Now you can get central heating on the NHS

Drugs, drips, wigs and wheelchairs have long been available on the National Health Service, but Cornwall Health Authority has gone further: it is paying for central heating.

In a scheme reminiscent of the public health movement of Victorian times, the authority has handed pounds 300,000 to local councils to improve housing. The money, spent on central heating and improved insulation, will be used in 120 damp houses where children suffer from serious asthma.

The hope is that the children's health will improve, so making long-term savings in NHS costs. But GPs argue that the cash should have been spent directly on long-term care.

"We all know that asthma is linked to damp housing," said Dr Andy Stewart, chairman of the local medical committee. "We write letters all the time to councils urging them to do something about it and we support the health authority investigating it. But the NHS in Cornwall is desperately short of money.Difficult decisions will have to be taken this year about which services to cut."

Dr Gabriel Scally, public health director for the South- west, however, said many health problems had environmental causes. "This could be an important contribution to reducing variations in health."

Dr Ian Mackenzie, medical adviser to the Cornwall and Isles of Scilly Health Authority, said the decision was taken in late 1994 when the health authority suddenly found itself with unspent cash.

"It is well known that there is a link between poor housing and health, and particularly that children with severe asthma suffer when houses are mouldy, damp and poorly heated. Because this money was non-recurring, the authority decided to spend it on improving the housing for such children.

"The issue is whether we are getting to the root cause of ill-health when we do that, or are we just dealing with the problems once they have arisen?"

One of the beneficiaries is Devan Blake, seven, who lives in a 1930s former council house in Penzance which is now run by the Penwith Housing Association. He and his mother, Catherine, 31, both suffer from asthma. Until January, the only heating was a solid fuel boiler which Mrs Blake says "left the front room boiling and the rest of the house freezing". The windows ran with condensation, the metal frames rusted, the walls grew mould, and clothes put away in cupboards became mouldy over the winter. "Devan had a lot of time off school with asthma, ear infections, being chesty and all that," she says.

The new heating has, she says, "made a huge difference". Devan has been off medication since April while she is using much less. At Devan's last check-up the family was told they did not need to return unless his asthma came back. The family's heating bills have halved.

The big question is whether the move is cost-effective. On average, each house has cost well over pounds 2,000 to improve. But Dr Mackenzie says inhalers and other treatment for asthma can easily cost pounds 300 a year, while clinic time and hospital admissions can cost much more.

A study of the families' use of NHS services before and after the improvements is under way. But a more comprehensive study has not been possible because of NHS spending rules. "Ideally," said Dr Mackenzie, "we would have taken two sets of children with similar problems and allocated them randomly to have the housing improvements or not - and then monitored what happened to their health.

"But we felt ethically that we couldn't ask families to take part in the study and then not guarantee them the same improvements later on if the intervention proved effective."

Dr Scally said that while encouragement for other health authorities to do the same was unlikely, "there will be difficulty in reducing health variations without co-operation with local government".