Shared learning database

Middlesbrough Environment City
Published date:
August 2016

Middlesbrough Affordable Warmth Partnership works collaboratively with several organisations to deliver a winter warmth programme of support to vulnerable people throughout the winter months. A team of delivery partners including: Cleveland Fire Service; Age UK; Volunteering Matters; Middlesbrough Council’s Staying Put Agency and Middlesbrough Foodbank provide a range of support including: emergency heating; boiler repairs; benefits advice and a befriending service.

To further reinforce links with the NICE guideline ‘Excess winter deaths and illness and the health risks associated with cold homes’ (NG6), the Affordable Warmth Action Plan now includes specific actions to: enhance a referral process into a single point of access hub: deliver a range of training to front-line staff: and further develop our housing database to include both health and home energy efficiency data to strengthen the links between cold homes and ill health, and to also begin to establish a data sharing protocol between relevant partners.

Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

Middlesbrough Affordable Warmth Partnership (AWP) coordinates a winter warmth initiative which has the following aims and objectives:

  • Reduction of the incidence of fuel poverty in Middlesbrough;
  • Reduction in the incidence of Excess Winter Deaths;
  • Raised awareness of the issue of fuel poverty locally;
  • Achievement of local carbon reduction targets;
  • Improved financial inclusion and household incomes;
  • Addressing wider determinants of health and Excess Winter Deaths.

To achieve these aims the AWP works collaboratively with a range of delivery partners to deliver a programme of help and support throughout the winter months.

Cleveland Fire Service – provide emergency support to vulnerable and fuel poor household where heating has broken down or is inadequate. Support includes temporary loan of safe electric heaters, provision of thermal blankets, wind-up lanterns and smoke detectors.

Age UK Teesside – provide one to one support to people over 65 to give energy efficiency advice, help and advice about switching energy supplier and benefits advice. Small energy saving measures such as draught excluders, letterbox covers and energy saving light bulbs were also provided.

Volunteering Matters – utilise existing community groups and meetings to raise awareness of affordable warmth with vulnerable groups, giving advice and signposting people to areas of support. They also co-ordinate a volunteer knitting group who knit items (hats, scarves and blankets). These have been distributed to those in need including refugees and asylum seekers.

Middlesbrough Staying Put Agency – provide emergency support with gas central heating to vulnerable people recently discharged from hospital, offering emergency repairs and temporary heaters, fleeces and blankets, slow cookers, carbon monoxide monitors and cold alarms.

Middlesbrough Food Bank – provide Food Bank users with a recipe for a simple healthy hot meal that can be reproduced using the contents of the bag of donated food. Access to Slow Cooker workshops are also currently being offered via the Food Bank.

Householders contacting MEC for advice can be referred on to any of our partners for further help in any number of areas, ensuring emergency or crises support alongside longer-term support with the wider determinants of fuel poverty and health.

Reasons for implementing your project

Middlesbrough is one of the most fuel poor areas of England with over 8800 (15%) households judged to be in fuel poverty. The health of people in Middlesbrough is generally worse than the England average. Deprivation is higher than average with recent reports stating that Middlesbrough has the largest proportion of highly deprived neighbourhoods in England (49%).

Middlesbrough Environment City (MEC) coordinates an Affordable Warmth Partnership which has worked collaboratively since 2008 to deliver a programme of help and support to vulnerable people throughout the winter months. The Partnership created an Affordable Warmth Action Plan with the aim of tackling fuel poverty and the health impacts related to living in cold homes.

The Partnership received funding from the Government’s ‘Warm Homes, Healthy People’ initiative during the winter of 2012/13. This was used to set up a programme of support for vulnerable people during winter. People for whom age or health makes them vulnerable to cold weather were able to access a range of services including boiler repairs, benefits advice and support with emergency heating where necessary.

‘Warm Homes, Healthy People’ funding has now ended but Middlesbrough Council Public Health continue to provide funding to the Affordable Warmth Partnership to continue provision of these services.

The project was successful at reaching lots of people e.g. during the winter months of 2013/14 and 2014/15 over 1700 people received support or advice through the Affordable Warmth Partnership’s Winter Warmth Projects. However, the AWP wanted to ensure that the project was reaching the most vulnerable and fuel poor residents.

The Partnership invested in the UNO Housing Database which is used to record client information and make onward referrals. The database also contains details of the energy efficiency of Middlesbrough households .This information has been overlaid with local public health data about excess winter deaths, hospital admissions for COPD, influenza, pneumonia, asthma and falls. Combining these two data sets is enabling us to identify key wards for targeting our Winter Warmth Programme

How did you implement the project

The Affordable Warmth Action Plan is revised every 2 years, and is currently being reviewed. We took this opportunity to align all actions with the NICE guidelines NG6. This process was effective in highlighting gaps, both in provision of support to vulnerable residents and the training needs of front line staff and partners of the project.

NICE guidelines have helped us develop a framework to ensure referrals, training, and responses to service delivery are co-ordinated effectively. The aim is to develop a single point of access to the project offering a wide and holistic range of support to help vulnerable residents build resilience to cold weather.

A range of training sessions for front line staff will ensure that all workers who come into contact with householders are aware of the health impacts of living in cold damp homes, and are aware of where to refer people for help.

