Learnings

Outcomes

Phase 1 of WARMTH was delivered in three milestones. Here is a summary of the outcomes delivered in the first milestone:

Milestone 1

Our first milestone was focussed on an in-depth study of existing material around the WHP trials including key players, SROI, customer journeys and any gaps in these areas to address. In our first report we:

• Set the scene – we researched insight around the impact of living in cold homes and the associated health impacts. Key reports from organisations such as NICE and Energy Systems Catapult clearly laid out the impacts to both individuals and the wider system.
• Highlighted key players, parties and responsibilities – we provided an overview of the WHP key players and their roles in the programme including the services and customer journeys that have been delivered in previous trials. It was also made clear that getting the right health partners on board would be critical for WARMTH’s success.
• Reviewed the results from the original WHO trials – we delivered an analysis of the trial results and how they provided social value measurements. This highlighted gaps between the original methodologies and the ED2 proxies required for a DNO model.
   

Milestone 2

Our second milestone focused on building potential model options and testing them with stakeholders. In our second report we found that:

• Access to health data will be challenging – From our engagement expert stakeholder groups, it has become clear that accessing patient data can be complex and timely, owing to the sensitive nature of the information and how data is stored. We will need to engage with data privacy expertise and lean on avenues that are already open in terms of accessing data. 
• Adopting a flexible approach to in-flight programmes may be necessary – There are a number of programmes already operating that are focusing on providing support to people with certain health conditions including our recommended categories. Although they may not use a prescription model for their programme, it may be that we can integrate WARMTH to deliver a trial within SPEN’s operating regions.
• There are opportunities with different participant groups – The original WHP trials focussed on people with respiratory issues and cardiovascular diseases as their target base. Looking at the NICE guidance, we propose focusing on wider cohorts including children with asthma or at risk of developing respiratory issues.
• There are a number of options for modelling WARMTH – We explored a number of options for modelling WARMTH. The preferred option was to use a hub to capture referrals information and then SPEN will manage the referral to determine the level of support required.

Milestone 3

In our final milestone deliverable, we delivered a cost benefit analysis to understand if WARMTH has the potential to deliver favourable SROI and support customers in most need. We found:

• The cost benefit analysis showed clear uplift on health benefits and therefore on SROI – by targeting the same FP activity at people with existing health conditions, the SROI is greater.
• If other housing considerations are also added, the SROI further increases – we found that if interventions are also received by people living in cold and damp homes, the value further increases. This also aligns to the challenges that many health and energy partners are seeing when it comes to detrimental impacts on health and wellbeing including respiratory diseases and mental health. 
• Even with additional cost associations, there is still a positive uplift – if costs are incurred, for example from administration costs for health partners to source and involve participants, we still see a positive uplift in SROI through WARMTH. 
• The modelling has not assumed the provision of WARMTH fuel vouchers – the modelling used in the cost benefit analysis has been based on the current income maximisation service provided. Fuel voucher provision through WARMTH and the testing of different packages, will form a key part of the next trial phase.

Lessons Learnt

Although stakeholder engagement with potential future partners wasn’t originally within the scope of the Phase 1 “discovery” work, introducing the concept of WARMTH as a way to test potential models enabled us to hold valuable discussions with those interested in supporting people with health conditions affected by fuel poverty.

This broader engagement (spanning individual GPs, Public Health Scotland, health charities, and wider NHS groups) helped us identify several important insights that will be critical for shaping the next stage of trial development:

1. Complexity of health systems and data access
   Health data access varies significantly across nations, regions, and even sub-regions, each with its own permissions, processes, and hierarchies. Flexibility will therefore be key when designing the model specification to account for these structural differences and the complexity of accessing patient data to target WARMTH at as well as any other future initiatives.
2. Existing programmes addressing cold-related illness
   Many local authorities and health boards are already prioritising work on the health impacts of cold homes, with active programmes underway. These offer valuable opportunities to collaborate, adapt, and share learning, especially around supporting those living in fuel poverty. By introducing a DNO and the support on hand through their vulnerability programmes, another sphere of support can be introduced to deliver greater impact. 
3. Refining the target patient group
   While the original Warm Home Prescription programme focused on people with cardiovascular and respiratory conditions, our engagement with leading health experts led us to consider an additional group: children with, or at risk of developing, asthma. The long-term physical, mental, educational, and social consequences for this group suggest that WARMTH could deliver particularly meaningful and lasting impact here.