In the latest of a series of blogs, NHS England’s Deputy Director for People with Long Term Conditions, gives an account of innovation in action – the fascinating partnership between the NHS and the Fire Service.
Six months ago we launched the joint Consensus Statement between NHS England, the Chief Fire Officers Association, Public Health England, Age UK and the Local Government Association.
The statement described our intent to work together to encourage local joint strategies for intelligence-led early intervention and prevention, and was launched on National Older People’s Day, 1st October.
Published alongside were the design principles that support the consensus statement and provide a framework to inform the design of locally agreed safe and well visits.
‘Safe and Well’ visits are catching on all round the country.
It is a person-centred home visit carried out by Fire and Rescue Services (FRS). The visit expands the scope of previous home checks by focussing on health, as well as fire. It involves the systematic identification of, and response to, health and well-being issues along with fire risk reduction.
An effective safe and well visit takes a holistic approach to reducing risk. This is achieved by considering the individual, their home environment and lifestyle. It places the wishes, behaviours, needs and abilities of the individual at the heart of the intervention.
Throughout a safe and well visit the aim is to empower and motivate people to make positive changes to their health, wellbeing and fire safety. By doing this the process is not limited to merely signposting to other agencies, but will also look to immediately reduce risks during the initial visit where appropriate.
I saw this in action myself while spending the day with Salford FRS, visiting some local people, including a very independent older couple with Tony, a FRS Community Advisor.
Tony talked to the couple about what could be done to help them manage their health and care better. This included practical health actions such as a referral for a home falls assessment and a medication review as the contents of the very full pill box was a bit of a mystery to them both.
Different areas of the country are at different stages of implementation of the safe and well visits. Some are just getting started through regional and sub regional joint discussions and planning, while others – such as Staffordshire – having already delivered more than 2,000 visits.
In some areas FRS are responding to Telecare alerts, making home modifications and delivering brief interventions.
The national guidance documents are being used in a number of ways, not only to inform safe and well visits, but as promotional tools and catalysts for supporting wider local discussions and action. For instance a number of FRS have recognised how they could use their resources to continue to respond to traditional fire and rescue incidents while also supporting ambulance trusts.
Co responding arrangements are beginning to emerge up and down the country. In September 2015, Greater Manchester FRS (GMFRS) became the first FRS in the UK to respond to cardiac arrests, using all of its front line fire engines, alongside North West Ambulance Service (NWAS) colleagues. To date they have attended over 1,200 cardiac arrests providing basic life support, to either support a casualty until NWAS arrive or to enable paramedics to focus on advanced life support.
This approach will hopefully lead to an improvement on the current cardiac arrest survival rate in Greater Manchester, which stands at 8%.
The benefits of “Fire as a health asset” are already being realised with more integrated approaches to targeting people needing support through better co-ordination, prevention and early intervention. This is demonstrating an increase in the reach and impact of all services.
So far the best established and most robustly evaluated work is the Greater Manchester FRS Community Risk Intervention Teams (CRIT) who carry out holistic home safety checks to identify and mitigate risks in the home; fitting a wide range of risk reduction equipment to improve quality of life and reduce demand for services. They have also begun to respond to cardiac arrests, other categories of life threatening calls and falls in the home on behalf of the ambulance service as well as concern for welfare calls on behalf of the police.
Evaluation so far has shown the NHS is likely to benefit fiscally from CRIT on an annualised basis by £635,320 comprised of:
- Benefits incurred as the result of fast response-times by CRIT which have either saved lives or prevented neurological damage; and
- Benefits incurred by prevention-type activity which have reduced the likelihood of falls which could incur A&E attendances, hospital admissions, and social care.
We have set the national direction and commitment and this is now being replicated through local events, meetings and presentations; encouraging local areas to use their collective capabilities and resources more effectively to enhance the lives of the people in their communities.
There is an e-learning package available for GPs developed with the RCGP, and implementation guidance in the Working Together document for the safe and well visit published today which utilises the learning so far with examples from across the country to support rollout.
This approach is not about replacing health resources or asking fire staff to become health professionals but making sure that public resources are used to maximum effect to deliver the best outcomes we can.
The time will probably never be better for public services to work better together to support individuals and communities to improve their quality of life in a collaborative and cost effective way.
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Jacquie White is NHS England’s Deputy Director for Long Term Conditions with responsibility for improving the quality of life for people with Long Term Conditions, Older people and those at End of Life.
Jacquie has over 15 years’ experience of working in and supporting health and social care teams to improve the quality of services for and with their local population.
Having started her career in fundholding in a small rural general practice, Jacquie has worked across the public sector at a local, regional and national level.
She has significant experience of both commissioning and provider development and of supporting teams to integrate care across organisational boundaries.
Jacquie has developed and led national transformation programmes. This includes the development of the National Long Term Conditions Year of Care Commissioning Programme as part of the Department of Health’s approach to QIPP working with teams across the country to test implementation of the model at a local level to deliver person centred co-ordinated care.