Understanding the practices of Healthcare Practitioners regarding

fuel poverty in Tameside and Glossop; A qualitative study

Dave Mc Conalogue

Tameside and Glossop◦ GM PCT area◦ Rural/urban◦ Our population◦ Fuel Poverty and its impact

Background to issue

19% 19%19%

20% 20% 20% 20% 20%21%

22%

0%

5%

10%

15%

20%

25%

Stockport Trafford Bury Bolton Tameside Oldham Wigan Rochdale Salford Manchester

Per

cen

tag

e o

f ho

use

ho

ld

Local Authorities

Greater Manchester North West England

Fuel Poverty in Tameside

EWM in Tameside

11.4

16.6

20.2

9.9

19.7

15.514.5

22.9

16.716

15.2 15.7

23.6

16.9 16.4

0

5

10

15

20

25

2006/07 2007/08 2008/09 2009/10 2010/11

Exc

ess

Win

ter

Mor

talit

y In

dex

Years

NHS Tameside & Glossop North West England

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

The Role of Healthcare Practitioners (HCP)

Fuel poverty reduction and HCPs ◦ Under-researched◦ Limited methodological detail◦ Experiences of HCP?

Social determinants of health and HCPs◦ Wider literature base◦ UK studies lacking◦ Patients are comfortable discussing issues◦ HCPs focus on biomedical aspects of care◦ Experiences of HCPs?

What the Literature Says

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

Research Aims and Objectives

GP and District Nursing from Tameside and Glossop area (5 GPs, 4 DNs)

9 Semi-structured Interviews Digitally recorded and transcribed Thematic Analysis

Methodology

Practitioner perception of patient pride

Perception that patients do not directly present

social issues

How HCPs understand fuel poverty

How practitioners define fuel poverty

Understandings about the relationship between health and

fuel poverty

How practitioners recognise patients living in fuel poverty

The environment where the patient is seen

Practitioner perception of importance of developing a relationship with the patient

Accessing help/support for patients living in fuel poverty

Practitioner sense of responsibility for tackling

fuel poverty

The experiences that patients feedback to the practitioner

Practitioners understanding of their role in tackling fuel

poverty

The practitioner’s personal experience with a

service/organisation

Practitioner’s understanding of the local relevance of organisations

Practitioner understanding of my role

as a GP Commissioner

Practitioner’s relationship with a service/organisation

Awareness of fuel poverty in patient population

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)

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)

Participant Quotes

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)

Participant Quotes

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)

Participant Quotes

Determinants of referral behaviourPersonal 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)

Participant Quotes

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.

Recommendations

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

Limitations of Research

NHS and Local authority cuts Local services scaling down The Green Deal Energy companies

What happens next?