A Scotland without fuel poverty is a fairer Scotland: report

4. Collaborative partnerships at the local level

4.1 Importance of local partnerships

The continuing high levels of fuel poverty indicate that we need to be better at identifying, reaching and helping the fuel poor. Fuel poverty does not exist in isolation and those who experience fuel poverty are very often engaged with public services for other reasons.

Increasingly, key local agencies - health, social care, education, housing - are recognising that the services they provide for people need to be better inter-connected to meet a range of needs to improve outcomes for the people they serve. This approach helps ensure that when engaging with one part of public service, people are provided with a package of services to meet the range of needs they have.

In this way, the client does not have to seek multiple services separately for themselves; demonstrate eligibility for services over and over again; or repeatedly explain their circumstances to various organisations, which can cause people to drop out of services before all of their needs are met.

There are efficiencies to be gained for public services from being inter-connected as they:

• Share information instead of gathering the same information over and over again.
• Provide complementary services that enhance overall outcomes.
• Prevent further demands on public services as part of the 'spend to save' approach.

Community Planning Partnerships, local authorities, and Health and Social Care Integrated Joint Boards ( IJBs) have a key role to play in this approach, with social landlords, development trusts and charities acting as community anchors.

Many frontline services are routinely in contact with households who are fuel poor or at risk of fuel poverty. The problem is that when these services connect with individuals with a single focus, e.g. health, social care, fuel supply, benefits, etc., fuel poverty is not a routine consideration by the staff involved, even when the likelihood of fuel poverty is high (e.g. dependent on welfare benefits, poor housing conditions, low paid job). Furthermore, when services tend to work in isolation of each other, there can be confusion over who does what, creating duplication and gaps in services.

Currently, individuals who need more than one type of support are often required to use many routes into services. This is a big issue for those who are vulnerable, and are less able to organise or represent themselves. This can cause confusion and disengagement.

This issue is replicated in national and local government policy where fuel poverty largely sits within the housing division and is not embedded as a key component of a wider cross-departmental approach to tackling poverty, social inclusion, inequalities, health and wellbeing or economic development (see next section).

In some cases, social landlords have been quicker to recognise the link between fuel poverty and other debt problems (including rent arears) and have integrated energy saving advice into wider household support services. Those in private housing are less likely to benefit from such support unless they request it.

4.2 Achieving wellbeing

There are a growing number of local wellbeing partnerships (e.g. Fife, Highland, Perth and Kinross, and East Ayrshire). These partnerships are responding to local need and are consistent with four main government strategies which support a collaborative approach to eradicating fuel poverty:

Health and Social Care Integration brings together some NHS and local authority care services under one statutory, unitary partnership. The aim is to keep people healthy and at home and prevent hospitalisation or residential care. This means the home needs to be suitable for healthy living - whether in relation to grab rails, ramps, or the ability to achieve a warm home.

Public service reform foresees collaboration across organisational boundaries and a focus on prevention and early intervention, with the aim of tackling inequality and poverty. At the same time this approach saves money for frontline services through efficiencies and addressing issues before more expensive interventions are required.

Community Planning is the over-arching partnership framework for service delivery. The guidance for Community Planning Partnerships emphasises a preventative and early intervention approach, and a focus on addressing inequalities. Local authorities have a duty to initiate and facilitate community planning.

Community Empowerment means supporting communities to do things for themselves and to have their voices heard in the planning and delivery of services.

Recommendation - Collaborative partnerships 37: Local partnerships that are focused on improving wellbeing should be developed and resourced to take a lead responsibility for ensuring the eradication of fuel poverty in their areas. They should be co-ordinated through Community Planning Partnerships and work with national services, such as Home Energy Scotland, as required. Funding for prevention and early intervention should be ring-fenced to support this approach.

Some areas already have strong local partnerships in place, taking a lead on fuel poverty eradication, while others are in development. In all cases they require more resources to provide the leadership, co-ordination, skills and capacity to further wellbeing in their communities. These local partnerships are critical to realising the full potential of national services such as Home Energy Scotland because they are well-placed to identify people in need and make appropriate referrals.

We developed a framework of current actions to address fuel poverty to better understand the strengths and potential gaps or duplications in current systems (see appendix 5). We also set out in more detail the role of Home Energy Scotland here.

