Transcript Document

CLAHRC
For South Yorkshire
Measurably reducing excess winter
deaths, illness and fuel poverty in
populations
Unique selling point (USP)
Strong multi-disciplinary team, combining scientific and economic
expertise with experience working on the front line and strategically
for the NHS, Department of Health, local government and the World
Health Organization.
Abacus team.
Prof. Chris Bentley • Prof. Geoff Green • Jan Gilbertson • Catherine Homer
• Dr. Paul Redgrave • Dr. Bernard Stafford • Prof. Angela Tod
In winter2010/11 there were around 23,700
‘excess winter deaths’, or 1,300 more people
dying per week in the winter than the rest
of the year
Average of 144 Excess Winter Deaths per year
1990-2010 in Rotherham, for example
The Threat of Winter
DEAT
H
DEPRESSION
Results
Social Cost of Cold Homes e.g. in Sheffield 2011/12
£Million
Premature
Death
Cardio
Vascular
Illness
Respiratory
Illness
Falls at
Home
Common
Mental
Disorders
Total Cost
£1.856
£1.894
£1.083
£0.845
£9.638
£15.316
NHS Primary
Secondary and
Tertiary Cost plus
Social Care Cost
-
£0.462
£0.497
£0.250
£2.112
£3.321
GDP Loss
-
-
-
-
£0.934
£0.934
Number of Cases
58
148
114
88
1 369
-
Total Social Cost per
Case
£0.0320
£0.0159
£0.0139
£0.0124
£0.0093
-
Total Social Cost
£1.856
£2.356
£1.580
£1.095
£12.684
£19.571
Loss of Well-Being
HWB
Producing Percentage
Change
at Population
Level Level
Producing
Percentage
Change at Population
C.C.
Bentley
Bentley
2007
2007
Intervention Through
Services
An Abacus proposal for an integrated
programme of local action to pro-actively and
systematically protect identifiable vulnerable
people from avoidable illness and premature
death
Abacus excess winter deaths and illness: capability and resilience
model
The Challenge:
To bring access to all the key 9 evidencebased interventions to as many vulnerable
people as possible, in a systematic, rather
than patchy process.
a) Coronary Heart Disease (Harison et al. 2006)
b) Generic ‘Decay’ model (not to scale)
Have the
problem
Eligible for
intervention
Aware of
problem
A
B
C
Active use
of systems
Optimal
input
D
It is clear that, in trying to address the ‘decay’ in
a population’s appropriate access to, and use of
services, the role of individual services (such as
medical GPs or Energy Sector companies) is
essential, but not sufficient.
The service will have a responsibility to decide
which people identified as being at risk can
benefit from which intervention, and then make
that intervention available.
They also contribute to drawing people at risk
into their services, and helping them to use the
interventions properly when they have access.
Benefit from evidence based interventions across populations
(not to scale)
Have the
problem
Eligible for
intervention
Aware of
problem
A
B
Active use
of systems
Optimal
intervention
C
D
Chris Bentley 2012
However, in order to address the whole ‘decay’
pathway, it will be necessary to recruit other
partners.
This might include community based
organisations, and other parts of the Third
Sector as well as other public sector
organisations with frontline staff in
communities.
Benefit from evidence based interventions across populations
(not to scale)
Have the
problem
Eligible for
intervention
Aware of
problem
A
B
Active use
of systems
Optimal
intervention
C
D
Chris Bentley 2012
A. Defining and reaching out to the vulnerable
creating a ‘list-of-lists’ virtual register of most at risk
List-of lists
• In order to systematise access to the 9 key
interventions, a register of the identified most vulnerable
people will be needed
• This can be a ‘virtual’ register, whereby:
– frontline staff identify the most vulnerable on their
own caseloads, and establish their own list
– A (Cold Weather Plan) co-ordinator compiles a
register of staff across the agencies keeping such a
list (but doesn’t need the patient/client names)
– This ‘list-of-lists’ constitutes the virtual register
Constructing the ‘List-of-lists’
B. Screening for risk and the ability to benefit
systematic checklist of uptake on the 9 key interventions
Vulnerable Resident
Stroke Association
Snow Angels
Age UK
Fire and Rescue
Benefits Agency
Housing
Social Care
Community Care
Primary Care
Commissioning Organisations
However, the potential is for …….
• The HWB could establish a coordinating sub-group, or assign
responsibility for this programme to an existing sub-group. In some
areas this has been an expanded Affordable Warmth sub-group, in
others the Seasonal Excess Deaths or Cold Weather Planning Group.
In the latter cases, there have been strong links to the Local
Resilience Forum
• In order to drive strong integrated actions, the sub-group might
assign or appoint a dedicated programme coordinator
• Under the auspices of the HWB structure commissioning
agreements to be reached whereby each vulnerable older person
has a named key worker, out of those already involved
• This could be, for example:
– a district nurse
– a home care worker from social care or
– a voluntary sector advocate
Health and
Wellbeing Board
EWD
Task Group
Key Worker
Vulnerable Resident
And, once established …….
• Each key worker would be empowered, supported and
have the necessary arrangements to:
– Carry out a simple screening assessment of uptake on
the 9 key interventions
– Where appropriate, be able to make a straightforward
referral for more detailed assessment and delivery of
any missing interventions
– Keep a simple record of progress against each of the
9 for his/her ‘list’
– Make a regular return to the co-ordinator/keeper of
the list-of-lists
Assessment of vulnerable elderly against 9 interventions
Thermal
efficiency
Household
income
Falls
assessment
Vaccinations
Medication
review
Nutrition
hydration
Assistive
technology
Patient
A
GP
------------
Patient
B
GP
------------
Contingency
plan
Patient
C
GP
Patient
D
GP
Patient
E
GP
Assessed/No problem
Referred/In process
At risk
Personal
resilience
C. Quality service inputs
what good looks like for 8 of the interventions
Co-ordinating delivery
• Responsibility for delivery of each of the 9 key interventions
would largely continue through specialty agencies as now
• Focus would need to be on the connectivity (‘wiring diagram’)
amongst agencies
• Arrangements would need to be simple and efficient; e.g.
single point to receive referral; minimalist referral mechanism;
feedback updates to referrer at agreed points
• Referrals to other agencies requires patient agreement /
consent
• Commissioners would need to agree target response times, as
part of their quality specification
• Key workers could support communication with their
vulnerable patient/client where necessary
D. Supporting good self management
the 9th intervention – maximising personal assets
Factors influencing older people in keeping warm and well at home
Situation or contextual

