to keep comfortably warm in their home in the past two weeks included:

• Black, African, Caribbean or Black British (44%) or Asian or Asian British adults (31%), compared with 18% of White adults

• adults experiencing moderate-to-severe depressive symptoms (36%), compared with 16% of adults with no or mild depressive symptoms

• adults living in the most deprived areas in England (30%), compared with 11% of adults living in the least deprived areas

These were similar to the groups reported in late autumn and winter 2022.

Adults at risk of cold-related illnesses (18%) were just as likely as those not at risk of cold-related illnesses (20%) to report they were occasionally, hardly ever, or never able to keep comfortably warm. At-risk adults include those with health conditions, such as asthma or cardiovascular diseases, that could be worsened by cold weather, as defined in Section 9: Glossary.

Figure 2: Groups more likely to report heating insecurity included Black, African, Caribbean or Black British adults and those experiencing moderate-to-severe depressive symptoms

Proportion of adults across sub-groups occasionally, hardly ever or never able to keep comfortably warm in their home in the past two weeks, Great Britain, 18 October 2023 to 1 January 2024

Notes

1. Question: "In the past two weeks, how often were you able to keep comfortably warm in your home?"
2. Base: all adults.
3. For further breakdowns and all response options, see our accompanying dataset.

The reported impacts of being occasionally, hardly ever or never able to keep warm and being unable to afford food and house bills, when combined, could mean an increased risk of poor health over the winter months.

In the latest pooled period (18 October 2023 to 1 January 2024), we found that, of adults who reported occasionally, hardly ever or never able to keep comfortably warm in their home:

• over 1 in 10 (14%) also reported running out of food in the past two weeks, and could not afford to buy more (compared with 4% of all adults)

• just under 8 in 10 (76%) also reported that they found it very or somewhat difficult to afford their energy bills (compared with 39% of all adults who pay energy bills)

• around 6 in 10 (59%) also reported that they found it very or somewhat difficult to afford their rent or mortgage payments (compared with 35% of all adults who pay rent or mortgage payments)

Heating and eating

In the latest pooled period, we found that 19% of adults were occasionally, hardly ever or never able to keep comfortably warm in their home (heating insecure) and that 4% had run out of food and could not afford to buy more in the past two weeks (food insecure). Those who were experiencing difficulties with both heating and food are likely to be the most vulnerable.

In the latest period, we found 3% of all adults were occasionally, hardly ever or never able to keep comfortably warm in their home and had run out of food in the past two weeks.

The groups more likely to report these measures were:

• adults experiencing moderate-to-severe depressive symptoms (10%)

• those who are economically inactive because of reasons other than retirement (8%)

• those living in the most deprived areas in England (7%)

• disabled adults (6%)

For more detail, see our The impact of winter pressures on different population groups in Great Britain: vulnerable groups dataset.

Our fortnightly Public opinions and social trends bulletin tracks the most common actions taken by adults to reduce spending. Between the period 4 to 14 January 2024, the most commonly reported actions were:

• spending less on non-essentials (62%)

• shopping around more (51%)

• using less fuel, such as gas or electricity, in their home (45%)

• spending less on food shopping and essentials (40%)

Changing behaviours when food shopping can be one way to reduce costs when people experience increased energy and housing costs.

In the latest pooled period (18 October 2023 to 1 January 2024), when we asked adults what actions they were having to take to save money on food because of the increased cost of living, the most common responses were:

• eating out less at, for example, takeaways or restaurants (62%)
• buying cheaper food (53%)
• buying discounted food (37%)

These were also the most reported responses in late autumn and winter 2022.

While a high proportion of adults across all groups report taking these actions, there are some actions which some groups appear to be doing more than others.

Around 1 in 5 adults (21%) reported buying more tinned or longer shelf-life food, eating food past its use by date (20%) and eating smaller portions (18%). Adults more likely to report all of these actions were:

• those experiencing moderate-to-severe depressive symptoms (37%, 35%, and 34%, respectively)
• living in the most deprived areas in England (32%, 21%, and 26%, respectively)
• disabled (31%, 27%, and 26%, respectively)

We asked respondents about the things that were having a negative impact on their mental and physical health in the past month. Respondents also had the option to report that winter pressures were not having a negative impact.