Home Energy Scotland ( HES) is funded by the Scottish Government to provide an impartial energy advice service, including behavioural advice, referrals for measures, benefits checks and energy bill management. It also provides online tools and videos to help householders. HES provides national coverage through a network of regional advice centres and outreach staff in remote rural and island locations.

The HES network is evolving its practice to provide an even more comprehensive service, touching on all causes of fuel poverty. For example, HES is developing the capability to support tariff switching and is undertaking a pilot project on energy management, supporting households in the use of heating controls, as referenced earlier.

HES has also established relationships to accept referrals for fuel poverty advice and support on a national, regional and local level with a wide variety of partners. These include GP practices, hospitals, NHS frontline staff, local authority housing departments, and a wide range of local community groups. For vulnerable households, HES uses specific referrals and signposting to local outreach services providing in-depth energy and fuel debt advice and advocacy: these services are typically delivered by local authorities, housing associations and voluntary organisations.

HES has recently launched a referral portal for partner organisations to encourage closer integration of services for a single client across multiple organisations. This allows online referral to HES from partner organisations and for referring organisations to track the outcomes of referrals that they have made.

It is important to build on these efforts with better, and sustained, coordination at the local level throughout Scotland. Without these local partnership arrangements there is a risk that fewer people will be aware of or access HES support. There is also a risk that interventions do not have the desired impacts if you remove the role of the trusted intermediary, whose relationship with the household continues beyond engagement with HES.

Many of the exemplar partnerships on fuel poverty are area specific and dependent on local public services getting to know each other, working together across agencies and getting to know the people they serve. Some challenges exist not least with the insecurities across parts of the third sector which are vulnerable to fast staff turn-over connected with the challenges of short term funding.

Clearly the extent and reach of the local partnerships to help the vulnerable depends on leadership, resourcing, skills and capacity of local organisations. It is vital that funding is ring-fenced for prevention to resource this holistic approach.

4.3 Key components of the local partnership approach

Community Planning Partnerships have already developed partnership working across health and social care, housing, communities, education, police, fire and rescue, etc which provide the opportunity to take a collaborative approach to identifying and addressing fuel poverty. In many cases fuel poverty will only be recognised when services work together to understand the range of challenges people face.

Already there are examples where this approach is working well and could provide lessons for future fuel poverty work - four case studies are provided in section 4.4.

The key elements of the local, collaborative approach would be:

• A whole person approach that starts with the individual.
• A focus on what is needed to improve the individual's wellbeing - including education, social care, housing, etc; prioritise and use local services and resources to meet needs.
• That affordable warmth and energy becomes part of a 'Routine Intervention'.
• A multi-disciplinary, multi-agency collaboration that is locally based.
• Rapid feedback to the partnership on action(s) taken to ensure the individual's needs are being met.

The emphasis should be on the simple equipping of frontline services with basic skills in identifying anyone at risk, or potential risk, of fuel poverty as part of a more holistic needs assessment. Routine enquiry and potential intervention within universal service settings will help ensure that all those at risk of fuel poverty can access support. The Healthier Wealthier Children project ^[87] is a good model of using a routine intervention to maximising incomes as part of the universal health service. A simple chart of the proposed approach is given in figure 4.

Figure 4: Local partnership approach

There is real potential to maximise efficiency through partnership working, and more flexible use of the existing workforce i.e. fewer people going into homes to do different things and more piggy-backing of tasks and different services. This approach does not imply extra people and services are required, but better use of existing resources with the right support and investment for the longer term.

Partnership approaches will vary across Scotland and should be tailored to the specific needs of the area. However, each should provide a complete and co-ordinated service addressing all four causes of fuel poverty as part of efforts to secure wellbeing and tackle inequalities.

Recommendation - Collaborative partnerships 38: The Scottish Government should work with local government, NHS and other agencies to take a more radical and innovative approach to data sharing to identify the fuel poor and those at risk of fuel poverty in order to trigger fuel poverty assessments.

A data matching programme that supports the local partnership's fuel poverty work and in particular assists with targeting activity where health benefits can also be achieved should be developed. Lessons could be learned from the current homelessness/health data matching exercise. This will take time and demand resources, but in the long term could provide significant savings.

