Theme 1: Social prescribing

Key findings

There have been several recent pilot projects which utilise social prescribing to provide fuel poor households with energy credit and/or home upgrades/efficiency measures.
Evidence of impact on health, in particular, has varied depending on the pilot, but the biggest project, the Warm Home Prescription (WHP), found a positive (self-reported) impact on physical and mental health.
In order to roll out social prescribing as an approach to fuel poverty and its associated health challenges, effective use of data is vital. The WHP Taskforce highlighted that NHS boards should assess the data that they have available to identify how many people in their area have a health condition made worse by living in a cold home and publish these figures. This focus on data was shared by the Moving Together project evaluators.
Effective collaboration between health professionals and those specialising in fuel poverty/energy advice is vital for the success of any social prescribing.
Sustainable funding is needed to allow for social prescribing projects to continue to run and innovate.

Case study 1: Warm Home Prescription (WHP)

Key details: The Warm Home Prescription programme has so far supported over 800 vulnerable households in its main 2022–23 trial, with subsequent pilots and expansion phases aiming to reach several thousand more.

Organisation(s): Energy Systems Catapult (all iterations); NHS Gloucestershire Clinical Commissioning Group (CCG) (2021-2022); NHS partners in England and Scotland – Aberdeen/Aberdeenshire, Middlesborough, Gloucestershire, London (2022-2023); NHS Greater Manchester; Severn Wye Energy Agency (2021-2022); Changeworks (2022-2024); NEA; Scottish Power (2024-2026); SGN (2024-2026)

Location(s): Gloucestershire, Teesside/Middlesbrough, London, Aberdeen/Aberdeenshire

Duration: 2021 – present

Who it supports: Warm Home Prescription is a service helping people who struggle to afford energy and have severe health conditions made worse by the cold. The service allows them to stay warm and well at home, and out of hospital in winter whilst reducing the energy consumption and carbon emissions of their home.

What is delivered: The service works to deliver rapid, practical help:

NHS teams (including social prescribers and complex care teams linked to GP surgeries) identify eligible patients.
Eligible patients are those whose health is made worse by living in a cold home, particularly those with respiratory or cardiovascular conditions, or other long-term conditions where cold increases the risk of deterioration or hospitalisation. They also must be unable to heat their homes to safe temperatures due to low income or financial insecurity, high energy costs or energy inefficient housing.
Patients are contacted by the NHS and offered a “warm home prescription” to be delivered by local energy advisors – who credit their energy account.
Patients can immediately start heating their home to a healthy temperature.
Further home energy upgrades are arranged where possible.

Evaluation and evidence:

In September 2023, Energy Systems Catapult published the results of an evaluation[2] focused on the impact of the 2022/23 trial on recipients’ health and wellbeing, as well as their attitudes to heat. The research included qualitative interviews (n=30) and two postal/online surveys (n=496, n=513) with WHP recipients. Delivery staff were also invited to take part in an online survey (n=30) and interviews (n=4).

The evaluation found that, overall, WHP had a positive impact on recipients’ reported mental and physical health, as well as their willingness to consider home retrofit measures. 79% and 70% of recipients reported that WHP had a positive effect on their physical and mental health respectively. 8 in 10 (81%) recipients reported heating their homes to a higher temperature than in the previous winter, with most recipients heating their home to healthy temperatures throughout winter.

In September 2023, the Centre for Regional Economic and Social Research (CRESR) at Sheffield Hallam University published an Impact and Value for Money assessment of the WHP project[3]. To support the evaluation recipients were invited to take part in two surveys. The first was at the time when they first received a WHP and the second was at the end of winter 2022/23. In total 496 responses were received to the first ‘baseline’ survey and 513 patients completed the second ‘follow-up’ survey. In total 340 WHP patients completed both a baseline and follow-up survey. In addition, two temperature loggers were sent to all patients who received a WHP to assess whether they heated their home to a recommended temperature. In total 815 patients were sent two loggers and were asked to position one of the loggers in their living room and the other in their bedroom. By the end of the project 628 patients sent back the bedroom logger (giving a response rate of 77%) and 643 patients sent back the living room logger (giving a response rate of 79%).

The total estimated direct operating cost of the WHP project was just under £825,000 (excluding VAT). Energy bill payments for patients who received a prescription comprised the largest cost category – 70% of expenditure (£573,700).

