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The Health of the Nation: Analysis of Cost-effectiveness and Success Factors in Health-related Fuel Poverty Schemes

Lewisham Council
SE2 Ltd
Date: 2017


There is substantial evidence that demonstrates a connection between fuel poverty and poor health outcomes, but, despite the existence of numerous programmes designed to alleviate fuel poverty, its levels have not declined significantly. It is known that initiatives have often missed the most vulnerable households, in part because of inadequate data, but also because fuel poverty has multifactorial causes. Much activity is supported by locally based organisations and networks, but over the last decade the government has drastically reduced central funding, thus undermining their ability to target households in need. This failure continues to pose serious consequences for the health of households in fuel poverty.  

Key research Question

The study aimed to identify possible hidden costs involved in the delivery of fuel poverty and health schemes and where opportunities for the more efficient use of resources existed (e.g. improved coordination among services). A secondary aim was to develop an evidence base of existing activity at a local level, including ‘what works’ in terms of referrals to health-related fuel poverty schemes, with a view to shaping policy and practice. 

Summary of activity

The researchers undertook a literature review of health-related schemes and the current policy context. Data were collected via surveys and semi-structured interviews with scheme providers and referral agencies. The analysis of the results included a small quantitative assessment of costs. Outputs included a workshop with scheme managers and policy-makers and guidance documents on project design and delivery. 


  • The majority of schemes were operated by less than two full-time staff, with just under a half relying on less than one full-time equivalent. This made their sustainability fairly vulnerable.  

  • Nevertheless, the schemes were broadly capable of reaching people in need but needed greater flexibility in terms of eligibility criteria to deliver the support people needed. They represented a cost-effective route for suppliers to reach households.  

  • The research estimated that if the current pace of engagement is maintained it will take 17 years to reach every fuel poor household. Existing approaches mean social housing and private rented properties are losing out.  

  • Trust was an essential element to secure the ‘buy-in’ of referral agencies, which valued the ability to feed information into schemes. Referral schemes worked best where they relied on broad networks of referrals, but continuity of schemes was vital to maintaining a strong network. 

  • Health services were not bearing the costs of tackling fuel poverty-related health challenges, which were primarily falling on local authorities and the voluntary sector.  


  • Better cost analysis of fuel poverty schemes is needed to demonstrate their value. This should include a move towards assessing the full cost of delivery per household, rather than just the cost of a specific intervention. 

  • Data sharing among agencies should be improved, including information on outcomes, in order to inform better targeting. The monitoring and evaluation of schemes must remain integral to projects to assist this process. 

  • Schemes should offer a range of measures in order to broaden their appeal, but they should ensure that their information is clear and brief.  

  • Policy-makers must address the short-term status of much funding and its destabilising impact on schemes. 

  • Future research should be carried out on health outcomes by intervention, the costs and benefits of preventive actions, the relationship between the low income–high cost indicator of fuel poverty and the welfare system, and the identification of which measures are most effective at cutting carbon emissions or alleviating fuel poverty.  

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