The following data sources provide opportunities for the local partnership to identify the fuel poor and trigger a fuel poverty assessment:

• Council tax rebate data includes details of income, housing costs and council tax band. This could be linked to EPC data for a more complete picture of the household and property.
• Housing benefit data (soon to be housing element of Universal Credit).
• Scottish Welfare Fund grants, free school meals take up, clothing grants and discretionary housing payment claims.
• Energy use data held by the supplier which can highlight unusual patterns of bills. This information could be used to trigger a fuel poverty assessment.
• Department for Work and Pensions (and in the future, the new Scottish Social Security Agency) hold data on households dependent on benefits. This could be part of the Scottish Government's new social security strategy.
• Health data could be used to target those frequently using health services for conditions that could be aggravated by living in a cold or draughty home e.g. respiratory problem), allergies and asthma.

Recommendation - Collaborative partnerships 39: Partnership work at the operational level should be supported by strategic leadership, co-ordinated across portfolios, in central and local governments and be given recognition in the National Performance Framework.

The partnership approach needs to go beyond the operational level and be matched by cross-departmental working at all levels in order to put individual and community needs at the centre of policy and practice. It should operate within the framework of the national fuel poverty strategy to ensure there is an adequate level of support in all parts of Scotland. It will improve health outcomes and help address inequalities, and reduce the burden on public services caused by poor health.

This approach supports:

• The Scottish Government's plan to shift the balance of care from hospitals to home. The potential for this will be limited if people cannot afford the energy to sustain good health and wellbeing in their own home. We believe that where a health or care agency opts for a home based solution then they also have an obligation to ensure that the heating regime in the home is suitable and affordable. In this way, the risk of fuel poverty and addressing it becomes a central part of designing home-based care and health packages.
• The focus on Getting It Right For Every Child ( GIRFEC), providing every child with the best start in life: ready to succeed. The Good Places Better Health process identified "appropriately ventilated, well insulated and affordably heated" homes as important for childhood health and wellbeing outcomes ^[88] .
• Addressing the Educational Attainment Gap ^[89] , because children's education can be marred by living in a cold, damp house when health problems keep them off school, or a cold home means there is no warm, separate room to do their homework. ^[90]

There is a preventative spend case for taking action on fuel poverty beyond climate change (which is the policy objective this is currently most closely aligned with) i.e. that, in the longer term, this approach will improve health and help address health inequalities. It will also reduce the burden on public services caused by poor health, and should form part of the Scottish Government's vision for shifting the balance of care from hospitals to home.

The partnership approach advocated here can form part of the wider government focus on early intervention and preventative spend e.g. early years and education where a child's life chances can be improved if it does not have to go home and study in a cold, damp house. Given these relationships to multiple government objectives, action on fuel poverty should also be reflected in the National Performance Framework.

Recommendation - Collaborative partnerships 40: Local agencies should put in place training and skills development that support frontline staff to identify challenges people face in sustaining good health and wellbeing, including signs of fuel poverty or the risk of fuel poverty, and make appropriate referrals to specialist advice and support services.

Local partnerships need to maximise the opportunity to identify challenges people have to achieving affordable warmth and energy through routine contact and to support them to address these. This should be easier than trying to determine whether someone meets a definition of fuel poverty, by providing an indication of risk to fuel poverty. It will also reduce the pressure on services and resources that are needed to make it happen.

This should be done in the context of working towards a rights perspective: rights to a decent standard of living that promotes good health and wellbeing. It would place a responsibility on all public services to have a clear understanding of what this means and a responsibility to act if they identify people whose life circumstances are preventing wellbeing.

It is possible to build on the training already being developed and delivered across different areas and teams to ensure we achieve sensitive and respectful approach eg. to promote dignity, eradicate stigma, enhance individual and community empowerment.

In practice, this means:

• Connecting with individuals and families from a more holistic perspective.
• Analysing the data routinely collected across a range of sectors to identify indicators of fuel poverty.
• Being more radical and innovative about sharing information and data, that when connected, might highlight concerns regarding fuel poverty.
• Checking wherever the risk of fuel poverty seems likely.

