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

0.00

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

R p

er 1

00,0

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 Phil.Hatcher@Liverpool.gov.uk

Ian Watson Programme Co-ordinator Ian.Watson@Liverpool.gov.uk

www.liverpool.gov.uk/healthyhomes

Liverpool City Council