The Seasonal Health Interventions Network (SHINE) is a project run by Islington Council aiming to reduce the number of Islington residents in or at risk of fuel poverty, as well as reducing excess seasonal deaths and hospital admissions in the borough. SHINE is a partnership between Islington Council and agencies across the health, housing and voluntary sector.

A recent review of SHINE partners identified 132 teams across 86 different organisations. Since beginning in December 2010 SHINE has handled over 6,900 referrals for vulnerable residents in Islington, leading to approximately 31,000 interventions. SHINE is believed to be the largest referral network of its kind in the UK, unique in the range and scale of interventions offered and its strong links with health services.

Islington residents are referred by partners to the SHINE Hub, where they are assessed for around 30 separate, evidence-based interventions. Interventions provided include: energy advice, ‘Energy Doctor in the Home’ visits, heating and insulation improvements, independent living services provided by third sector organisations, financial checks, falls assessments, medication reviews, access to grants for private sector housing and many more.

SHINE also focuses on helping residents in Islington to manage and reduce energy and water debt. In 2013/14 over £18,000 of debt relief was secured from energy supplier trust funds, 22% more than the year target of £15,000. A pilot for bulk-referrals of Islington residents to energy suppliers for the Warm Home Discount in 2013/14 enabled us to refer an estimated 1,010 new household for the £135 discount, bringing approximately £136,000 in bill reductions for Islington residents.

Objectives and beneficiaries

The overall objectives of SHINE in Islington are to:
• reduce fuel poverty
• reduce excess winter deaths
• reduce excess winter hospital admissions
• reduce health inequalities and improve health outcomes
• reduce financial inequality and improve financial outcomes

SHINE has either met or far exceeded its numeric targets over the past four years. To 2013/14 SHINE exceeded its annual targets by at least 11%.
In 2013/14 targets for referrals and interventions were 2,830 referrals leading to 12,524 interventions, a positive variance of 99% and 100% respectively.
In 2013/14 SHINE’s target figure for debt relief secured from energy supplier trust funds was £15,000, which was exceeded by 22%.
The target for the Warm Home Discount pilot in 2013/14 was £9,450 in savings which was exceeded by 1343% with an estimated £136,350 saved for residents.

SHINE is targeted at Islington residents whose vulnerability to cold conditions is evidenced by local mortality and hospital admission statistics and those for whom their medical conditions increase their risk of fuel poverty. There is a large evidence base that many of these medical conditions are exacerbated by cold housing. Priority groups are:
• People aged over 65
• People with respiratory disease
• People with cardiovascular disease
• People with dementia or severe mental illness
• People with autoimmune disease (e.g. lupus, cancer, multiple sclerosis)
• People with haemoglobinopathies (sickle cell disease, thalassaemia)
• Low income families with children under the age of five

In excess of 80% of our clients fall into at least one of these groups, with the remainder being younger disabled people or low income families with children aged between five and fifteen. Older people have the greatest risk of winter death and non-elective winter hospital admissions so these constitute 51% of all clients. 56% of clients declare a disability. Over half of all clients are currently in fuel poverty as defined by 10% or more of income being spent to achieve adequate warmth, and a further significant number sensitive to even minor energy price rises. Since the start of the project we have built a considerable referral network comprising of a wide range of agencies such as the health sector, social care providers, social landlords and third sector organisations. A number of key health and social care services have integrated a referral to SHINE in their care pathways. SHINE is also included in a number of council services’ referral pathways, for example housing and welfare rights. One of the major benefits to partner agencies is the time saved from having access to a wide range of around 30 interventions from a single point of referral, rather than having to make multiple individual referrals to various services. SHINE also serves to add value to its member services by increasing connectedness, increasing referrals of their target groups and allowing their clients access to additional services.

Strong points of the practice

Islington Council’s Seasonal Health Interventions Network (SHINE) aims to tackle energy or fuel poverty, as well as health inequalities by offering a package of services, or ‘interventions’, through a single referral.

SHINE works in partnership with 132 teams across 86 different organisations in Islington to gain referrals from various vulnerable groups. Referrals are made by front line workers such as health professionals, housing officers, social services, children’s services and voluntary and community sector partners. This partnership approach ensures that those residents who may not come forward for help are reached.

