Family doctors prescribing double glazing and loft insulation for patients living in cold, damp homes can transform lives and slash the huge sums spent by the NHS on cold-related ill health, a ground-breaking trial has shown.



The pilot project in Sunderland found GP and outpatient visits plummeted by a third after patients’ homes were made warmer and cheaper to heat to the tune of hundreds of pounds a year.

The impact of cold weather on health is estimated to cost the NHS £1.5bn a year and over 18,000 people died prematurely last winter. However, energy bills have soared in recent years, leaving millions of people in fuel poverty and unable to heat their homes properly.

“We’re able to heat the whole house for the first time in god knows how long, it’s unbelievable,” said Margaret Boulton, who took part in the trial. Her husband John suffers from chronic obstructive pulmonary disease (COPD), a serious lung condition made worse by cold, damp conditions. “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 so much better. He’s much happier in himself because he’s not suffering.”

Margaret and John Boulton say the experience has changed their lives for the better. Photograph: Gentoo

“As a country we need to be ashamed of the excess winter deaths in the UK. It is truly shocking,” said Dr Tim Ballard, vice chair at the Royal College of GPs. “This ‘boiler on prescription’ scheme needs to be seen as a wake-up call for commissioners. The scheme is good for people, good for the NHS and, to top it all, good for the environment. The big challenge now is to replicate this across the UK.”

The idea for the trial began after Gentoo social housing and sustainability group, which has 28,500 homes in Sunderland, noticed that tenants said they felt happier after their homes were made more energy efficient. “We heard anecdotally that people were feeling better, both in their health and in having more money in their pockets to do things that made them happier,” said Gentoo’s Paul Burns, who led the pilot.

Gentoo contacted Sunderland’s clinical commissioning group, which agreed to provide £50,000 for a proper trial. They selected 12 homes with very poor insulation and lived in by people with COPD, which affects over 1m people in the UK. Half the homes received £5,000-worth of double glazing, efficient boilers and loft, cavity and wall insulation, improving their energy efficiency rating from a G Rating up to D. To ensure the trial was objective, the people in the study were not themselves Gentoo customers.

The results of the first six months, released to the Guardian on Tuesday, showed those in the warmer, drier homes visited their GP, outpatients and A&E departments significantly less, while there was no change in the control group. While energy bills dropped by £30 a month, the temperature in people’s living rooms and bedrooms rose by over 3C. Burns said work had made a “massive” difference to people’s quality of life.

“Overall we’re definitely saving money. I know this because I’ve been able to put more money aside for food shopping,” said Boulton. “We can’t thank the doctor and Gentoo enough. This whole experience has really changed our lives for the better.”

Derek Lickorish, chair of the government’s Fuel Poverty Advisory Group: “This is proof positive that warmer homes cut the costs to the NHS and transform people’s lives: saving £30 per month is a life-changing sum of money for many vulnerable customers.” After last winter’s row over high energy bills, when David Cameron reportedly said the “green crap” had to be cut, Lickorish said the subsequent reductions to energy efficiency schemes were “unforgivably perverse”.

Outpatient appointments are estimated to cost the NHS about £100, GP visits about £20, while an emergency hospital admission costs £2,500. “Prescribing energy efficiency looks like a really, really cost-effective thing to do,” said Ballard. “There is only so much medicine itself can do. Peoples’ home and social circumstance play a bigger role.” Life expectancy in the less affluent districts of Sunderland where the trial took place is 67 years, compared to 80 years just a couple of miles away in richer parts of the city.

Ballard said cold, damp homes have a triple whammy on people’s health. The direct effect is hypothermia, particularly in older people. “I have seen patient after patient come in with very low core temperatures,” he said. Second, is the effect on respiratory conditions, with asthma and COPD patients suffering particularly badly in cold, damp houses, said Ballard. It also damages mental health and wellbeing, he said: “It’s the attritional thing about being in poverty [due to high energy bills] and being cold.”

For Mrs Yvonne Angus of Hylton Castle, and others like her who suffer from Chronic Obstructive Pulmonary Disease (COPD), a warmer, less damp home has direct health benefits. Photograph: Gentoo

The success of the pilot in improving health and cutting NHS costs has attracted interest from other clinical commissioning groups in the North East and in setting up schemes to enable GPs to prescribe energy efficiency across the country.

A recent report from the International Energy Agency highlighted the benefits to physical and mental health of warmer homes, on top of lower bills and reduced carbon emissions. It cited a retrofit programme for low-income households with existing health problems in New Zealand, which showed a benefit-cost ratio of 4 to 1, with up to 90% of the benefit coming through better health.

In the UK, the National Institute for Health and Care Excellence (Nice) have been consulting on new guidelines on reducing cold-related deaths and illness since July 2013, but have yet to published them. The government have been consulting on a new fuel poverty strategy since July 2014.



“The links between many diseases that are caused or worsened by living in cold conditions are now clear,” said Peter Smith, at National Energy Action, which is working to raise awareness in the health sector of energy efficiency solutions. “Sadly however, we are still seeing many thousands of vulnerable people perish each year because of cold and damp housing.”