We found that the impact on mental health appears to have deteriorated since February 2023, with 48% of adults reporting that their "mental health has not been negatively affected" in the latest period, compared with 54% in February 2023.

In the same period, the impact on physical health appears to have improved, with 64% of adults reporting that their "physical health has not been negatively affected" in the latest period, compared with 59% in February 2023.

A higher proportion of adults reported that having to cut back on energy use at home in the past month had a negative impact on their mental health (24%) and physical health (14%), compared with adults who reported:

• not being able to afford enough food (9% reported a negative impact on mental health, 6% on physical health)

• not being able to afford their rent or mortgage (6% reported a negative impact on mental health, 3% on physical health)

Negative effects on mental health

For all of the winter pressures asked about, a greater proportion of adults reported that their mental health had been negatively affected more than their physical health.

When looking at the things that negatively affected people's mental health, there were differences between groups of the population.

Around one-quarter (24%) of adults reported that waiting too long for a GP or hospital appointment was having a negative impact on their mental health. Groups more likely to report this included:

• adults experiencing moderate-to-severe depressive symptoms (40%)

• disabled adults (38%)

• adults with a health condition (32%)

A similar proportion (24%) of adults reported that having to cut back on energy use at home was having a negative impact on their mental health. Those more likely to report this included:

• adults experiencing moderate-to-severe depressive symptoms (45%)

• adults living in the most deprived areas in England (37%)

• adults who are economically inactive for reasons other than retirement (34%)

Not being able to afford enough food (9%) was also reported by adults as having a negative impact on their mental health. Those more likely to report this included:

• adults experiencing moderate-to-severe depressive symptoms (26%)

• Black, African, Caribbean or Black British adults (25%)

• adults who are economically inactive for reasons other than retirement (22%)

Around 1 in 20 adults (6%) reported that not being able to afford their rent or mortgage was having a negative impact on their mental health. Those more likely to report this included:

• Black, African, Caribbean or Black British adults (17%)

• adults experiencing moderate-to-severe depressive symptoms (15%)

• younger adults aged 16 to 29 years (10%) and 30 to 49 years (9%)

GP practice access and NHS waiting times

In the latest pooled period, we also found:

• just over half (52%) of adults reported they had tried to contact a GP practice either in person, on the phone or online in the past month, with 33% reporting it was difficult or very difficult to do so

• one-quarter (25%) of adults reported they were waiting for a hospital appointment, test, or to start receiving medical treatment through the NHS, which has increased since the previous periods (21% in late autumn and winter 2022 and 21% in February 2023)

• among those waiting for a hospital appointment, test, or to start receiving medical treatment through the NHS, 18% reported waiting for over a year

For more detail on the difficulties respondents experienced when accessing NHS services, see our GP practice access and NHS waiting list datasets.

At risk of cold-related illnesses

Exposure to cold temperatures can have negative impacts on people's health. People who are particularly at risk of cold-related illnesses include those:

• aged 65 years or older
• who are pregnant
• with a cardiovascular condition
• with a lung condition
• with a rheumatic condition
• with a mental health condition diagnosed by a doctor
• who have attended hospital because of a fall in the past three months

Given the higher cost of energy this winter, adults who use electrical medical equipment at home (for example, ventilators or humidifiers) are also included in this group.

Disabled adult

To define disability in this publication, we refer to the "core" definition set out in the Government Statistical Service (GSS) harmonisation guidance. This identifies a "disabled adult" as a person who has a physical or mental health condition or illness that has lasted, or is expected to last, 12 months or more, and that this reduces their ability to carry out day-to-day activities.

Employment status

"Employed or self-employed" does not include people on government training schemes. The Opinions and Lifestyle Survey (OPN) does not ask whether a person is on a government training scheme, so caution should be taken when comparing these figures with other labour market sources.

