Case Study – Working with the health service to tackle cold-related illness

5 March 2015

The case recounted here is a testament to the caring approach of a health worker, Jackie, and to what can be achieved when support organisations connect to one another’s valuable services.

Jackie referred her patient, Mark, to the advice team at the Centre for Sustainable Energy (CSE) because she recognised the impact his heating system was having on his wellbeing. New National Institute of Health and Care Excellence (NICE) guidance has been published that highlights what Jackie already knew – the significant and detrimental impacts of cold homes on physical and mental health, and the demands placed on the health service as a result.

“The nurse was one of a kind and it made a huge difference to me she could help find additional support”

Mark suffers from hereditary respiratory problems and is on 24-hour oxygen. At one of his regular hospital checkups, Jackie discovered that he needed some advice and support to improve his living environment and keep on top of bill payments. Having received training from CSE’s Home Energy Team on the link between home heating and health, she made a referral to Lisa – one of the team's energy advisors.

“It all started with Southmead... I wouldn’t have known what to do next...
I have been referred on for support I didn’t even know existed”

Lisa visited Mark in his home. On arrival, it was immediately obvious that his mobility was impaired by his health condition. He struggled to get up the stairs to his first floor flat (taking about 15 minutes to recover). Lisa contacted his housing association and requested a swap to a ground floor property. Once inside, she realised why the heating setup was causing him so much stress and anxiety. Mark was paying for his energy using a pre-payment meter and is on a low income. A 24-hour oxygen supply that relies on electricity, in combination with upfront payments for energy could have serious consequences if Mark was unable to top-up his meters, for example. A typical electricity meter has only a limited amount of emergency credit, after which the power cuts out. Lisa contacted his fuel supplier and asked for them to change the pre-payment meter to a credit meter. They were happy to do so because of his condition.

“Changing the gas and electric meters from prepayment to credit has made a 100% difference to my life.

“I was on a prepayment meter which was a real issue due to my constant oxygen – if the electricity [had] run out I would have been up the creek”

Lisa also accredited Mark's Warm Home Discount – a £140 rebate on the household electricity bill – to his new meter, and made sure that he was on the Priority Services Register. Amongst other benefits, this ensures emergency help in the event of a power cut. Finally, she gave Mark details of organisations that provide benefits checks; he was not claiming Personal Independence Payment (PIP), which is extra income he is likely to be entitled to because of his illness.

Later that month, Lisa revisited Mark to help set up direct debit payments for his new credit meter and showed him how to take meter readings and phone them in. He should be saving around £100 per year on energy payments.

When Lisa last visited, Mark was packing his belongings; the housing association had approved the swap to a ground floor flat and he should be moving very soon.

“I am so grateful for the help I got from CSE – they were lovely people who couldn’t do enough for me and were so polite”

Jackie is also thankful for the connection she's formed with CSE.

"I would like to thank Lisa and her colleagues...[for providing] support and advice.

"Recommending changes in energy tariffs and converting people from a prepayment key/card to an alternative meter has made such a difference, especially for our patients who are reliant upon continuous oxygen therapy." 

Ensuring that people are warmer, safer and more comfortable at home is a key to tackling health problems that are caused or exacerbated by cold living conditions. As part of Bristol Green Capital, CSE has received funding to enable the implementation of the NICE guidance on cold homes in Bristol, and in doing so, create a national exemplar for delivering the recommendations of this important new guidance.

CSE will work to make all departments of the health service in Bristol aware of the new NICE guidance on cold homes, support the health service in integrating the guidance within existing practice, and collaborate with support organisations across the city to establish a single-point-of-contact system – somewhere for the health service to refer patients who need help in securing affordable and accessible warmth.

If you are interested in making referrals to support those living in cold homes, please contact Phillip Morris on 0117 934 1400 or email

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