Winter 2019/2020

Warmth on Prescription

Designing a new service for vulnerable energy consumers

Living in a cold home is putting millions of people at risk of ill health.

Over 10,000 people die each year as a result of living in cold homes in England and Wales. This figure includes people with respiratory and cardio-vascular diseases as well as conditions affecting the immune system such as arthritis and COPD. The NHS spends over £1 billion per year treating illnesses caused and exacerbated by cold homes.

But how could we solve this? What could a solution look like?

The Service

During Winter 2019/20, I led the design of an innovative service called Warmth on Prescription. This allowed people to heat their home to ‘healthy temperatures’ at no additional cost to them.

Using advice from health care professionals, the project used the NHS’s recommended indoor temperatures. Their advice was used to choose who to test the service with; prioritising those with respiratory illnesses made worse by the cold.

A principle of the service design was the idea that people pay a set amount for prescriptions, regardless of the actual cost for the medication.

Hypothesis

As part of a small team of researchers, designers and a fuel poverty specialist I ran a lean design experiment. This focused on three research areas:

• How might the healthcare services be used to identify vulnerable consumers?

• How might this service help vulnerable consumers be more comfortable and feel healthier?

• How might we understand the costs to deliver the service to vulnerable consumers over the winter period?

Approach

We used our experience of designing complex energy services to tackle this experiment. Our principle was simplicity due to the short time, limited budget and small team we had. It was a challenging design task for many reasons, here are three of them:

1. Finding vulnerable participants for the trial

2. Helping vulnerable participants achieve comfortable and healthy temperatures

3. Understanding the cost to deliver Warmth on Prescription

Challenge 1: Find vulnerable consumers

Engaging with healthcare services and vulnerable consumers is hard

What we needed to do:

Identify individuals with a health condition that was made worse by cold living conditions

How we did it:

• The initial aim was to identify candidates through the NHS, to mimic how a service might be delivered at scale. I spent a considerable amount of time interviewing healthcare professionals and working with the Clinical Research Network to prepare a pitch. The outcome was that to identify candidates through the NHS would require ethical approval from Health Research Authority and would take 6 months; too late for Winter 2019/20;

• I had concurrently been talking with special interest groups and respiratory charities. After a lot of interest, pitches and discussions – we ran out of time;

• I continued to speak directly to local surgeries and gained approval to place leaflets in waiting rooms in two surgeries in South Birmingham;

• With time running out, we approached a recruitment agency with a strict screener to ensure we had participants over the cold period.

What we learnt:

• Extremely hard to find the most vulnerable consumers;

• Even though cold homes over winter is a top priority, it’s still tricky to access the NHS for innovative, lo-fi research;

• To work with the NHS, ethical approval from Health Research Authority is mandatory. We now know this process takes 6 months to achieve; so can plan this into any future projects.

Challenge 2: Deliver triallists healthy temperatures

Triallists were happy to heat to healthy temperatures, but without smart heating controls this was difficult to track and control.

What we needed to do:

• Enable triallists to have their home within a healthy temperature range. There could be many ways to do this – from the technically complex and challenging (installing smart controls keep temperatures inside of the healthy range) to the simple (select a warmer setting on the thermostat). We opted for a middle ground – still enabling control whilst, as a fake “service provider” getting some confidence that the customer was setting healthy temperatures

Challenge 3: Understand the costs to deliver

Triallists didn’t question payment amount or increase in energy bills at the end of the trial

What we needed to do:

Fake the prescription and deliver a fixed price for their heating. A “real” service would be similar, pay a fixed amount that you can afford to ensure you are warm. Then the “prescription” provider (NHS / supplier / government or all) would pay the difference of how much it cost to deliver that warmth.

How we did it:

• This “real” service was not an option as a prototype. We faked it by telling triallists that they won’t pay any more than they do now. The terms of the prescription would cover any increase in energy bill;

• We used HED (Home Energy Dynamics) inputs (house type / size / existing temperature preferences) to calculate the estimated costs;

• We sought current and last years’ consumption to get a ballpark figure, even though weather would have had an effect;

• Scheduled check-in with triallist at the start of next Winter in the event of any irregularity (i.e. participant’s direct debit changes, participant has large surplus).

What we learnt:

Triallists were happy to receive payment to cover the increase to their energy bill from their usual spend but did not question the exact figure or any specifics of increase in temperatures

Since COVID, a larger trial has taken place, plans to scale up for the next cold heating period. If you are interested to collaborate or know more, please drop me a line.