Healthy Homes ProgrammeUtilising non-traditional Public Health workers
Ian Watson, Programme Co-ordinator
“Reducing health inequalities caused by poor quality housing conditions, and improving access to health related services in Liverpool”
Population: 436,000
Liverpool has among highest mortality rates and lowest levels of life expectancy. (SMR 30% higher than England & Wales)
Index of Health Deprivation 2007
- Over a quarter of Liverpool’s SOAs fall within the most deprived 1% in England and over a half are within the most deprived 5%.
Large health inequalities. - 10 years difference in life expectancy
Overall Context
Health inequalities
Health inequality - JSNA
Healthy Eating (obesity and ill-health);
Smoking (prevalence 29% vs 24%
nationally); Regular physical activity
(reduces obesity, improves
mental health and well-
being);
Quality of housing;
Low incomes; and
Limited access to health
services. http://www.lho.org.uk
Infant mortality - interventions
Targeting vulnerable groups
Engaging residents with Children’s Centres and
clinicians
Reducing child poverty
Reducing obesity
Reducing smoking
Improving housing and reducing
overcrowding
Reducing sudden unexpected
deaths in infancy
Factors that contribute to the gap between North West and England
Health Poverty Index
The indicator Home environments (labelled 'Ind.' on the bar chart below) is made up from 4 sub-indicators : 1. Living alone 2. Social support scale* 3. Polluted local environment 4. Poor quality housing
http://www.hpi.org.uk/
Health and housing (BRE)
Overall Context - Housing
Poor housing conditions cause up to 500 deaths and around 5,000 illnesses requiring medical attention each year in Liverpool. (BRE estimates)
5,500 rented properties contain in the region of 7,500 category 1 hazards. (2006 stock condition survey)
Liverpool has the worst overall rate of fuel poverty in the country at 7.5% - some wards approach 50%. (CSE 2003)
Rate of excess winter deaths - 242 per year (2009 NHS profile)
For each winter death, there are 8 emergency admissions (DoH)
27% of households in Liverpool lack central heating
Accidents
1 Death
63Hospital Admissions
1043A&E attendances
3456Of population
Accident pyramid shows ratio between different types of accidental injuries in Liverpool according to outcome/severity
6th highest cause of death (154 in 2008)
4th highest accident related mortality in the country - higher than in Merseyside and in the North West.
2nd highest accident related hospital admissions in country (8033 in 07/08)
50% of accident mortality caused by falls in 2008
Accidents in the home cause 58 deaths per year in Liverpool (2005 PCT).
Accidents - falls
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2.00
4.00
6.00
8.00
10.00
12.00
14.00
93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006 2007 2008
DS
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er 1
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00 Liverpool
Knowsley
Wirral
England
Falls mortality for Liverpool
Hospital admissions for falls higher in most deprived areas.
90% falls mortality - people of over 65 yrs of age (522 hip fractures in older people in 2007)
Health inequalities – upstream / downstream
Reducing inequalities in health may depend on reducing inequalities in life chances and life circumstances
Programme objectives
Identify 15,000+ properties targeting need (Property condition and occupier vulnerability). Focus on private rented sector.
Assess the health needs of each occupant, and prioritise 2,750+ for HHSRS inspection.
Referrals to health and well-being related services.
Home Safety promotion (particularly under 11s and over 65s).
Through the removal of hazard exposure, the programme is designed to reduce premature deaths by up to 100 when fully implemented and reduce GP consultations and hospital admissions by over 1000 cases.
Prioritising areas for intervention
Engaging communities
Programme overview
Advocates knocking on doors
Single Assessment Process
Partner referrals to improve lifestyle and well-being
Case Support allocated to most in need Making homes healthier and safer
Health awareness and promotion campaigns
HHP Index
IMD (4 of 7 domains)
Distribution of PRS & RSL
Rates of years of potential life lost
Emergency hospital admissions
Residence for hospital admissions for falls
Residential burglary
Housing Benefit Rate
Fuel Poverty Indicator
Programme of intervention
Identify areas to be surveyed
Contact Neighbourhood Managers
from LCC & PCT
Contactcommunity leaders, Cllrs &
local resident groups to identify the needs of the area
Identify barriers andpotential problems/
Issues
Publicity, promotion and events
Vulnerable and hard to reach residents
- language issues- health & safety issues
Poster and leaflet campaigns
Community Engagement
Advocates / Case Support
Tackling health inequalities
Financialdeprivation
Benefit Maximisation team
CAB
Age concern
Next Step
Pension Service
Active City
Clinicians
Liverpool Addiction Services
PCT Health Trainers
Morbidity
Smoking Fag Ends
Oral health Patient Advisory Liaison Service
Infant mortality Children’s Centres
Clinicians
Alcohol and drug dependency Liverpool Addiction Services
Mental healthClinicians
Healthy eating& obesity
Taste4Life
PCT Health Trainers
City Safe
Referrals to Partner Agencies
CarelineSocial Care
CarelineSocial Care
LCCEnergy
Efficiency
LCCEnergy
Efficiency
City SafeCity Safe
English Churches Housing
English Churches Housing
Next Step
Next Step
CAB Fuel Poverty
CAB Fuel Poverty
Fire Service
Fire Service
PCTHealth Trainer
PCTHealth Trainer
AddictionServices
AddictionServices
Active City
Active City
Taste 4 Health
Taste 4 Health
Sure StartSure Start
PensionService
PensionService
