Picture the scene: you come down with flu, and take to bed. Your house is both cold and damp, so you develop complications that necessitate a stay in hospital. Once your strength is up, and you’ve been treated, you return home. Your house is still cold, still damp. The conditions aren’t conducive to your already precarious health, so you return, wearily, to your doctor.
This catch-22 affects thousands of households in Britain. Much of the housing stock built during the big building drives in the 1970s is poorly insulated, and not especially well maintained. Heating your home becomes expensive, and the entire building is energy inefficient.
Poorly insulated homes and fuel poverty affect health to a huge degree, and cost the NHS huge sums every year. With cuts to housing associations and councils, it’s difficult to make the case for preventative work on homes that saves multiple parts of the welfare state and local services’ money if one body has to foot the bill alone.
To try to test out joined-up care, housing association Gentoo launched a pilot with the NHS in Sunderland, targeting households in fuel-inefficient homes with at least one tenant with a respiratory problem likely to be exacerbated by cold and damp. The households were given a “boiler on prescription” – directly prescribed a new boiler and insulation work, including double-glazing, to see if the home improvements translated to health improvements.
The social value was easily measured: each tenant was tracked, with the number of GP appointments and accident & emergency admissions logged over the course of a year, and compared with their previous rate.
Working with the local Clinical Commissioning Group, Gentoo looked at the demographic statistics of their tenants in comparison to the local area. One in three Gentoo residents from the area involved in the pilot had presented themselves at A&E in the previous year, compared to one in seven of people across the city. Gentoo residents were therefore more than twice as likely to require emergency medical help. Additionally, there was a difference in life expectancy of 13 years across the city from the poorest to the most affluent neighbourhoods.
After developing a pilot for £50 000, the results were stark: in the first six months alone GP appointments had been reduced by 28% among the pilot group and outpatient appointments by 33%.
Margaret and John Boulton had their boiler replaced, as John had chronic obstructive pulmonary disease, so was often ill. “He still has bad turns when he spends time outdoors in the cold, damp air. But in the house it’s a totally different story now,” Margaret says. “By this time last year he had been into hospital five or six times – he was really poorly and we had a terrible Christmas. So far this year – touch wood – he’s not been in hospital once and his health is generally so much better. He’s much happier in himself because he’s not suffering.”
As well as lowering tenants’ energy bills by a third on average, the scheme has saved the NHS substantial sums. Outpatient appointments are estimated to cost the NHS around £100, GP visits about £20, while an emergency hospital admission costs at least £2,500. With healthier tenants spending less on heating, Gentoo have fewer worries about rent arrears, and healthier housing stock, no longer plagued by damp.
“We know from the Marmot Report that health inequalities affect health and being cold does this more so than many other things. As a country we need to be ashamed of the excess winter deaths in the UK – it is truly shocking,” says Dr Tim Ballard, vice chair at the Royal College of GPs. “It is difficult for the healthcare system to positively influence these areas but the Gentoo Boiler on Prescription project needs to be seen as a wake-up call for commissioners. This report shows that this scheme is good for people, good for the NHS, and to top it all good for the environment that we all depend upon. The big challenge for us all now is to replicate this across the whole of the UK.”
Source:- http://www.theguardian.com/housing-network/2015/dec/03/sunderland-gps-prescribing-boilers-pills-warm-homes
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