A ’wellbeing adjusted life years’ (WELLBY) approach was used to assess the value of benefits of WHP to the patients themselves. A WELLBY is equivalent to one person experiencing a one point improvement on a ten point wellbeing scale for one year. Patients on average experienced a 1.4 WELLBY increase over the winter period. Across all 823 patients this means the WHP project supported 1186 additional WELLBYs. The average expected social value of the increase in WELLBY is £5,100 per WHP patient. Using this approach, therefore, the 1186 additional WELLBYs supported by the WHP project produced just over £4.173 million in value. Comparing this monetised societal benefit to the estimated cost of the WHP project suggests that for every £1 of expenditure, WHP supported £5.1 of wellbeing social value to patients.

CRESR recommended that further testing and evaluation of the WHP project is needed to validate these findings in other contexts and to consider the extended (i.e. receiving a WHP over multiple winters) and longer-term impacts of a WHP, particularly on health care demand where the evidence is currently weakest.

Following on from the winter 2022/23 trial, in July 2023 WHP offered home energy improvements to 364 homeowners across two areas (Aberdeen in Scotland and Teesside in England). The home improvements offered were designed to reduce the energy consumption needed to achieve healthy temperatures. Those offered the service had previously received an energy credit from WHP in 2022/23. 166 householders were initially interested in taking part and 92 of those ended of having home energy improvements.

In order to evaluate the benefits of implementing home energy improvements to deliver a warm home, the following was undertaken[4]:

Research was carried out with participants (those who took up the offer of a WHP of home energy improvements) and non-participants (those who declined to take up the offer). Surveys were sent to participants at the beginning and end of the trial. The number of surveys received back were: n=81 beginning of trial, n=71 end of trial Surveys were sent to non-participants at the beginning and end of the trial. The number of surveys received back were: n=55 beginning of trial, n=196 end of trial.
Temperature loggers were issued to participants and non-participants (a total of 155 sent). The number of loggers received back were: n=68 participants n=34 non-participants.
Qualitative interviews were conducted at various points in the customer journey. 3 rounds of n=8 x 30-minute phone calls with residents and 3 rounds of n=2 x 30-minute phone calls with IMTs (Installation Management Team).

The research found that mental health and wellbeing were maintained throughout this winter and further analysis suggested that the intervention positively impacted mental health. From the available sample of people who had home energy improvements (n=68), temperature logger data shows that over half (53%) of them achieved healthy temperatures above 18 degrees Celsius for most of the time. Most people did not put their health at extreme risk over winter 2023/24. While around half of that sample achieved temperatures above 18 degrees Celsius most of the time, three quarters kept the rooms at temperatures above 16 degrees Celsius almost all the time.

Case study 2: Gentoo’s Boiler on Prescription Scheme

Key details: small scale pilot providing home improvements for the homes of six patients with COPD in Sunderland.

Organisation(s): Gentoo Housing Association, Sunderland Clinical Commissioning Group (CCG), Durham Darlington Easington and Sedgefield (DDES) CCG

Location: Sunderland

Duration: Launched in 2013 and trial data collected over 18 months. Closing report published in March 2016

Who it supported: Partnerships with CCGs allowed for actual health data to be used to target and as a measure of success. Using this, Gentoo were able to establish that one in three Gentoo customers in the local area of their retrofit scheme had presented themselves at A&E in the previous year, compared to one in seven of non-Gentoo customers across the city of Sunderland. Those eligible had Chronic Obstructive Pulmonary Disease (COPD) and lived in a Gentoo home with an EPC rating of D.

What was delivered: In January 2014 six homes of patients of Chronic Obstructive Pulmonary Disease (COPD) were improved with a combination if energy and thermal measures including new boilers, double glazing and insulation.[5]

Scheme aimed to help Gentoo customers to be healthier and happier in their home, and help CCGs to:

Reduce emergency admissions and re-admissions.
Improve patients’ self-care and sustainability.
Improve the quality of life for people with long term health conditions.
Increase life expectancy of the local population.

Evaluation and evidence: It is important to note that this was a very small scale intervention, and so the evaluation evidence[6] should be treated with caution.

As previously noted, six homes of patients of Chronic Obstructive Pulmonary Disease (COPD) were improved with energy and thermal measures. A control group was also created with six patients with COPD who frequently attended their GP and hospital but whose homes had not been improved with any thermal or energy efficiency works.

Results after 6 months of the trial:

28% reduction in GP appointments.
33% reduction in outpatient appointments.
Up to 35.6% reduction in gas consumption per month.
Up to £29.92 saving on gas bill per month.
Generally, an increase between 2 and 7 SAP points, however a maximum increase of 47 points.
Up to a 42% increase in living room temperature.
Up to 14% increase in bedroom temperature.