One example is making better use of patient discharge plans from hospital. These plans, and the Single Shared Assessment process should be amended to reflect living conditions (which would include consideration of fuel poverty) as an issue in discharge management.

A useful resource could be the training materials developed for the Shelter Scotland Healthy Homes project which helps health and social care workers spot signs of fuel poverty and know how and where to refer patients for help. ^[91] The HES network is also keen to upskill partner staff to identify the fuel poor.

4.4 Case studies

4.4.1 Healthy Heating Partnership - Fife

The Healthy Heating Partnership was formed to help achieve objectives to eradicate fuel poverty in the Local Housing Strategy. It is made up of NHS Fife, Citizens' Advice and Rights Fife ( CARF), Fife Federation of Tenants and Residents Association ( FFOTRA), Housing Association Alliance, Cosy Kingdom, and the Fife Housing Partnership. Some examples of innovative approaches at identifying and engaging with those in, or at risk from, fuel poverty are:

Transition to Universal Credit: Housing Management Officers contact all new applicants who are being changed onto Universal Credit to ask how they will manage during the 6 week transition period until they get their first payment. They discuss with the tenant what support the partnership can offer - for example a weekly meter top up until they receive their first payment. During this time the officer will also find out what other support needs they have and make appropriate referrals to other agencies or signpost the applicant towards local food banks, debt relief advice etc.

Back on Track: This project was set up to help 800 tenants who had self-disconnected from the gas service for financial or other reasons. The housing officer worked with the Cosy Kingdom partnership to offer a package of support, including a home visit, to help them get their gas heating back on and assess any other support requirements at the same time. At the home visit a number of areas would be looked at such as energy advice, benefit & tax credit check, debt and income maximisation advice, negotiation with utility providers on the tenants' behalf regarding affordable repayment agreements, advice on cheapest tariffs available and switching, plus the handy man service to install simple measures such as draught-proofing. Any further support requirements (childcare, employment, mental health, alcohol or drug problems, etc) would be agreed with the tenant and referrals or signposting to the relevant agencies done.

Client example: A tenant who is under a methadone programme and suffers from depression, needs help clearing his debt so he can get his gas service restored. He's worried about his home being warm enough for when his son visits on weekends. The housing management officer worked with the supplier to negotiate repayments, used Back on Track funding to help clear the debt, and applied for Warm Home Discount. Cosy Kingdom installed thermal curtains and low energy lighting to reduce his energy bills. He is now receiving help with other debts, has re-registered for his methadone prescription, and was given some food vouchers.

4.4.2 Improving the Cancer Journey - Glasgow

Improving the Cancer Journey is an integrated health and social care initiative involving Macmillan Cancer Support, NHS Greater Glasgow & Clyde, Glasgow City Council, social care providers Cordia, and Glasgow Life. The partnership aims to help people with cancer meet their needs - whether they are emotional, practical, medical or financial. This would include the ability to afford a warm home and other energy use.

The service starts with the NHS sending a letter to every newly diagnosed patient with cancer. This approach means everyone is engaged; not just people actively seeking information and support, who may already be more empowered than other members of the community.

The letter offers a Holistic Needs Assessment ( HNA) to establish what kind of support is required. A link worker from the Macmillan team prepares a care plan (see appendix 6) which clearly sets out the concerns and plan of action, including referrals to existing statutory agencies and support services which help patients self-manage their needs. The service had one year of funding to provide energy audits and advice from the local energy advice service G-HEAT. The funding was also used to repair and upgrade heating systems, purchase efficient white goods, and for lined curtains, insulation and draught-proofing. G-HEAT refers patients to Home Energy Scotland for support from Scottish Government programmes.

4.4.3 Advice Partnership in Renfrewshire and LEAP

The Advice Partnership in Renfrewshire facilitates referrals amongst members to help meet individuals' and families' needs. It includes partners from Renfrewshire Council, NHS, Citizens Advice Bureau, Shelter, Foodbank, housing associations, local mental health and wellbeing organisations, debt relief services and energy advice organisations such as LEAP (Local Energy Action Plan). More recently it established both an online referral system which can share data between agencies and a website backed up with a freephone telephone number which helps people identify their needs and self-refer or be referred to the right organisation ( www.advicerenfrewshire.org).

