Population health management of fuel poverty.

Abstract

Fuel poverty is a wider determinant of health1,2 and of legitimate interest of Integrated Care Systems (ICSs). A total of 60 573 deaths have been attributed to cold between 2000–2019 in England and Wales.3 The National Institute for Health and Care Excellence4 recommends a single point of contact should be commissioned to support patents vulnerable to cold including those over 65 years, under 5 years, with mental health conditions, chronic cardiovascular disease, or chronic respiratory disease. Nottinghamshire County Council has co-commissioned the Nottingham Energy Partnership (NEP). NEP supports clients to access support according to their financial and housing circumstances. Opportunistic referral of appropriate patients by healthcare clinicians is challenging. Referrals have been below the service’s capacity. A Population Health Management (PHM) project has been developed by Nottingham and Nottinghamshire Integrated Care Board. Data are used to generate lists of at-risk patients likely to be eligible for support. Iterations have generated referrals matched to specific grant criteria and availability such as a specific number of households not yet connected to gas. Practices from five Primary Care Networks took part in one iteration. Patient-level health data were linked via residential address with Energy Performance Certificate (EPC) where available, and Index of Multiple Deprivation (IMD). Patients at risk of cold-related harm, living in areas associated with IMD deciles 1–2, and resident in homes with EPC ratings E, F, or G were triangulated. Primary care medical centre staff sent SMSs to patients offering NEP referral if they opted in. A total of 154 patients were referred between December 2022 and March 2023. Seventy-nine (51%) were contactable. All 79 received a measure of support. In total, 157 wide-ranging interventions were instigated including two cavity wall insulations, 15 loft insulations, 12 solar power systems, and one heat pump. The initial capital cost of these improvements combined with their 1-year projected savings reaches £144 740. Other interventions included 55 Priority Services Registrations, 8 mobility aids (Homes for Living), 26 water-saving discounts, 15 vouchers, boiler optimisation, hardship funding, and financial advice. This PHM approach is deployed periodically in Nottingham and Nottinghamshire to alleviate health inequality, tackle fuel poverty, and is potentially generalisable. © British Journal of General Practice 2024