Labour’s ECO4 scheme sends NHS patients into damp homes, driving A&E crises
THE RATIONALS
In the waiting rooms of Britain’s health centers, a single sheet of A4 still circulates. It is authenticated with NHS details on headed paper or via official email, and bears the title of the Great British Insulation Scheme and ECO4 Flex Medical Referral Letter Template, in the clipped language of officialdom. The GP completes it in under a minute, patient name, postcode, diagnosis, asthma, COPD, respiratory vulnerability, and a tick beside the statement that the condition is “severely adversely affected by living in a cold home.” The form is emailed to the local authority. Weeks later, a contractor arrives with rolls of insulation and a grant cheque drawn on the public’s energy bills. The patient, reassured by the doctor’s signature, opens the door. Six months on, the same patient is back in A&E, gasping through airways irritated by black mould that now carpets the walls. The referral was meant to prevent illness. Instead, it delivered it.
This is not a rare misadventure. It is the direct, documented outcome of a policy loop that begins in the surgery and ends in the emergency department. The Energy Company Obligation Phase 4 (ECO4), launched in April 2022 and extended to March 2026, was designed to insulate 450,000 low-income homes. A key eligibility route, Route 3 under ECO4 Flex, relies explicitly on NHS referrals to identify households where cold and damp exacerbate health conditions. Ofgem’s guidance is unambiguous, general practitioners, nurses, and occupational therapists may certify patients using a standardised template available on council websites nationwide. The form remains live in 2025, downloadable from local authorities including North Kesteven District Council, where it explicitly targets “households identified as low-income and vulnerable, with an occupant whose health conditions may be impacted further by living in a cold home.”
The National Audit Office (NAO) audited 60,000 properties installed before January 2025 and delivered its verdict on 15 October 2025, 98 per cent of external wall insulation (EWI) installations, estimated at 22,000 to 23,000 homes, require major remediation to prevent dangerous damp and mould. One-third of internal wall insulation (IWI) jobs, 9,000 to 13,000 homes, are similarly defective. In total, more than 30,000 homes are affected, a figure confirmed by the NAO, with DESNZ acknowledging clear failings in ECO4 and GBIS leading to widespread damp and mould risks. The NAO’s language is restrained: “There have been clear failures in the design and set-up of the schemes… weak consumer protection and quality assurance arrangements.” The consequence is less restrained, insulation that traps moisture, fosters mould, and reverses the very health gains the referral system was created to secure.
The health pathway is explicit. NICE Guideline NG6, cited in Ofgem’s eligibility criteria, identifies cold homes as a trigger for respiratory exacerbations. The Medact coalition of health professionals wrote to Health Secretary Wes Streeting on 27 May 2025, stating that nearly 8.8 million people spent the previous winter living in damp and mould in cold homes they cannot afford to heat and that effective insulation could reduce new cases of childhood asthma by 650,000. The annual cost to the NHS of cold and damp homes is £500 million. Yet the referral pipeline continues to feed patients into a programme that the NAO has shown to be 98 per cent defective in its flagship measure.
Ed Miliband, Secretary of State for Energy Security and Net Zero since July 2024, has overseen ECO4, funded via energy bills at a total obligation value of £1.2 billion since its 2022 launch, despite the NAO’s 2023-24 estimate of £55-81 billion in public sector fraud and error losses highlighting ongoing risks. The scheme was framed as part of the “Clean Power 2030” mission, with DESNZ claiming annual bill savings of £280 million and carbon reductions on track. The NAO report, published in October 2025, found the schemes “off track” for emissions targets and remediation lagging, only 2,934 homes had been repaired by September 2025, fewer than 10 per cent of the confirmed total. TrustMark, the certification body, had flagged 388 installers as non-compliant by August 2025, thirty-nine had been suspended. Many simply ceased trading, leaving homeowners to fund repairs themselves, with average costs hitting £11,200 per home, potentially £336 million in homeowner liability for 30,000 affected properties.
The human toll is measurable. In Luton, Mohammed’s family saw their child’s asthma worsen after a 2023 ECO4 insulation job coated the bedroom in black mould, rendering it uninhabitable and the home unsellable, per a BBC report on 4 September 2025. In Lancashire, Ian Lofthouse, 74, received government-backed cavity wall insulation in 2016 to cut bills. Defective work trapped moisture, triggering rampant damp and mould. His COPD and asthma rapidly deteriorated, leading to pneumonia, encephalitis, kidney failure, and a fatal stroke on 1 May 2024. Legal fees from a collapsed claims firm left his family in debt and the home unsellable. These cases are not outliers. They represent the 15 per cent of ECO4 installations, approximately 36,585 homes by March 2025, that the NAO deems botched, with up to 3,400 posing immediate respiratory hazards.
Wes Streeting, Health Secretary since July 2024, has warned repeatedly of a “challenging winter” with flu peaks and corridor care, as stated in his Labour Conference response on 26 September 2024. His 10-Year Health Plan, launched in July 2025, promises prevention through community services, yet the Medact letter gathering dust in his inbox identifies damp homes as a preventable driver of respiratory admissions. NHS England’s Winter Plan 2025/26, published on 10 October 2025, anticipates surges in respiratory illness due to flu and cold weather pressures, amid ongoing A&E challenges, yet the referral forms, still branded with the NHS logo, continue to circulate. No public health notice has been issued to GPs. No pause has been placed on Route 3 eligibility. The pipeline remains open, feeding the crisis Streeting vows to fix.
The propaganda is relentless. DESNZ press releases speak of “record delivery” and “transforming lives,” as in their 2025 updates claiming 243,900 homes upgraded by March. Ofgem’s website hosts the referral templates without caveat. The NAO counters with “systemic failure,” yet the forms keep moving. In January 2025, DESNZ acknowledged a “serious systemic issue” with ECO4 installations in a Commons statement, yet no halt to referrals followed. The Electoral Commission opened a probe into suspected fraud on 22 October 2025, estimating £56–165 million skimmed. Awaab’s Law, enforced from 27 October 2025, requires landlords to remedy mould within seven days, ECO4 victims, as owner-occupiers, fall outside its scope, creating a legal chasm between social tenants and grant-dependent households.
This is not incompetence alone, it is a structural inversion of intent. A policy conceived to reduce NHS pressure now increases it. A referral system built on clinical judgement now undermines it. The public pays through energy bills for the installation, through taxes for the hospital admission, and through lost productivity for the illness in between. The NAO audit, the Medact warning, the ministerial admissions, and the live referral forms are all in the public domain. The connection is not speculative, it is statutory, financial, and clinical. As winter looms, with NHS England anticipating pressured wards amid national respiratory surges, the failings sharpen, a green promise that exacerbates the health risks it aims to mitigate.
The scale is industrial. By March 2025, 243,900 homes had received ECO4 measures, 60,600 more were treated under the Great British Insulation Scheme, per Ofgem’s Q1 quarterly report. The NAO audited only a sample. The true extent of damp-inducing failures may never be known until winter admissions spike and postcode data are released. Until then, the NHS logo on the referral form remains the most potent symbol of a net zero promise that has curdled into preventable harm. Doctors refer in good faith, patients suffer in silence, ministers expand in defiance. The mould spreads, and the crisis brews.
#NetZero #LabourHypocrisy #NHSCrisis #ECO4Scandal #GovernmentWaste
The Rational Forum is a reader-supported publication. If you like our work please share, comment or consider becoming a free or paid subscriber, failing that you can always buy us a coffee to help keep us going.
This article (Net Zero’s Mould Referral Scandal) was created and published by The Rationals and is republished here under “Fair Use”
Featured image: The Rationals
Leave a Reply