commissioning to prevent excess winter deaths through cold
DESCRIPTION
Tim Anfilogoff, Herts Valleys Clinical Commissioning GroupTRANSCRIPT
Commissioning to Prevent Excess Winter Deaths through Cold
Tim AnfilogoffProgramme Manager Older People
Herts Valleys CCG
The Strategic Context • 600k population• single CCG plan delivered through four distinct
localities• strong joint working with LA• £626m income - £22.5m QIPP challenge• Ageing population• Life expectancy difference of 8 years• Largely good health outcomes but low patient
satisfaction, rising trend in admissions
Our Vision
• Commissioning health care for the people of West Hertfordshire with: – No inequality in service delivery – No needless pain, disease or death – No feelings of helplessness amongst users and
staff – No unwanted delay or waste
Sequence of health effects
It can take over a month for death rates to return to normal after a cold spell
Health Costs of Cold Dwellings
• Estimate of dwellings associated with excess cold in EoE = 68,000
• Cost to the NHS of NOT improving these dwellings = £15m
• Discussing methodologies with District Councils on demonstrating impact of Keep Warm and other interventions in terms of cost benefit
A Classic Whole System Issue
• Prevention (vulnerability to cold of older people, stroke, cardiovascular, COPD)
• Issues around admission to hospital (and readmission if discharged into cold homes)
• Fuel Poverty• Cultural issues (healthy to have window open)• Complex range of types of support without a
co-ordinating function• Private home ownership• New responsibilities for wellbeing
Health and Wellbeing Strategy
2011-13
• Hertfordshire County Council led partnership which accessed warm homes funding for the last two winters
• Trying to build in some sustainability while system changes
• Winter comes every year!
What happened last year in West Hertfordshire…
• £400K from DH for the county
• More planning possible than
for winter 2011/12
• CABx in Hertfordshire gave
extra 9,249 clients energy
saving benefits and debt advice
and helped them access about
£233k extra income in West
Herts
KEEP WARM STAY WELL
What happened last year in West Hertfordshire (2)…
• Groundwork visits 462
homes for energy checks
(twice as many as whole
county in 11/12) • 70 older people got £130
rebates energy providers• Hertfordshire Community
Foundation made 186
emergency grants • 2004 referrals to other
community and preventive
services
Helping those with Long Term Conditions in 2012-13
DistrictHouseholds with longterm conditions
Dacorum 89
Hertsmere 69
St Albans 49Three Rivers 20
Watford 61
288
• Visits by Groundworks in
W Herts = 462• 288 were to
people with at least one long term condition or disability
reside
Case study, Mr & Mrs Ryder• Mr and Mrs Ryder, Stevenage
(real names and photo of couple, happy to be identified)
• In their 70s and live in own home in Stevenage. Mr Ryder has mobility issues and registered disabled
• Mrs Ryder early stage dementia• Home very draughty so referred for
free draught proofing which has helped enormously
• Groundwork Hertfordshire explained energy bills and tariffs and helped them save money
• They also received a Warm Pack with thermal mugs and hot water bottles they now regularly use.
Our Target Groups• Over 75 • Frail• Young children• Living in deprived circumstances• Elderly people living on their own• Homeless or people sleeping rough• Pre-existing cardiovascular or respiratory illness + other chronic medical conditions• Severe mental illness• Dementia• Learning difficulties• Arthritis, limited mobility or otherwise at risk from falls• Living in homes with mould• Fuel poor (needing to spend 10% or more of household income
on heating their home)• Carers• The rurally isolated• BME Groups
Simplifying the message• Worked with Public Health at the
DH to simplify key message• We recommend that all vulnerable
people heat their living room to 21ºC during the day and their bedroom to 18ºC at night
• Promotion by thermometer cards which
• Media focus on fuel price rises doesn’t help
• Public perception that it is extreme cold that kills
• Anyone that needs help or assistance to heat their home is advised to call HertsHelp.
Support includes…• Extra working capacity amongst
all CABx in Herts • Home energy visits from
Groundwork Hertfordshire• Extended opening hours in
homeless shelters etc• Small grant scheme via the
Community Foundation• ‘Blue light’ response service –
heat for those without, draught-proofing, warm packs, etc.
• Frontline staff awareness training + engagement of GPs and other professionals over the impact of cold and about this project
Home visits – what we do• Checking residents heating systems• Supplying emergency radiators• Checking loft and cavity wall insulation• Referring for draught proofing• Referrals for boiler replacements• Applying for grants
Home visits – what we do
• Explaining energy bills• Applying for the Warm Home Rebate of £120• Explaining how to use thermostats• Advice on ideal temperatures• Energy saving tips and advice• Advice on avoiding condensation and mould
Referrals… referrals• All referrals routed via
HertsHelp via a call or simple tick-box card completed and mailed Freepost for a call-back
• Web www.hertsdirect.org/hertshelp
• Email [email protected]• Telephone 0300 1234 044• Minicom 0300 456 2364 • Via Skype Skype – HertsHelp • Text 81025• FREEPOST RSAK-JZGA-UJSJ,
Keep Warm, Stay Well, HertsHelp, Hertlands House Primett Road, Stevenage SG1 3EE
• Primary Care awareness of HertsHelp improving
• CCG focus on prevention and self care
• Signposting by busy primary care to local community groups needs further development
Next Steps
• Discussions between Public Health, Social Care and CCG to put together funding package
• One off basis this year – more sustainable approach thereafter