factors
Money

Age

Social connections

Housing type and
tenure

Health
Attitudinal factors



−
−
−


Making ends meet
- Thrift
- Competing priorities
- Pride
- Struggling
I can manage
- Thrift
- Hardiness
- Stoicism
It's my business
Mistrust
Pride
Privacy
I'm frightened
- Privacy
- Personal safety/
vulnerability
I'll stay as I am
- Struggle with change
- Like routine
- Fear
- Trust
Barriers




Awareness
- Knowledge
- Information
- Experience
Technology
- Heating
- Information
- Banking
Disjointed systems
- Fragmentation or services
- Local differences
- Lack of referral systems
Visibility
- Fuel
- Money
- Information
- Older people
KWILLT
Intermediate Outcomes
Summary
• A strong case can and should be made to commissioners
that deaths, illness and misery of severe winters are largely
preventable.
• There is a substantial financial case to also take into
account, and this emphasises the key impact of mental ill
health.
• It is proposed that a virtual register of the most vulnerable in
an area be established, possibly as a ‘list-of-lists’
• A checklist of evidence-based key interventions should be
established, and co-ordinated mechanisms set up to ensure
those on the lists are systematically assessed for all
• ‘Organised efforts of society’ working together will be
necessary to reduce ‘decay’ in access to and use of services
by the most vulnerable. This will be necessary to achieve
improvements in population level outcomes