SHINE uses a ‘single point of contact system’, whereby a vulnerable resident will be assessed for up to 30 different services from a single referral. SHINE also makes direct referrals on to the various services, as opposed to merely signposting people. This ensures that people are not lost going through the process. The referral pathways of all services have also been simplified substantially, as many previously had referral forms of multiple pages.

SHINE aims to tackle the three contributing factors of fuel poverty: energy inefficient housing; low household income; and inefficient or expensive heating systems. This is achieved by offering a variety of services covering these areas, such as replacement boilers, ‘Energy Doctor in the Home’ visiting service and benefits checks. Households are also assessed to see if they are eligible for any government energy bill subsidies or discounts to ensure they can heat their home adequately.

A major strength is the linking of the housing and health agendas which is imperative in tackling health inequalities. SHINE is the largest affordable warmth scheme of its kind in the UK and has been recognised on a national, European and global level.

Traditionally housing conditions and other wider determinants of health have not been considered when looking at a vulnerable patient’s health. However it is known that are demonstrable health effects resulting from poor quality and energy inefficient housing. We are now embedded in local multidisciplinary teams addressing the needs of the 2% most complex health cases in the borough, bringing consideration of wider determinants straight to the attention of primary care practitioners.

Expected results and benefits for climate change adaptation and mitigation

SHINE has assisted over 6,900 residents since December 2010, leading to over 31,000 seasonal health and affordable warmth interventions. The energy efficiency improvements to properties, through the Energy Doctor in the Home visiting service, replacement boilers and insulation installed has resulted in reduced CO2 emissions of 11,534 tonnes since the start of the scheme. Monetary savings have been calculated as £1,280,000 (€1,639,000) since the start of the scheme.

SHINE has successfully linked with academic institutions including Kings College London (KCL) and University College London (UCL). Research projects have included:

• social isolation in vulnerable Islington residents and attitudes towards extreme weather in two Islington wards
• overheating case study of a vulnerable residential building, and
• actual rather than modelled costs of electric storage heating

This work has informed the direction of SHINE and ensures the project is targeted effectively. Research has also been conducted in community resilience to climate change in areas such as flooding and heat waves events.

Replicability potential of the practice

The SHINE project model readily lends itself to being replicated. It does not require the creation of new services because it links existing services through a single point of contact. The model takes a partnership approach, relying on partner organisations to deliver services and to make referrals into the hub for their clients. The tools for setting up a scheme similar to SHINE, the training, development and operational tools, are all adaptable and replicable within other EU or OECD countries.

Draft guidance from the influential National Institute for Health and Care Excellence (NICE) on tackling excess winter deaths and illnesses recommends that referral and coordination services like SHINE are set up at a local level to help vulnerable people who live in cold, unsafe homes. Such referral services are likely to include health and social care professionals and third sector organisations as members, and to provide access to services such as insulation and heating support, welfare benefit checks to maximise income and advice on managing energy effectively in the home. The final NICE guidance is due to be published in March 2015.

Fuel poverty and excess winter mortality and morbidity are issues affecting a number of EU countries. The UK until this year was counted in the top five EU countries in terms of high excess winter death rates, along with Portugal, Spain, Ireland and Greece. A recent study has ranked the UK as having the sixth highest excess winter death rate in the EU, after Malta, Portugal, Cyprus, Spain and Bulgaria. Warmer countries typically have housing stock which is not well prepared for periods of extended cold weather, and lower indoor temperature is a factor known to affect excess winter death rates. SHINE is a way of linking together the disparate yet interrelated agendas of health, housing and energy to tackle the issues of energy poverty and seasonal health in a holistic and multi-disciplinary manner.

SHINE has already found replication within London – a SHINE scheme is running in the neighbouring London Borough of Hackney and a similar model has been adopted by the other London boroughs of Lewisham and Wandsworth, as well as the City of Norwich. It has been proven that SHINE can be replicated in other contexts and can be made relevant to the local context. SHINE can be applied as a model that plays to existing local strengths, and to strengthen existing local services.