How can we embed a health inequalities approach to addressing fuel poverty in off-gas households?

Farmhouse set in a remote location in Wales

How can being ‘off-gas’ increase vulnerability? 

Households which are off the gas grid are some of the coldest and most energy inefficient in the UK, as well as some of the most expensive to heat. Many people living in such properties struggle to meet their energy needs for comfort and warmth and are at risk from cold-related ill health.  Connecting them to the gas grid could potentially bring threefold benefits relating to health, energy efficiency and fuel poverty reduction.

Do we target support to improve health or to tackle fuel poverty?

Ideally, the answer to this question is that we tackle both through a population-wide initiative designed to tackle health inequalities at each level of society and which is tailored  to the varying support needs of different groups. However, in the current context of limited funding for energy efficiency and cold-related ill health initiatives, such an approach is unlikely. Instead, there is a tension between targeting for health alone and targeting to address vulnerability in the more complex sense. Interventions might seek to achieve significant health outcomes that are manifest at population level through a blanket targeting approach. This carries the risk of some of the some of the most vulnerable and/or deprived households miss out should support not be tailored to their needs and requirements. Or, interventions might direct help towards those who are the most  vulnerable and at risk of deprivation, and who are least able to pay (i.e. the worst first). This approach risks missing some households who are not deprived (or at least, not the most deprived) but nevertheless suffer from cold-related health conditions in an attempt to combine potential health gains with a reduction in deprivation (including the experience of fuel poverty). In these cases, improvements to health are unlikely to be detectable at general population level.

What is Connecting Homes for Health? 

The Connecting Homes for Health pilot research project aimed to test and measure the impact of applying health-based eligibility criteria to the provision of free gas grid connections (through the Fuel Poor Network Extension Scheme) and free  first-time gas central heating measures alongside tailored energy efficiency advice and support (funded through WHD II) on the health and wellbeing of vulnerable residents who are in or at risk of fuel poverty and at risk from cold-related ill health. The research element of the project was funded by Northern Gas Networks and led by NEA.

How did the scheme look to improve health whilst reducing fuel poverty?

To identify targeting hotspots, a mapping exercise was designed and carried out for County Durham and Sunderland. This involved identifying GP practices within the two local authority areas that were showing high prevalence of multiple cold-related ill health indicators according to the Quality Outcomes Framework using a weighted ranking system. These were then overlapped with the Index of Multiple Deprivation (IMD) rank (along with additional deprivation indicators) and fuel poverty prevalence at Ward level in order to give each GP practice catchment area an overall health/deprivation/fuel poverty risk score. Postcodes falling within a 2-mile radius of each of the highest scoring practices were identified and given to NGN, who carried out an additional layer of mapping to identify which properties were off-gas.

A comprehensive desk-based evidence review was carried out to understand the relationship between cold homes and ill health and to inform development of the eligibility criteria for the scheme. The pilot needed to balance narrower eligibility requirements (to capture the most vulnerable), whilst allowing for some flexibility (to capture other households in need and at-risk).

Such preliminary mapping activities and health-based eligibility criteria were extremely important to be able to identify target communities, but they should be the start and not the end point of a successful recruitment strategy -especially when it comes to engaging and retaining the participation of extremely vulnerable clients. The reality is complex and expensive to deliver. It is about fully understanding individual household situations and needs and ensuring the scheme has been designed to recognise and accommodate those needs. It involves making repeated efforts to maintain contact and engage via letters, phone calls, text messages and face-to-face home visits, all dependent on what works best for an individual client and their specific needs. It involves taking on burden of completing, submitting, and processing paperwork on behalf of some clients, or using small crisis funds to remove barriers that could otherwise prevent their participation in a scheme. This takes time to work out on a person by person basis and time as well as creativity and dedication to deliver. Importantly, it also means making sure advice and support continues to be provided before, during and after measures have been installed.

To find out about the impacts that can be achieved by taking this kind of approach, take a look at NEA’s Connecting Homes for Health project.