Working together to improve public health and wellbeing

Development of consensus statements

NHS England has published consensus statements with fire and rescue services, policing and social care services, and the ambulance service.  These statements encourage local areas to develop joint strategies for opportunity and intelligence-led prevention and health improvement. Their intention is to ensure that people supported by our organisations get the personalised, integrated care and support they need to live full lives, sustain their independence for longer and in doing so we will improve the public’s health and reduce unnecessary demand on health and social care.

Working with policing and social care services

NHS England has supported the launch of a joint consensus statement between policing, health and social care organisations to improve people’s health and wellbeing, prevent crime and protect the most vulnerable people in England.  This has been agreed and developed by Association of Directors of Public Health, Association of Police and Crime Commissioners, Clinks, College of Policing, Faculty of Public Health, Local Government Association, Nacro, National Association for Voluntary and Community Action, National Police Chiefs’ Council, NHS England, Public Health England, and the Royal Society for Public Health.

The Policing Vision 2025, published at the end of 2016, recognised the growing diversity and complexity of the policing landscape requiring collaborative work across the system to prevent crime and protect vulnerable people in England. The factors which lead to poor health, such as adverse childhood experiences, poverty, social exclusion and addiction, are also factors which increase the likelihood of being involved in crime.  By working together and intervening early to address these common factors, we can improve public safety and reduce crime and help to improve outcomes for individuals and the wider community.

The consensus is supported by the Policing and health collaboration in England and Wales: landscape review, which provides a snapshot of collaborations between policing and health, and identifies the blockers and enablers for developing and strengthening joint working.  It is also supported by the practical guide, Putting information sharing at the heart of collaborative working: Information sharing between the police and health services for prevention, published by The Centre of Excellence for Information Sharing. This resource uses case studies to illustrate effective information sharing between police and health and how Caldicott information sharing principles are applied.

Further information on the joint consensus statement is available on the National Police Chiefs’ Council website.

Fire as a health asset programme

NHS England has launched a joint Consensus Statement with the Chief Fire Officers Association (CFOA), Public Health England (PHE), Local Government Association (LGA) and Age UK. The statement encourages local commissioners and Fire and Rescue to roll out ‘Safe and Well’ checks in people’s homes when they visit.

Working with commissioners, FRSs will aim to extend the 670,000 home safety checks already carried out each year into a ‘Safe and Well’ visit to help particularly the vulnerable and those with complex conditions. To help do this, we have also jointly published design principles for safe and well visits, which can be tailored to reflect local needs, and guidance on working together to help services develop these in their area.

There are common risk factors between health, fire and other services, which increase demand such as multi-morbidity, cognitive impairment, smoking, drugs, alcohol, physical inactivity, obesity, loneliness and cold homes. The risk for someone over the age of 65 of dying in a fire is more than twice as high as the average risk for all ages. As well as reducing the risks of a fire, they will aim to reduce health risks such as falls, loneliness and isolation which will also reduce unplanned admissions and help people to stay in their own homes safely and for longer.

A Safe and Well visit is a person-centered home visit carried out by fire and rescue services. The visit expands the scope of previous home checks by focusing 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 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 should not be limited to merely signposting to other agencies, but will also look to reduce risks during the initial visit where appropriate.

Resources to support the fire as a health asset programme:

Fire as a health asset case studies

The Chief Fire Officers Association website has an expanding collection of resources relating to Fire as a Health Asset work. These include a number of case studies showcasing individual fire and rescue service’s (FRS’s) work and a document produced by CFOA which describes the impact that Safe and Well visits have had on eight individuals and the outcomes of their assessment.

The Local Government Association’s ‘Beyond Fighting Fires 1’ contains eight case studies on the work of fire and rescue services (FRSs) and partner agencies with people with dementia and other vulnerable people to reduce not just fire risk but other risks in the home. FRS staff are also being trained in promoting healthy living in a variety of ways including advice on diet and exercise.

Beyond Fighting Fires 2’ looks at transformation in the FRS and describes collaborative projects with clinical commissioning groups, police and ambulance services and an increasingly wide variety of other partners.

