Winter Warmth Programme

Ian Preston’s vision for addressing fuel poverty through the NHS

16 July 2014

I recently wrote a blog piece about the implications of privatising energy policy (here). In that article I suggested a 'Winter Warmth Programme' as a way of maximising the benefits that warm homes bring to health.

Here I want to take a closer look at how the Winter Warmth Programme could work.

The aim of the scheme is to deliver affordable warmth and an associated health improvement, therefore providing a clear rationale for a minimum standard of energy efficiency and heating control.

What I'm proposing is an ambitious government-backed programme to support domestic energy efficiency and maximise the income of those suffering from the health impacts of cold damp homes. Under the Winter Warmth Programme, frontline health professionals like GPs and health visitors would be able to prescribe a package of support to clients suffering from a cold related illness or a disability made worse by living in a cold home.

This support would be in the form of practical energy efficiency measures like insulation, new heating systems and so on. And rather than focus on a set of predefined measures or a narrow group of eligible households, the scheme would aim to bring all referred households up to a minimum standard of efficiency where ever possible, for example EPC Band D with a fully controllable heating system.

This proposal goes much further than the previous schemes (such as Warm Front, CERT etc.) in which health professionals have referred clients to organisations like CSE. In these cases our ability to help was dependent on two things:

  1. That the client was in receipt of the right combination of benefits 
  2. That they lived in a certain type of property (e,g. that could be insulated simply)

Under the current ECO, referrals have become even more complicated and are dependent on a third-party assessor to confirm eligibility. You have to ask yourself why a busy health professional would refer a sick and potentially vulnerable householder for support when there is no guarantee that they will receive any help at all.

Under my proposed Winter Warmth Scheme, the help would be guaranteed. And by placing health professionals at the heart of the eligibility decision-making process the scheme would:

  • Trust doctors, nurses and other health workers to use their expertise to prescribe energy efficiency as a way of making a home warmer and achieving a positive health outcome
  • Provide them with confidence that their referral will lead to a positive outcome
  • Reduce the burden that cold-related illness places on the NHS

I would advocate the provision of these measures at no cost to any householder. However, if an element of means testing is required then the minimum package of support could be given to those that qualify for free prescriptions. The report for the Secretary of State for Health by Professor Sir Ian Gilmore on implementing exemption from prescription charges for people with long term conditions estimates that 60% of people qualify for free prescriptions.

How could this work?

In a nutshell, once a client was referred to the agent managing the energy efficiency scheme, his or her home would be assessed to determine the energy efficiency measures needed to bring it up to a minimum standard. Alongside this, a benefit check would seek to maximise household income and trigger eligibility for additional support for energy costs, like the Warm Home Discount.

Who pays? Is this a case for the use of public funds?

Many commentators have called for the reintroduction of a state-funded energy efficiency programme to protect those on low incomes. And as the Winter Warmth Programme has a health improvement dimension, it would have a stronger claim for the use of public expenditure than Warm Front and other schemes that came before.

Other schemes are funded via energy bills rather than taxation. But, whilst the Winter Warmth Programme is designed to address the current gaps in our energy policy with respect to vulnerability, it does not seem fair or consistent with current public spending to use energy bills to pay for health interventions.

The rationale – why make homes warmer?

The negative health impacts of living in a cold and/or damp home have been identified by multiple studies. The principle risks are around cardiovascular disease and respiratory illnesses, with the young and elderly particularly susceptible. Poor mental health, in the form of depression and anxiety, is another key impact, to which worry over unaffordable fuel bills can be added. However, the majority of householders affected by these conditions are unlikely to present to the NHS and as such will prove much harder to identify and track.

For a good overview of the impact of cold homes on health see the Marmot Review or the recently published draft guidance on excess winter deaths and morbidity and the health risks associated with cold homes from the National Institute for Health and Care Excellence (NICE). The Winter Warmth Programme would support at least four key recommendations from the NICE guidance (1, 5, 6 and 8).

Delivering savings to the NHS 

Age UK has calculated that the annual cost to the NHS in England of cold homes is £1.36 billion, not to mention the associated cost to social care services, which is likely to be substantial. The average cost of making a property energy efficient is just £7,500, whereas the cost of keeping an older person in hospital is estimated at £1,750–£2,100 per week.

The full economic impact of cold homes across all conditions and ages has yet to be identified. However, we know that accessing health data to track the impacts and economic benefits of interventions is fiendishly difficult for a third party outside of the health service. As these conditions often cause frequent (and sometimes life threatening) attacks, the majority of sufferers are likely to present directly to the NHS and as such, any reduction in these patients’ presentations should be relatively easy to track. By placing the health service at the centre of the policy’s delivery we would ensure that the benefits are fully quantified in the context of the savings achieved.

Update | 11 Aug 2014
An article in today's in Guardian by the
National Housing Federation's Jake Eliot  says that 'poor housing costs the NHS more than £600m a year and can have devastating impact on residents' health. Read it here.
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