The literature review found that while multi-agency work was common, few areas were explicitly working on the NICE agenda. Major challenges included a lack of leadership and difficulty in building joint work into the competing priorities of partner organisations. 

The absence of evaluation in the NICE guidelines makes it hard to assess progress nationwide, but the evidence from ‘exemplar’ areas indicates that while there are challenges, the guidelines can be implemented with sufficient funding and leadership. 

The case study of Portsmouth suggested that although progress was being made, combining housing and health, resident engagement, funding and silo working all remained major barriers. In addition, there were significant challenges in bringing local authority and health actors together to co-deliver on fuel poverty. Health and Wellbeing Boards and Clinical Commissioning Groups continue to remain largely separate from local fuel poverty agendas, and this lack of ownership means that the agenda remains predominantly led by local authority housing teams.  

A lack of dedicated sustainable funding was likely to prove a major obstacle to successfully delivering single points of referral in many areas, as was the absence of a strong national lead on the issue of fuel poverty. Ongoing cuts to public sector budgets create a risk that agencies will concentrate on their core business and ignore collaboration.