The "economically inactive – retired" and "economically inactive – other" categories represent people who are not in employment but are not defined as unemployed because they have not been seeking work within the last four weeks, or they are unable to start work in the next two weeks.

The "economically inactive – other" category may, for example, include people who are studying, have caring responsibilities, or are disabled.

Ethnicity

The ethnicity disaggregation used has been chosen to provide the most granular breakdown possible, while producing robust estimates based on sample sizes. While the questions asked in the OPN are not completely aligned with the Government Statistical Service (GSS) harmonised standard, the reporting of the five-category ethnicity groups is aligned with this guidance.

The five-category ethnicity breakdown includes:

1. Asian or Asian British: Bangladeshi, Chinese, Indian, Pakistani, or any other Asian background

2. Black, African, Caribbean or Black British: African, Caribbean or any other Black, African or Caribbean background

3. Mixed or Multiple ethnic groups: White and Asian, White and Black African, White and Black Caribbean, or any other Mixed or Multiple ethnic background

4. White: White British, Gypsy or Irish Traveller, Irish, or any other White background

5. Other ethnic groups: Arab or any other ethnic group

If respondents answered "Don't know" or "Prefer not to say" to the question, they are excluded from this analysis.

Health condition

Adults self-report whether they have a health condition or not when answering the question: "Do you have any physical or mental health conditions or illnesses?".

If respondents answered "Don't know" or "Prefer not to say" to the question, they are excluded from this analysis.

Index of Multiple Deprivation

The Index of Multiple Deprivation (IMD) is the official measure of relative deprivation for small areas in England. The IMD ranks every small area in England from 1 (most deprived area) to 32,844 (least deprived area).

Deciles are calculated by ranking the 32,844 small areas in England, from most deprived to least deprived, and dividing them into 10 equal groups. These range from the most deprived 10% of small areas nationally to the least deprived 10% of small areas nationally. For this analysis, to ensure robust sample sizes, we have further grouped deciles into quintiles (five equal groups).

Moderate-to-severe depressive symptoms

We use the two-item version of the Patient Health Questionnaire (PHQ-2) (PDF, 131KB) to identify adults with depressive symptoms, to have a better understanding of the impact of winter pressures on these adults. Respondents were asked the following questions, and were presented with four response options ranging from 0 (not at all) to 3 (nearly every day):

• Over the last two weeks, how often have you been bothered by having little interest or pleasure in doing things?
• Over the last two weeks, how often have you been bothered by feeling down, depressed or hopeless?

A "depressive symptoms" score was then derived by summing both responses chosen, resulting in a score ranging from 0 to 6. A person's PHQ-2 score sits in one of two categories:

• no to mild symptoms: this refers to a PHQ-2 score of between 0 and 2 (inclusive)
• moderate to severe symptoms: this refers to a PHQ-2 score of between 3 and 6 (inclusive)

If respondents answered "Don't know" or "Prefer not to say" to either of the questions, they are excluded from this analysis.

This release contains data and indicators from the from the Office for National Statistics' (ONS's) Opinions and Lifestyle Survey (OPN). Further breakdowns, and associated confidence intervals for the estimates, are contained in our related datasets.

Sampling

The analysis throughout this article is based on adults aged 16 years and over in Great Britain. The analysis in this report is based on 11,994 adults from a pooled dataset comprising five waves of data collection, covering the following periods:

• 18 to 29 October 2023
• 1 to 12 November 2023
• 15 to 26 November 2023
• 29 November to 10 December 2023
• 13 December 2023 to 1 January 2024

Further information on the survey design and quality can be found in our Opinions and Lifestyle Survey QMI.

Weighting

Survey weights were applied to make estimates representative of the population.

Weights were first adjusted for non-response and attrition. Subsequently, the weights were calibrated to satisfy population distributions considering the following factors: sex by age, region, highest qualification, and employment status.

Population totals based on projections of mid-year population estimates for June 2021 were used. Therefore, the resulting weighted sample is representative of the Great Britain adult population by a number of socio-demographic factors and geography.