Dave Mc Conalogue
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Tameside and Glossop
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GM PCT area
Rural/urban
Our population
Fuel Poverty and its impact
25%
Greater Manchester
Percentage of household
20%
19%
19%
Stockport
Trafford
19%
North West
England
22%
20%
20%
20%
20%
20%
Bolton
Tameside
Oldham
Wigan
Rochdale
21%
15%
10%
5%
0%
Bury
Local Authorities
Salford
Manchester
NHS Tameside & Glossop
Excess Winter Mortality Index
25
North West
England
22.9 23.6
20.2
19.7
20
16.6
15.5 15.2
15
16.7 16.9
15.7
16 16.4
14.5
11.4
9.9
10
5
0
2006/07
2007/08
2008/09
Years
2009/10
2010/11
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Identification of the fuel poor (FPH, 2006)
Engaging them in confronting their issue
Supporting them to assess available sources
of help (Donaldson, 2000)
‘Successes’ in Tameside and Glossop
◦ GP LES: referrals from 3 (out of 42)
◦ AWARM: approx. 25 referrals from HCP
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Fuel poverty reduction and HCPs
◦ Under-researched
◦ Limited methodological detail
◦ Experiences of HCP?
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Social determinants of health and HCPs
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Wider literature base
UK studies lacking
Patients are comfortable discussing issues
HCPs focus on biomedical aspects of care
Experiences of HCPs?
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to explore community HCPs’ understanding
and experiences of fuel poverty, and their
perception of their role in supporting their
patients to move out of fuel poverty
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GP and District Nursing from Tameside and
Glossop area (5 GPs, 4 DNs)
9 Semi-structured Interviews
Digitally recorded and transcribed
Thematic Analysis
How practitioners define
fuel poverty
Understandings about the
relationship between health and
fuel poverty
Awareness of fuel poverty
in patient population
How HCPs understand fuel poverty
Perception that patients
do not directly present
social issues
Practitioner perception of
importance of developing a
relationship with the patient
How practitioners recognise patients living in
fuel poverty
The environment where
the patient is seen
Practitioner sense of
responsibility for tackling
fuel poverty
Practitioner
understanding of my role
as a GP Commissioner
The practitioner’s personal
experience with a
service/organisation
Practitioner perception of
patient pride
Practitioners understanding
of their role in tackling fuel
poverty
Practitioner’s understanding of the
local relevance of organisations
Accessing help/support for patients living in
fuel poverty
Practitioner’s relationship with a
service/organisation
The experiences that patients
feedback to the practitioner
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Defining Fuel Poverty:
“It would be those people who needed to make a choice
about the absolute money that they had and choosing
to eat rather than to keep themselves warm.” (Sandra,
GP)
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The link between fuel poverty and health
outcomes:
“I mustn’t have been provided with decent enough
information to persuade me that it’s a big health issue...
but if there’s a strong enough link between fuel poverty
and ill health, and that could be proven, then I certainly
could integrate that into my practice…” (Elaine, GP)
Healthcare practitioner awareness of fuel
poverty:
“It’s not something I ever really come across. I really
don’t think I’ve ever been on a household visit and
thought ‘bloody hell it’s cold in here’.” (David, GP)
Recognising patients living in fuel poverty:
“And the only reason I found out was that I went on a
home visit and the house was freezing in winter,
and I asked the lady if she had trouble paying for
her heating” (Swapna, GP)
Perceptions about patient pride:
“I think a lot of the proud elderly might not do
(accept they are living in fuel poverty), because a
lot of the elderly you know they like to pay their
way, they don’t like to be seen that they’re taking
off the state.” (Anna, District Nurse)
“The initial concern when we were thinking about
asking that as a sort of standard question, was that
people might be offended by it. But, actually, I
don’t think that we had any experience of that at
all.” (Pam, GP)
Determinants of referral behaviour
Personal Relationship with organisation:
“Well, no, it’s just because I’ve had involvement with Age
Concern in… I was involved in a Fall’s Programme, with
health and Age Concern; I was involved in that. So I kind
of know, with that, what kind of things they look into…”
(Sharon, District Nurse)
Positive experiences:
“…if you send a patient off and they come back and say
‘Oh, they did this, and they did that, and it was really
useful’. It is that personal feedback that really, in a
sense, personalises it, … I think that sort of personal
feedback, is the most likely thing to generate further
referrals.” (Pam, GP)
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Evidence-based information to HCPs to make
explicit to them the health outcomes associated
with fuel poverty.
Development of systematic approach to the
identification of the fuel poor as an integrated
part of the patient assessment process and
appropriate health check procedures.
Processes and initiatives to aid HCPs to identify
and deal with fuel poverty, need to be led and
supported by HCPs.
Fuel poverty reduction services to build
relationships with HCPs at team and practice
meetings, or road-show events.
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Only 9 interviews across two professional
groups – Data saturation?
Participants largely self-selecting – more
likely to be engaged?
Transferability to other professionals
Pre-interview swotting-up
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NHS and Local authority cuts
Local services scaling down
The Green Deal
Energy companies