Chapter 6 - Vulnerability and health care
There is strong evidence to suggest (see Appendix 3 - Catalogue of Publications - Health Impacts research) that fuel poverty, vulnerability and health care issues are closely linked. Ensuring that all vulnerable people and households are both identified and properly helped requires an increasingly well-focused and collaborative approach, similar to the very successful 'Care and Repair' and 'Handyperson' service model, which continues to prove its effectiveness in reaching and helping elderly and disabled people to secure improvements and adaptations to their homes and quality of life. The experience of Task Force members strongly suggests that additional, high quality and predominantly locally-based and well-trusted service providers are particularly effective in ensuring that all the help and support required actually reaches the most vulnerable and fuel-poor rural consumers and ensures that verifiable improvements are made to their lives and well-being. As a further direct consequence, evidence also suggests that adopting this approach will help reduce NHS burdens and public expenditure costs.
The Task Force has, therefore, concluded that all vulnerable households, wherever they live, should be accorded top priority ( see 2.2) in the new strategic approach to tackling fuel poverty. The key to finding, reaching and helping them is to ensure that rural areas are served by a comprehensive and well integrated and co-ordinated network of skilled local and national energy carer service providers.
Critical actions required are as follow:
6.1 SG and Ofgem to consider National Institute for Health and Care Excellence ( NICE) March 2015 Guidelines on excess winter deaths and illness and the health risks associated with cold homes, with a view to expanding and improving the rural dimension of their existing definitions of at risk groups and sectors of society who are defined as 'vulnerable.'
6.2 SG to "rural-proof" all of its fuel poverty programmes to ensure that they prioritise and, in practice, reach, all vulnerable clients, especially those living in off-gas, rural areas.
6.3 SG to contract HES to further develop its existing third-party portal service to ensure that it delivers to all rural and remote areas and provides a seamless referral mechanism between all health, social care and locally based support organisations. The purpose is to ensure that all vulnerable households actually receive the help and support they need.
6.4 NHS Scotland to discuss with the Royal College of General Practitioners ( RCGP) and other relevant professional bodies with a view to agreeing a process of contractual obligation by which all patients with fuel poverty-related health conditions, including all those living in rural and remote GP practice areas, are referred to appropriate fuel poverty advice and support agencies for the practical care measures they need.
6.5 To further facilitate and support inter-agency collaboration, SG to share its comprehensive mapping service, which identifies all of Scotland's fuel poverty / affordable warmth service providers, the geographical areas they cover and whether they make referrals to Home Energy Scotland and vice versa.
6.6 Ofgem to expand the role and duties of energy suppliers in line with the recommendations put forward in Ofgem's recent Priority Services Register Review. In summary, this "will require companies to move away from a 'box-ticking' approach and adopt pro-active procedures to identify and help their vulnerable customers."
6.7 Ofgem to include in their annual reports on the retail energy market, the extent to which each of them has addressed and mitigated the detriment to customers as highlighted by CMA in its recent Energy Market Investigation report. They should make particular reference to reductions they have made to the energy bills of vulnerable clients and the numbers and percentages of those who have switched from the dominant supplier - with specific reference to those living in off-gas rural areas.
6.8 SG to commission a comprehensive 'energy carer' pilot to assess the effectiveness of high quality, in-home, locally delivered, holistic support in bringing verifiable affordable warmth improvements to cold, vulnerable, fuel poor households living in any part of remote rural Scotland.
6.9 As a consequence of the completed Priority Services Register ( PSR) review, Ofgem to impose meaningful changes to the PSR license conditions currently applied to energy companies to make sure that they give Ofgem the details of all their vulnerable consumers so that Ofgem can ensure that appropriate "hand-holding" support is made available to them for switching and/or other suitable fuel poverty alleviation measures.