In the rugged landscapes of the Outer Hebrides, a groundbreaking project has attempted to expand the boundaries of healthcare. The ‘Moving Together’ initiative has reshaped local health services by approaching fuel poverty as a key determinant of health as part of a programme that builds on social prescribing.
What is Social Prescribing?
Social prescribing is a healthcare approach where patients are referred to non-medical support within the community. It’s an emerging trend in addressing the social determinants of health (SDoH), factors like living conditions and financial stability that profoundly impact our health and wellbeing. Typically, social prescribing involves activities or advice services. ‘Moving Together’ has expanded this scope by involving organisations working on energy and housing alongside community and health services, led by Tighean Innse Gal.
The ‘Moving Together’ Project
‘Moving Together’ took a bold step by integrating fuel poverty, a condition where people can’t afford to heat their homes properly, into a social prescribing framework . In the Outer Hebrides, where harsh climates make warm homes essential, an ageing population places demands on health services, and poverty means that people are unable to invest in their homes, around 200 households benefitted from this initiative. The project provided a range of support, including advice on saving energy at home and help with managing fuel debts. They also assisted people in accessing funding to improve the energy efficiency of their homes. The broad approach not only targeted immediate health concerns, it also engaged with the deeper socio-economic factors affecting health, namely inequalities in income and housing quality. Delivery was particularly challenging given the context: one home visit can involve a day’s driving including a boat journey.
Impact on Health, Wellbeing and Health Practice
The effects of fuel poverty on health and wellbeing are stark. Our research report documents stories of residents, overwhelmed by the cost of heating, living confined to just one room or being hospitalized with hypothermia. The project has led to improvements in both physical and mental health, with residents reporting feeling warmer, healthier, and happier. For some, the support has been life-changing, allowing them to reclaim their homes and live more comfortably and independently:
‘It is marvellous to have the whole house warm instead of a cold upper floor and a warm ground floor.’ (Householder interviewee)
The project also demonstrated the value of home visits and their ability to give clues to fundamental issues affecting health. This helped health professionals identify issues aggravated by cold and damp homes.
“I think being in the home is so, so important because I think someone going into a GP’s surgery is hiding something that they might have at home…It might be embarrassing for someone that they can’t afford to heat their home.” (Project Stakeholder interviewee)
By working through networks of support and trusted health professionals, such as specialist community nurses, the project was able to help householders to overcome anxiety about having work done on their homes:
“I met one of the patients a couple of weeks ago, who found it a really stressful thing, a really stressful experience, because they’d got mental health issues and so they almost backed out at the last minute, but between TIG and mPower input, which they found very, very supportive, they were able to go through with the work that needed doing. So it’s not just identifying the work, I think it’s the … workers providing the support for that individual … [because] allowing somebody into the home is a big thing for them.” (Project Medical Professional Interviewee)
Beyond Traditional Social Prescribing
In the fuel poverty world, what sets ‘Moving Together’ apart is its comprehensive approach. It’s not just about energy efficiency; it’s about understanding and addressing the broader social and health needs of individuals. In terms of social prescribing, it reflects a broader approach that addresses some of underlying social inequality rather than simply focusing on individual actions and community activities. From helping residents manage their finances to facilitating significant home improvements, the project has demonstrated that tackling structural inequalities can profoundly impact health outcomes. This model of social prescribing acknowledges the interconnectedness of various social determinants and addresses them in a coordinated, holistic manner.
‘Moving Together’ reflected the power of collaborative, community-focused health initiatives. Its legacy underscores the need for health services to continue to evolve beyond traditional boundaries and address the broader social factors influencing health. By doing so, we can envision a future where healthcare is not only about treating illness but also about fostering overall wellbeing through comprehensive, community-driven approaches.
This blog is a summary of the recently published academic paper – Homes and health in the Outer Hebrides: A social prescribing framework for addressing fuel poverty and the social determinants of health