The Partnership sought to improve the targeting of the project. MEC used £10,300.00 of the Public Health affordable warmth funding to purchase the UNO housing database which holds details of the energy efficiency of housing in the Borough.

We are able to use UNO to map areas of Middlesbrough where there is a high incidence of cold and fuel poor homes and compare these areas with those of a high incidence of hospital admission for cold related illnesses. Public health data for local hospital admissions and Excess Winter Deaths was used for this exercise which will allow us to target the project to those areas of most need. This data is shared with all Affordable Warmth Partners to allow them to focus key elements of all winter warmth programmes.

The database is also being adapted to incorporate health and wellbeing information of people accessing the project. This will help build a database of vulnerable people allowing us to offer year round support.

Training staff and using the database to target vulnerable people presented us with barriers we are working to overcome.

Take up of training was low, but we are working to revamp the training package to include bite sized sessions for team briefings, and an e-learning module. This will fit in better with staff schedules and allow ongoing access to the e-learning module to refresh and update learning.

Being able to populate the data base with accurate and useful data is also an emerging issue. To improve this situation we are planning a household questionnaire to collect up to date housing and health data.

To access our fuel poverty action plan please click here.

Key findings

We evaluated the 1st winter of using the database referral process (2015-16). This helped build a picture of how clients access the project and their referral pathway through the project. It showed us that clients approach the project differently for different needs and is helping us focus delivery in other ways.

During winter 2015/16, 68 people contacted MEC directly for help. The majority contacted us requesting crises support with heating issues:

  • 43 needed help with boiler repairs/replacement
  • 18 had no heating/hot water and were referred for emergency repairs
  • 6 were referred to the Fire Brigade for emergency heating

Our partners reached other vulnerable people during outreach events and one to one advice sessions. Over 2600 people accessed the project this way during winter 2015/16. We conducted an evaluation with clients attending an event where an energy efficiency advice session ran alongside a regular tea dance for people over 65 and people with mobility problems. 25 people responded indicating that their main worries over the winter months were:

  • 7 reported health being affected by the cold –
  • 5 reported fuel bill costs
  • 6 reported keeping warm
  • 1 person was concerned about being isolated.

The group received advice about energy bills, fuel switching, keeping warm, insulating the home and where to get help with grants for boiler replacements. 5 people went on to switch to a cheaper tariff for their energy supply. This demonstrates a good example of wider engagement of people to address the wider determinants of health inequalities.

These results exceeded our expectations for last winter and all partners met their targets for engagement. The project is successful at raising awareness of fuel poverty issues, energy efficiency and staying healthy and warm at home, whilst also giving practical help to improve household income, access boiler replacement/home insulation grants, thus help reduce carbon and make homes easier to heat.

Outreach events, e.g. exercise, healthy cooking, and befriending opportunities help the project address the wider determinants of health and EWD.

Future assessment will consist of a pre and post questionnaire to gauge impact on health and wellbeing. We will include 3 questions:

  • How much does the cold affect your health physically and mentally?
  • How much do you worry about paying winter fuel bills?
  • Do you feel warm enough in your home during the winter?

Collecting this information will help demonstrate the value of the health improvement outcomes of the project.

Key learning points

The Affordable Warmth Partnership is already seeing the advantages of using NICE Guidelines as a planning tool within the Action Plan. Key areas we have used the guidelines to improve and plan are:

Developing a framework for Training Front line staff.

We did encounter barriers to the take up of the training offered. Staff found it difficult to fit in extra training sessions, and found it difficult to add in another referral process. To overcome this we are:

  • amending existing training sessions to include information about health impacts of cold homes
  • developing e-learning to supplement training
  • introducing prompt cards for staff to carry to act as a reminder and prompt referral if needed.

Developing the database for the single point of access hub

This is successful as it helps us manage referrals securely and allows project evaluation. However, the amount of data we need to introduce to the database to give accurate details of SAP ratings, running costs and fuel poverty presented us with a challenge. Going forward we will address this by introducing a household energy efficiency survey in target areas to collect this data, and we have assigned more staff hours to the project to maintain the database.

Project Evaluation.

We found that current evaluation is not robust enough on the evaluation of health and well being of clients accessing the project. To address this we will include three questions around health and wellbeing which clients will answer before and after receiving help.

The key to success with a multi-agency approach is to ensure that all partners are clear about the processes involved, and to keep partners engaged throughout the project as delivery develops.

Key points:

  • A presentation should be made to all partners at the outset to ensure that everybody is clear about how and why the project is being developed and how the NICE guidelines are being incorporated.
  • When setting up a single point of access hub with multiple delivery partners it is important that all partners understand the referral process and understand what services other agencies and partners are delivering.
  • Set up regular meetings with all delivery partners allowing everyone to share feedback about their own particular delivery area, allowing problems to be addressed quickly.
  • Evaluation of the project should be clearly thought out before the project starts. A method for evaluating the impact on health and wellbeing needs to have a process in place before the project starts.

Contact details

Melanie Greenwood
Health Projects Lead
Middlesbrough Environment City

Is the example industry-sponsored in any way?

Funding is provided by Middlesbrough Council Public Health. During 2015-16 they provide funding of £50,000.