There has long been an association between poor housing and adverse health outcomes, which has been increasingly recognised by government. A wide range of national policy also emphasises the need for greater partnership working between professionals operating in the health and housing sectors, but financial and organisational factors have hindered more effective coordination. The extensive resources dedicated to energy efficiency programmes in the UK offer significant scope to improve residents’ health, while the scope for health workers to tackle fuel poverty is considerable. An earlier report funded by Eaga Charitable Trust (CT) (Henwood, 1997) had called for a proper evaluation to understand effective approaches and highlight good practice. Despite this, there is currently limited evidence on ‘what works’ in this context.
Key research Question
The study sought to identify examples of local schemes that utilised partnership working to deliver both positive health and energy efficiency outcomes. By examining these examples in depth, the authors examine the barriers to more integrated approaches and the factors that enhance collaborative working and highlight the types of approaches that have proved effective in improving the health of households receiving such measures.
Summary of activity
The authors convened an advisory group to help identify suitable schemes that met a number of preconditions. As well as a strong partnership element, the introduction of training for health professionals on energy efficiency and referral pathways for households to access funding and other support also acted as inclusion criteria.
A questionnaire was used to gather data from workers via individual interviews and/or group discussions. The questions focused on how the project came about (e.g. sources of funding), what monitoring occurred, what barriers had been identified and lessons learned, and any future activity.
Subsequently, stakeholder workshops were held in three of the ten case study areas, and feedback was gathered from participants at a ‘Health, Housing and Affordable Warmth’ seminar.
Analysis of the data from the case studies involved developing an evaluation matrix that recorded best practice.
Several common themes emerged from the ten case studies. The majority of partnerships dealt with general health matters, although a number specifically focused on asthma. All the projects included local councils and health authorities as partners, and three-quarters focused on health visitors.
Barriers to effective partnership included the reluctance of GPs and health visitors to participate in projects, inadequate monitoring, a lack of time and limited budgets. Factors that contributed to success included involving health workers in the development of the project, fitting training around existing meetings, providing ongoing training and getting strategic buy-in from health authorities.
The authors concluded that successful projects demonstrated that they included a good range of partners from different sectors, had good knowledge of how fuel poverty and poor health interacted in their area, had a robust system of monitoring that incorporated impact and feedback indicators and included built-in comprehensive training with attached resources. Not all of the ten case studies achieved this.
At a local level, it is suggested that those delivering energy and health collaborations could be supported by engaging an external agency with a remit to identify potential partnerships and help develop them. A clear decision-making and communication structure laid out in a partnership agreement would also assist progress, as well as allowing more flexible management and funding arrangements.
At the national level, measures proposed include a best practice guide and greater promotion of what works, as well as guidelines for practitioners on research findings. A set of standard criteria for data and quality of life indicators would improve the comparability of monitoring.
In addition, funding for partnership working needs to be aligned and pooled to ensure that initiatives can be effectively resourced. More research is required to demonstrate the connections between energy efficiency and health improvements, as well as better coordination of the research agenda.