Make it Happen: This LEAP project provides intensive support to vulnerable households. Through one to one visits, the advisors get a really good feel for the day to day challenges that people are facing, often not related to energy advice. They work with the client to identify the changes that will have most impact on their lives and then together 'make it happen' through practical measures like draught-proofing or referrals for debt relief or other services.

After a home visit, LEAP provides a 'Home Action Report' and will follow up with another home visit to put the practical measures in place. Further follow up calls or home visits are made to make sure people are happy with the outcome and find out if more help is needed. LEAP will also follow up with referrals until the household has had the support they were referred for. They also chase up referral partners if there are outstanding items to progress.

There are plans to establish a data sharing agreement ('local referral pathways') with individuals and families to help pass on referrals to other organisations and both the client and the referral agencies can track progress - e.g. follow up required, visit made, other support required, outcomes, etc.

Client example: Woman's Aid made a referral to LEAP in support of the wider family to improve the situation for the father's home. This would give the mother respite and help maintain a relationship with the daughter and father.

John was desperately seeking resolution to his problems with energy bills ever since his meters were changed, and described himself as being at his wits end. He was worried about his fuel bills, his monthly outgoings along with trying to keep his home warm and cosy enough for his disabled daughter to still be able to stay with him.

LEAP arranged a home visit and talked through all the issues with John.

They reviewed the meter readings and worked with Renfrewshire Advocacy Service who helped with getting the meters registered and correct readings on the system. They also installed some draught-proofing to help keep the heat in. In the end, John received a refund plus a goodwill payment from his supplier and all his details are now correctly updated on the system.

4.4.4 Wellbeing and the East Ayrshire Community Plan

Wellbeing is one of three key priorities at the heart of the East Ayrshire Community Plan ^[92] and the partnership is committed to working collaboratively to support people to achieve and sustain good health and wellbeing. The partnership has created innovative locality planning arrangements with multi-disciplinary locality teams (a locality could be a school or a GP practice) that take a whole-person approach to provide the public services people need in a seamless way that also promotes their health and wellbeing.

This approach is underpinned by community led action plans which have now been developed in 16 communities. They are the bed rock of local planning arrangements. This is a change from a single service or solution addressing one issue for an individual or household and the services are shaped to fit this agenda.

The development of the Housing Asset Management Framework will contribute to achieving the vision of East Ayrshire's Local Housing Strategy: "Everyone in East Ayrshire can afford to access a quality home that meets their needs and aspirations, and is located within a safe and attractive neighbourhood in which they are proud to live. "

The purpose of the Housing Asset Management Framework ( HAMF) is to provide a framework for managing the local authority property assets to ensure that East Ayrshire's housing stock meets the present and future needs of tenants, sustainability of tenancies is improved and the best use made of resources. The key objectives of the framework are:

• Ensuring that the Council has a sustainable, quality housing stock within strong and vibrant communities.
• Using resources as efficiently and effectively as possible.
• Maximising resources for further investment in existing and new stock.

This approach will ensure that the cost of fuel is not higher due to circumstances outwith the household's control e.g. poor quality housing or off gas grid. Key elements of the HAMF include:

• Improve existing social housing to match the quality of the new builds (it therefore does not cost more to heat).
• Work with off gas communities to develop local solutions to achieve equity of cost compared to housing on gas grid.

4.4.5 Lessons learned and challenges

• Face to face communication is essential to understand what is really going on in the person's life and clients open up more when they are in their own environment.
• Often fuel poverty is masking many other problems in a person's life and it cannot be tackled in isolation so partnership working is key.
• The biggest challenge is time and resources, as complex cases often take a lot of effort to put the necessary support in place and it can be difficult to keep the customer engaged while this is all happening. Good relationships with customers is paramount if we are to achieve trust and long term solutions to the wider picture of poverty, health, inequality and social value.
• The partners all have different ways of sharing and holding data, and making referrals. Getting data and feedback from the larger agencies in a way that makes it most effective for the individual and family, while keeping the individuals engaged in the process can be challenging.
• Short-term funding: Small third sector organisations are flexible and can provide a big impact for a small investment. However, they are reliant on grants and year on year funding and this can make it difficult to establish long-term relationships with larger partners.