Results after 18 months of the trial:

60% reduction in the number of GP appointments needed by those taking part in the trial.
Attendances at A&E have decreased by 30%. There is a difference in the winter period pre and post installation with fewer attendances post installation.
Outpatient appointments have decreased 22% (12 appointments) over the course of the trial. These appointments may relate to planned care for a range of conditions, and as a result it is possible that outpatient appointments may not be related to cold related health conditions.
Emergency admissions have decreased by 25% (2 appointments) over the course of the trial.
No significant change in either the number of items prescribed or the cost of the patients’ prescriptions.
Patients’ energy bills have reduced on average by 14% as a result of the improvement work carried out in their homes.

Case Study 3: Gluasad Còmhla (Moving Together)

Key details: tailored support provided to 198 households containing someone with a long-term health condition in the Outer Hebrides.

Organisation(s): Tighean Innse Gall (TIG), Langabhat Medical Practice, The Shed, Western Isles Association for Mental Health (WIAMH), Western Isles Foyer, Western Isles Citizens Advice Service

Location: Outer Hebrides

Duration: 2018 – 2020

Who it supported: GPs and health professionals identified people whose health was compromised by living in a cold or hard to heat home. Over two years, 199 households were assisted through the project.

What was delivered: Gluasad Còmhla (Moving Together) built on existing practice of Tighean Innse Gall (TIG) and other partners in the Outer Hebrides, to develop an innovative approach to identifying and assisting people whose health is compromised by living in a cold or hard-to-heat home. Project worked in partnership with GPs, as well as other health professionals, including health visitors and specialists in dementia and Parkinson’s disease.

The project provided tailored support to people with long-term health conditions. This included assistance with switching to more affordable tariffs, access to grants and benefits, home energy advice, and access to insulation and technologies including white goods and renewable energy systems. At the point of project referral, the client and their home was assessed in a holistic manner to ensure that all routes to making the home warmer were addressed. This included the behaviour of the client, the fabric of the house, health related needs and their household income.

Support provided by the project included home visits to look at energy issues in the home and/or provide advice. Initial conversations resulted in focused assistance, including help with bills and switching tariffs, identifying and applying for relevant grants and benefits, insulation, surveys of housing condition and monitoring. Other forms of assistance included installing renewables and helping householders access LED lights and energy-efficient white goods. This support is what TIG were able to give rather than necessarily the totality of the help required by the householders.

Evidence and Evaluation: The project was evaluated by the Sustainable Housing & Urban Studies Unit at the University of Salford[7]. This used a predominantly qualitative methodology consisting of interviews with individual householders (17) and stakeholders (23) and supplemented by an online and postal survey in January 2020 (27 responses out of a possible 198 households supported). Data from TIG covering the type and distribution of support measures was also analysed, and two workshops also held with stakeholders after the first phase of the project.

Householders evidenced a range of challenges relating to the quality of their homes and the impact on their health. One interviewee said that they had been close to moving away from their home but were now more confident that they could achieve a comfortable temperature in their current home: “it was coming to the stage that I was nearly… I would be better moving into another house for my health, but it’s warm now”.

Helping to lower costs resulted in people being more confident using their heating and could also have implications for other aspects of life, including diet, social life and mobility.

Whilst material changes to houses and financial savings were the measurable outcomes of the project, this feeling of support and guidance and the benefits of this for mental health and wellbeing should not be underestimated. Findings from householder survey on health should be interpreted with care. On the one hand, they suggest no clear relationships with overall health, ability to cope day to day, visiting GPs and seeking support from the NHS. On the other hand, this may reflect the nature of long-term conditions, which are not only unlikely to change significantly over the relatively short timescale of the project but are also subject to their own variances over time.

Householder comments reflected additional, less tangible impacts on wellbeing. One householder described being better able to cope, reporting that “other events have challenged me and affected my coping overall in 2019” but that “in respect of the work done, I cope better in the house, which is so important, as I rarely go out”.

Meaningful partnerships and trusted organisations were seen as important in spreading trust in the project, and the involvement of NHS staff gives particular authority to messaging.

GPs interviewed were positive about the project but were also candid about limitations. The GPs spoke about the limitations of the resources they had at their disposal when faced with complex health issues and other interrelated problems, and it is important to acknowledge the practical constraints placed on GPs in the form of short appointments and high patient volumes. Despite these constraints, health professionals saw potential in the holistic nature of Moving Together. There was also a sense that Moving Together had increased their awareness of the impacts of cold homes and provided them with a mechanism through which to act.