Blog: Health, cold homes, and fuel poverty: can we prescribe affordable warmth?

Lisa Glass
Lisa Glass

By Lisa Glass, policy officer at Shelter Scotland

The health implications of fuel poverty are well understood and widely accepted. Health, fuel poverty and cold homes are inextricably linked and the relationship is bi-directional: poor health increases susceptibility to fuel poverty, and fuel poverty can result in poor health. Certain aspects of medical care also exacerbate the consequences of not being able to afford fuel – for example medication that requires refrigeration, or the use of certain medical equipment which require electricity.

Over thirty per cent of all Scottish households are living in fuel poverty today, despite a Scottish Government target to eradicate it by November 2016. These 748,000 households require help and support to tackle fuel poverty and this needs to be delivered in a timely, sustainable, and equitable manner.

For the last year, Shelter Scotland has been running a ‘healthy homes’ project with funding from British Gas Energy Trust, looking to highlight the links between health and housing, and specifically focusing on fuel poverty. The project sought to understand the problem of fuel poverty, and explore solutions that involve working with the health sector.

Aside from the public health arguments and potential savings for the NHS, the health sector has been targeted to help tackle fuel poverty because of its reach, and through their role as trusted professionals. Could a GP, identifying a patient with asthma, acknowledge the patient’s cold home as a causal factor and ‘prescribe’ a top up for their meter, or a new boiler? Could an occupational therapist, supporting a patient with worsening arthritis, link them up with a local energy advice project to investigate installing central heating?

There are examples of excellent partnership work between the health sector and energy advice sector. Shelter Scotland and Energy Action Scotland are, in fact, currently working together to produce a catalogue of health-related fuel poverty schemes which will highlight some of the successes and challenges these schemes have experienced. This learning from existing pilots and projects should be analysed holistically to understand what works and what the barriers are, to encourage greater partnership work between the health sector and energy advice sector.

The health sector is, however, currently underutilised in the provision and targeting of fuel poverty support. One issue is that the health and social care workforce needs to be adequately supported and resourced to help support people in or vulnerable to fuel poverty. It needs to be as easy as possible for the health sector to engage in this agenda.

One such solution to this is training. Our ‘healthy homes’ project developed an online training course on fuel poverty, specifically targeted at frontline health and social care professionals.

The course sought to help practitioners identify and assess people at risk of fuel poverty, recognise the key links between fuel poverty and health and how to advise patients to help themselves by making small changes, as well as referring to national and local energy advice programmes.

The training was piloted for free to 150 practitioners around Scotland. Its associated evaluation identified a clear learning need for this subject area amongst practitioners, and outlined the benefits of undertaking the training for practitioners as well as the benefits that can be passed on to patients. Some key statistics are included below:

  • Prior to the training, whilst almost all staff (96%) felt fuel poverty was an issue for their patients, only 23% felt they had good knowledge of fuel poverty and only 11% said they had good knowledge on how to refer patients on for support.
  • After completing the training, 100% of trainees noted improved knowledge around issues of fuel poverty, how fuel poverty is interlinked with health, tips on behavioural changes that can be passed on to patients and referring patients on.
  • Almost all staff (92%) noted improved confidence in identifying and supporting patients at risk of fuel poverty.
  • 133 of 134 trainees felt the training was worth doing, and 131 of 133 thought it was relevant to their role. Every trainee stated that they learnt something new.
  • Of the 43 practitioners who participated in a follow up questionnaire three months after they had completed the training, over half (27) had already put their knowledge into practice with a patient.
  • The evaluation did however highlight two key issues.

    1. It is difficult for staff to find the time to complete the training, even our 30-minute online training course. As such we recommend fuel poverty issues should be included within core health inequalities training, and made available at an early stage of practitioner professional development to encourage participation.
    2. Implementing knowledge is difficult for practitioners with an already heavy and varied workload. Investigating potential trigger points for staff to identify fuel poverty and take action would therefore also be helpful, to help embed efforts to tackle fuel poverty into standard NHS practice.
    3. Our full report, ‘Working with the Health sector to tackle Fuel Poverty’, starts by looking at fuel poverty in Scotland today, how fuel poverty and health are linked and how the health sector is already involved in tackling fuel poverty. It includes an evaluation of our pilot training course for frontline health and social care practitioners which ran during 2016 and we also make a series of recommendations for future work in this field. It is available to download on our website.

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