25 October 2023

A ground-breaking project is under way to improve the health and wellbeing of people at risk of poor health because of fuel poverty.

Fuel poverty causes physical and mental illness and adds to pressures on health and care services. Government figures show that 13.4 per cent of UK households were in fuel poverty last year, a figure that is expected to rise as cost-of-living pressures continue.

Fuel poverty arises when a household needs to spend a certain proportion of its income on heating the home satisfactorily.

Now a collaboration involving Health Innovation North West Coast has developed a system to identify individuals at risk and interventions to help them in Cheshire and Merseyside.  

The project meets the NHS’s Core20PLUS5 health inequalities agenda, which focuses on improving outcomes for the most deprived 20 per cent of the population in five clinical areas, including chronic respiratory disease.

It aims to reduce hospital admissions and attendance at GP surgeries, limit exacerbations of patients’ conditions, and reduce people’s anxiety over the cost of fuel.

Its blend of population health and data-led approaches aims to deliver more coherent and effective interventions.

One of the key features of the project was how it identified a cohort who would benefit from interventions. It drew on the insights of the Combined Intelligence for Population Health Action (CIPHA) dashboard, which sifts health and care information from 2.6 million Cheshire and Merseyside residents.

‘Trailblazer’ projects were launched in St Helens and in Knowsley where teams identified patients with COPD as an appropriate group to focus on because they are particularly vulnerable to cold, damp homes and their condition can deteriorate in the wrong environment.

Teams then identified individuals who had a 50 per cent or higher risk of emergency admission in the next 12 months, were not in a care home, and were living in the most deprived and fuel-poor areas. That provided a cohort of 1,317 individuals in the region, a manageable figure for whom the project team were confident they could improve outcomes.

They were able to draw on support from primary care, local authority housing and social services teams, mental health services and third sector providers.

Teams then offered a very wide range of interventions, including referrals to a GP, to wellbeing services and to charities specialising in home heating.

Other individuals have benefited from the COPD telehealth service and pulmonary rehabilitation services, while others have received £500 payments from household support funds.

Project teams have also helped with changing inhalers, smoking cessation and made mental health referrals.

One of the patients to benefit from the scheme was Joe – not his real name – who needs a constant supply of high-flow oxygen and suffers from COPD and pulmonary fibrosis.

Joe says he must choose between maintaining his oxygen supply and heating his home, because he cannot afford to do both.

The project team was able to arrange for a new boiler to be installed in his home and for him to receive a £500 household warmth fund payment, among other benefits. You can read more about Joe’s experience below.

The project was led by NHS Cheshire and Merseyside and Health Innovation North West Coast, who identified the NHS Innovation for Health Inequalities Programme as a funding source. Partners include Liverpool Heart and Chest Hospital NHS Foundation Trust and Mersey and West Lancashire Teaching Hospitals NHS Trust.

Lucy Malcolm, Senior Digital Transformation and Clinical Improvement Manager at NHS Cheshire and Merseyside ICB, said: “We have learned a lot during the programme, namely that there is value in testing and learning from small pilot projects to support scaling up of work going forward.

“It has also emphasised that the people involved are crucial. The technology provides the data that we need, but it’s the people from health, social care, and other sectors, who have put their hands up to get involved, who are the heart of the programme, harnessing those insights to provide vital, life-improving support to our most vulnerable residents.

“Health Innovation North West Coast played a crucial role in getting the project off the ground and in helping to coordinate it.”

Rhiannon Clarke, the Programme Manager leading Health Innovation North West Coast’s involvement in the project, said: “It’s been a very exciting project to take part in because even the early results show it’s led to a marked improvement in people’s lives.

“Nobody should be in a position where their health suffers because they can’t heat their homes, so it’s really satisfying to know our work has helped to remove that worry.

“It’s been a complex and sometimes challenging project but also very rewarding.”


Joe’s story

“It’s been a choice between heating my home or using my oxygen.”

Joe has COPD and pulmonary fibrosis and requires high-flow oxygen 24 hours per day. He also has mobility problems and had been experiencing problems getting out of the house without a ramp for his scooter. With rising energy bills, he described having to choose between heating his home or using his oxygen.

Identified as part of St Helens trailblazer, Joe was referred to the local council’s Affordable Warmth Team for household assessment. He has been given an occupational therapy assessment for a stair lift and ramp assessment and was also helped to register on the Priority Services Register with his energy provider.

Joe has since had his boiler replaced and a full risk assessment of his home carried out, including the storage of the oxygen, ventilation and fire breakers and the care of the new oxygen concentrator he has been prescribed. A bespoke ramp has also been installed to improve his mobility and independence. He has received financial support via the household warmth fund to support improvements.

The community respiratory team also held a full medication review. This resulted in further improvements to his treatment, which should both reduce his energy costs and improve his quality of life.

The team has discussed with Joe and his family how to manage his deteriorating conditions – including discussions about advanced care planning and end-of-life care – while Joe’s wife was referred to a local carers’ society for support.


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