Here are examples of what some of those case studies contain:

  • West Midlands FRS targets interventions at vulnerable people with issues around frailty, mental health and terminal illness to tackle health inequalities.
  • All Gloucestershire FRS are dementia-trained and dementia nurses can refer for home fire safety checks. The service provides fire risk training to mental health teams.
  • Dementia friendly Kent FRS work to reduce fire risk in the home for people with dementia and identify early signs of dementia.
  • Wigan firefighters act as ‘health champions’ in their local community, working with over 20 partner agencies which can also make referrals to the FRS.
  • Cheshire FRS are using data analysis to pinpoint residents most at risk of fire and falls and in need of intervention.
  • Dorset’s Safe and Independent Living (SAIL) programme ensures vulnerable people receive assistance from the right agencies while ‘Days of Warmth’ aims to tackle the problem of cold homes and winter deaths in vulnerable local people.
  • Humberside firefighters have partnered with their CCG and Yorkshire Ambulance Service to provide first response to reports of falls in the home.

Why work together?

There are common underlying risk factors which increase demands on all services such as the number of long-term conditions, mental health conditions, cognitive impairment, smoking, drugs or substance misuse, physical inactivity, poor diet, obesity, loneliness and/or social isolation, cold homes and frailty. By identifying people with these risk factors and taking a whole system approach to interventions which are centred on peoples’ needs, we can make every contact count, irrespective of which service it is from.

For example the risk for someone over the age of 65 of dying in a fire is more than twice as high as the average risk for all ages. Fire service teams not only reduce the risks of a fire, they aim to reduce health risks such as falls, loneliness and isolation which will also reduce unplanned admissions and help people to stay in their own homes safely and for longer.

With the shared underlying risk factors and our individual resources, collectively we can support people to live longer, healthier lives, through an integrated approach to enhanced public health and prevention through better co-ordination and early identification and intervention. We can do this through our commitment to Making Every Contact Count (MECC).

Working with the ambulance services

NHS England launched a joint consensus statement with the Association of Ambulance Chief Executives and other partners. This statement reflects the evolving role of the ambulance service as a mobile healthcare provider using the richness of expertise residing in its workforce to help keep people well.

Further information about the support for this is available from the Association of Ambulance Chief Executives website.

NHS England’s Medical Director, Professor Sir Bruce Keogh said: “The vision for the Ambulance Service: ‘2020 and beyond’ includes an increasing role in prevention and health promotion. This consensus statement reflects the evolving role of the Ambulance Service as a mobile healthcare provider using the richness of expertise residing in its workforce.

Providing a clear statement on the joint national approach, highlighting our shared purpose and commitment to Making Every Contact Count and setting out the scale of the opportunity available, will help both realise the ambulance vision ‘2020 and beyond’ and support the increased focus on integration and prevention as set out in the NHS Five Year Forward View. It will help ensure that outcomes for patients are improved and resources across the healthcare system are utilised more effectively. It also recognises the need to broaden and deepen the involvement of the voluntary sector in developing solutions.

We are delighted to be a part of this consensus statement translating plans Into reality”

“All of these organisations have come together”, says Dr Anthony Marsh, Chair of AACE, “in recognition of the responsibilities we jointly hold in respect of population health and the opportunities open to us to both promote good health and to prevent ill health. We are committed to contributing to these aims through proactive and pre-emptive means, as much as we are responsive to those needing urgent and emergency care and treatment. We look forward to working with our voluntary organisations in particular, to increase the impact we can have by engaging in new public health initiatives collaboratively”.

Professor Kevin Fenton, National Director, Health and Wellbeing at Public Health England added, “Ambulance staff come into contact with the public millions of times each year and could be playing an even bigger role in helping to provide health promotion advice, care and support. These everyday interactions represent opportunities to start important conversations with people struggling with substance misuse or mental illness or those at risk of cardiovascular disease, social isolation or falls. PHE is pleased to be working with ambulance services and the other partners signed up to this consensus statement to really make sure that every contact counts.”