Reports today that one idea the Government is considering to deal with the winter energy crisis is allowing GPs to ‘prescribe’ vulnerable patients help with their energy bills. Cue universal condemnation. A short piece on why I think this might be a good idea…
Some context. Even without the current horrific bill rises, fuel poverty is a significant and persistent problem in the UK. Even with Government directing c.£2.5bn a year on trying to address fuel poverty and some progress since 2010, it still hovered above 13% of households in 2020 (obviously this winter the numbers will be much, much worse).
This translates into health problems and deaths. Our winter excess deaths (the amount of people who die in the cold months vs what you would expect) remains high, around 30k a year (figures for Wales and England — obviously energy costs not the only factor).
One of the things that policymakers struggle with is identifying the most vulnerable and targeting help to them. It is pointed out in countless think tank reports, including how badly targeted the Winter Fuel Payment is, for example. But the politics of removing such support is not straightforward (proposals to cut WFP was a factor in 2017 election manifesto shambles).
Energy companies also really struggle to identify households that a. are eligible for improvements to the efficiency of their home under the Energy Company Obligation (ECO) b. willing to allow the installation of insulation measures. Costs of identification are therefore high.
Where do the costs of these policy shortcomings fall? On the health service, when people with serious heart and respiratory conditions (COPD, emphysema, chronic bronchitis) do not get the help they need and so end of up at their doctors or in hospital. The cost of an overnight stay in hospital is thousands of pounds, much more expensive than the ‘normal’ annual energy bill and probably even more expensive than the horrific bills that many will face this winter. Hospital is expensive.
So an idea that has been kicking around in energy and health for a few years is social energy prescribing — could the health service prescribe a new efficient boiler/pay the bills/improve the insulation for the most vulnerable to keep them out of hospital?
Various pilots have been tried. We Energy Systems Catapult ran a small scale pilot last winter (part of the reason I am defending this idea). We are hoping to do a bigger trial this winter (if you work in the health service and interested get in touch with Rose Chard or Matthew Lipson.
In simple terms, social energy prescribing works by the health service identifying patients in its area with relevant pre-existing health conditions (perhaps through specialist respiratory nurses who deal with lots of these cases). If the patient agrees, they then get a visit from a local energy charity within a week to: check the heating system was working properly; show patients how to use their heating controls; pay for their fuel and perhaps upgrade heating controls (if needed).
As many have pointed out, GPs are already under huge constraints. While the original article said the GPs would be doing the prescribing, we don’t think that has to be the case at all. To be clear, this is not a substitute for simple (and probably universal) direct bill support that will be needed for energy consumers through the winter — things will be grim and many people will suffer without it.
At the moment, social energy prescribing is in the more research needed/larger pilot/innovation bracket. It is probably not in the briefing-to-the-Sunday-papers-as-a-potential-way-of-solving-the-once-in-a-generation-energy-crisis bracket.
I really hope some over-enthusiastic briefing plus subsequent Twitter backlash does not scupper a potentially powerful public health intervention to address one of the knottiest challenges in energy policy.
If we get this right, it could identify and help people who can benefit the most from energy support/retrofit interventions, potentially reducing fuel poverty and carbon emissions, while reducing pressure on an over-stretched health service.
This was originally a Twitter thread — lots of reaction, which you can find here….
