Medical evidence for ECO Flex energy grant applications, where a cold home affects your health.
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The ECO scheme funds insulation and heating improvements, and the Flex route lets local authorities refer households where someone has a health condition made worse by living in a cold or damp home.
Respiratory conditions, cardiovascular disease, limited mobility and immunosuppression all commonly qualify. The letter confirms the condition and the connection to home temperature.
ECO Flex is administered locally and qualifying conditions vary between councils. Send their statement of intent or criteria if you have it.
Covering the condition, how it is affected by cold, and any hospital admissions or worsening over winter.
Ready to submit with your application.
ECO Flex is administered locally, under each authority's own Statement of Intent, and qualifying conditions differ between councils. Some accept a letter from any GMC-registered GP; a few require it from the practice you are registered with, in which case a letter from us cannot be used.
It takes a few minutes on the council's website and it saves you the fee. Send us their criteria if you have them.
ECO funds insulation and heating improvements, and the Flex route lets a local authority refer a household where somebody's health is made worse by a cold or damp home. Loft and cavity wall insulation, heating repairs and replacements, and first-time central heating are the usual measures.
The point of the letter is to establish the health limb of that referral.
We assess you, not your house. The letter confirms a qualifying condition and how cold or damp housing affects it. It does not survey the property, rate its energy efficiency, or specify which measures should be installed — that is the assessor's and the installer's work.
The person with the condition. We cannot write about a tenant we have not assessed, and a landlord cannot obtain one on a tenant's behalf. Where the qualifying person is a child, a parent or guardian attends with them.
We have no relationship with any installer or scheme administrator. No fee, referral arrangement or commission passes between us and anyone who profits from the work going ahead.
If an installer has told you that a particular doctor will write the letter, treat that as a reason for caution rather than convenience.
Eligibility and funding are decided by your local authority and the installer, not by us. The letter is supporting evidence — it is not an approval, and we have no involvement in the grant decision.
The declaration is the local authority's to make. Send the letter with your ECO Flex application to the council or its nominated scheme, and keep a copy.
An installer may offer to handle the paperwork. That is usually fine — but the referral itself is the council's decision, and it is worth knowing where your application actually sits.
Take your time over step three. Get more than one quote if any contribution is asked of you, check TrustMark registration yourself rather than taking a leaflet's word for it, and never pay a deposit to a doorstep caller.
Eligibility and funding are decided by the local authority and the funding obligation, not by us, and we have no involvement in the decision. A property can be turned down on survey — for instance where a cavity is unsuitable for filling — even with a perfectly good medical letter.
People routinely qualify for these and never apply. They are free and they are separate from ECO:
Ask which criterion was not met. Where the gap is medical and we can properly evidence it, send us their reasoning and we will address it at no charge. Where the property was found unsuitable, that is a survey question rather than a clinical one.
A cold home is a health problem now, not only in the abstract. Heat the room you spend most time in rather than the whole house, keep the bedroom at a reasonable temperature, and treat damp and mould as urgent — report it to the landlord in writing, and ask environmental health to inspect if nothing is done.
If a respiratory condition is deteriorating, come back and be assessed. Do not wait for a grant to be processed.
We assess you, not your house. The letter confirms a qualifying health condition and how cold or damp housing affects it. It does not survey the property, rate its energy efficiency, or specify what measures should be installed — that is the assessor's and installer's work.
We have no relationship with any installer or scheme administrator. No fee, referral arrangement or commission passes between us and anyone who benefits from the work going ahead. If an installer has told you a particular doctor will write the letter, treat that as a reason for caution rather than convenience.
The patient has to be the person with the condition. We cannot write a letter about a tenant who has not been assessed, and landlords cannot obtain one on a tenant's behalf. Where the qualifying person is a child, a parent or guardian attends with them.
Check your council's criteria before booking. ECO Flex is administered locally under each authority's Statement of Intent, and a few require the letter to come from the practice where you are registered. Where that is the case, a letter from us will not be accepted, and we would rather you knew that before paying for an appointment.
The route into the Energy Company Obligation that lets a local authority refer a household on health grounds, rather than on benefits alone — funding insulation, heating repairs and replacements, and sometimes first-time central heating.
You do not have to be on benefits to qualify under Flex. That is the point of it, and it is why people miss it.
Commonly asthma, COPD and other respiratory disease; cardiovascular disease; limited mobility; immunosuppression; and conditions worsened by cold such as arthritis or Raynaud's.
The list is set locally and varies, so check your council's Statement of Intent before booking.
No. It is supporting evidence, not an approval. The council decides eligibility, and a surveyor decides what the property is suitable for. A home can be turned down on survey with a perfectly valid medical letter.
No — we assess you, not the property. We can say that cold and damp worsen your condition and describe what has happened as a result. We cannot rate energy efficiency or specify measures, which is the surveyor's job.
Where damp is the issue, an environmental health inspection is free and carries weight no medical letter can.
No. The letter has to be about a person we have assessed, and the patient must be the person with the condition.
The tenant can book themselves. A landlord cannot obtain one on their behalf, and nor can we discuss a tenant's health with them.
Yes, with a parent or guardian present. A child's asthma worsening in a cold or mouldy bedroom is a common and entirely legitimate basis for a Flex referral.
No, and deliberately so. No fee, referral arrangement or commission passes between us and anyone who benefits from the work going ahead.
If an installer has named a particular doctor who will write these letters, be cautious. The value of the letter lies in its independence, and there is a persistent doorstep-selling problem around this scheme.
Often fully funded, but not always — some measures require a contribution depending on the property and the funding available.
Get that in writing before agreeing to anything, get a second quote for any contribution asked of you, check the installer is TrustMark registered, and never pay a deposit to a doorstep caller.
Weeks to months, through council checks, survey and installation, and funding runs in obligation periods that can close.
Apply early rather than in December, when demand peaks and the winter you were trying to prepare for has already arrived.
The Priority Services Register above all — free with your energy supplier and network operator, giving priority in a power cut and advance warning of interruptions. Anyone with a long-term condition or a powered medical device should be on it.
Also the Warm Home Discount, Cold Weather Payments, and the Winter Fuel Payment if you are over State Pension age. Citizens Advice will run through all of it free of charge.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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