Age Concern
Age Concern
Roy CastleFag Ends
Roy CastleFag Ends
Healthy Homes
Healthy Homes
Patient advice and Liaison
Service
Patient advice and Liaison
Service
Benefit max
Benefit max
Progress - April 09 to August 10
10,582 properties visited
8,045 surveys completed
10,924 referrals to partners
1,844 HHSRS inspections carried out
£2.06M Private sector leverage
51 Health promotion eventsEmployment - 41 direct staff working on programme
- estimated 30 construction jobs in private sector
The Programme has engaged with 18,508 occupiers including:
Age
1480 under 5 years of age
1689 5 to14 years of age
1993 60 years of age and over
Disabled
1616 persons with a disability
Ethnicity
Customer Monitoring
19.6% of service users are not white British compared with 8.1% of population from BME communities
Ethnicity
Referral Partners Total Referral Partners
Total
EHO 1,795 Smoking 460
Dentist 1,635 Doctor 207
Food & Nutrition 1,333 Mental Well-being 718
Fuel Poverty 424 Benefit Maximisation
365
Fire Service 1,208 Age Concern 290
Education, Employment, and Training
630 Sure Start 220
Lifestyle Advisor 726 Alcohol & Drugs 76
Energy efficiency 837 Total referrals 10,924
Referrals to partners
Housing inspections
Time / Exposure
Fire (301) -inhalation of smoke/fumes (mild to fatal), burns (mild to fatal)
Falls (224) -physical injury (cuts, swellings, fractures, death), deterioration in general health for elderly
Electric (38)- shock mild to fatal
Collision&entrapment(21)-physical injury (cuts, piercing, trapping, crushing)
Falling elements (20)- Minor bruising to death
CO (5) -headaches to death, damage to nervous system
Overcrowding (17)psychological distress, poor hygiene, increased risk of accidents, spread of contagious disease
Entry by intruders (29) – emotional stress, injuries from aggravated burglary
Acute Chronic Generational
Hot surfaces (17) - burns and scalds, psychological distress
Excess cold (373) - cardiovascular conditions, respiratory diseases, rheumatoid arthritis, hypothermia
Damp and Mould (169) - respiratory disease, allergic symptoms, infections, depression and anxiety
Hygiene (74) - gastro-intestinal disease, asthma and allergic rhinitis, emotional distress, depression and anxiety
Disadvantaged groups
19.6% of service users are not white British vs 8.1% of population from BME communities
Prioritised accommodation occupied by asylum seekers, supporting people, & HMOs
Inbound referrals
Community engagement
37% of service users receiving benefits
Partner working
Developments:
£80K for HHP energy efficiency measures
Inbound referrals set up with 4 health centres.
Looking to use GP patient records systems to refer into programme.
Children Centres & RoSPA teaming up to deliver home safety scheme
Winter Survival programme – 100,000+ leaflets sent out with flu vaccination letters
Inbound Referrals
Police
Sure Start
Shelter
Benefit max
Health Centres
Community Mental Health Teams
Asylum Link
RSLs
Social Services
Fire Service
GP
Healthy HomesProgramme
Also member of:
Mental health and housing development group
Accident prevention strategy group
Climate Change resilience task group
Seasonal excess death working group
PCT Neighbourhood Model
Social Marketing
Deliver CO awareness programme
Run Winter Survival road shows
Run number of Healthy Homes road shows (working with CHATS)
Working with schools to deliver accident prevention programme
Support child accident prevention week
Produced tenant information pack
• HHSRS improvements• Warm Front• Efficiency measures• Promotion / campaigns• RSL HHSRS training
• Winter Fuel Payments• HHSRS – ensuring
affordable systems• Home Heat Helpline• CAB Fuel Poverty
• Benefit entitlement checks• Next Step job and career opps• HHSRS – healthier home,
healthier workforce?
Fuel costHousehold income
Energy efficiency
Fuel Poverty
Targeted approach by focusing on deprived areas, and inbound referrals
Tackling Fuel Poverty
Tackling health inequalities
Population health
Personal health
Community health
Leadership • Innovative • Stakeholder days• Central hub
Partnership• >16 partners• Customer Focus
Vision • Tackle health inequalities• 100 premature deaths prevented
Systematic• Working in priority SOAs• Street by street interventions• Addressing inequalities gap• Referral pathways• Reviewed and quality check
Industrial scale• 15,000 visits & 2750 HHSRS• 3 Community engagement • 18 Advocates• 2 Case Support• 10 Env Health
Community engagement• Protocol developed• identifies vulnerable & maximises effectiveness
Engagement with community• Personal interventions from Advocates• Diverse staff• Relationship with partners e.g. CHATs, NMS
Target support• Outreach into community• Inbound referrals• Health centre surgeries• Vulnerable groups e.g. Asylum seekers, BME• Respond e.g. Bilingual Officers
Impact at population level
Sustainability Embed programme into mainstream services:
- Single Assessment Process
- RSL Charter
Comprehensive – tackling many determinants of health
Increased awareness of services
Neighbourhood based – aligns with future delivery pathways
Partnership working and inbound referrals – flexible and
adaptable
Using GP patient records systems to refer
Cost benefit analysis – operational and investment efficiencies
Recognition
Used as case studies for local good
practice by:
- Audit Commission;
- LACORS;
- CIH; and
- Marmot Review.
Finalists in MJ Award for Tackling Health
Inequalities & Public Protection
Achievement, NBA Regional and
National for Customer Focus, and Chief
Medical Officer’s Public Health Award.
Contact details:
Phil Hatcher Programme Manager [email protected]
Ian Watson Programme Co-ordinator [email protected]
www.liverpool.gov.uk/healthyhomes
Liverpool City Council