Measurably reducing excess winter deaths, illness and fuel poverty in populations

1. CLAHRC For South Yorkshire Measurably reducing excess winter deaths, illness and fuel poverty in populations

2. 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

3. 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

4. The Threat of Winter DEATH Disability Hypothermia Accidents Illness Loneliness Misery Anxiety DEPRESSION

5. ResultsSocial Cost of Cold Homes e.g. in Sheffield 2011/12 £Million

6. HWB Producing Percentage Change at Population Level C. Bentley 2007 Producing Percentage Change at Population Level C. Bentley 2007

7. 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

8. Abacus excess winter deaths and illness: capability and resilience model

9. The Challenge: To bring access to all the key 9 evidence-based interventions to as many vulnerable people as possible, in a systematic, rather than patchy process.

10. a) Coronary Heart Disease (Harison et al. 2006) b) Generic ‘Decay’ model (not to scale) Eligible for intervention Active use of systems Have the problem Aware of problem Optimal input A B C D

11. 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.

12. Benefit from evidence based interventions across populations (not to scale) Active use of systems Have the problem Eligible for intervention Optimal intervention Aware of problem A B C D Chris Bentley 2012

13. 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.

14. Benefit from evidence based interventions across populations (not to scale) Active use of systems Have the problem Eligible for intervention Optimal intervention Aware of problem A B C D Chris Bentley 2012

15. Defining and reaching out to the vulnerable • creating a ‘list-of-lists’ virtual register of most at risk

17. 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

18. Constructing the ‘List-of-lists’

19. Screening for risk and the ability to benefit systematic checklist of uptake on the 9 key interventions

20. Commissioning Organisations Age UK Housing Snow Angels Fire and Rescue Social Care Community Care Stroke Association Primary Care Benefits Agency Vulnerable Resident

21. 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

22. Health and Wellbeing Board EWD Task Group Key Worker Vulnerable Resident

23. 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

24. Assessment of vulnerable elderly against 9 interventions Assessed/No problemReferred/In processAt risk

25. Quality service inputs • what good looks like for 8 of the interventions

26. 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

27. Supporting good self management the 9th intervention – maximising personal assets

28. Factors influencing older people in keeping warm and well at home KWILLT

29. Intermediate Outcomes

30. 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