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Healthy Homes Programme

The Healthy Homes Programme aims to reduce health inequalities caused by poor quality housing conditions and improve access to health-related services in Liverpool. Through interventions such as property assessments, referrals to health services, and home safety promotion, the programme aims to reduce premature deaths and hospital admissions.

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Healthy Homes Programme

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  1. Healthy Homes Programme Utilising non-traditional Public Health workers Ian Watson, Programme Co-ordinator

  2. “Reducing health inequalities caused by poor quality housing conditions, and improving access to health related services in Liverpool”

  3. Overall Context • 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

  4. Health inequalities

  5. 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

  6. Infant mortality - interventions • 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 • Targeting vulnerable groups • Engaging residents with Children’s Centres and clinicians

  7. 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/

  8. Health and housing (BRE)

  9. 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

  10. Accidents • 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). Accident pyramid shows ratio between different types of accidental injuries in Liverpool according to outcome/severity

  11. Accidents - falls • 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) Falls mortality for Liverpool

  12. Health inequalities – upstream / downstream Reducing inequalities in health may depend on reducing inequalities in life chances and life circumstances

  13. 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.

  14. Programme overview • Prioritising areas for intervention • Engaging communities • 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

  15. Programme of intervention 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

  16. Community Engagement

  17. Advocates / Case Support

  18. Tackling health inequalities Benefit Maximisation team CAB Financial deprivation Age concern Next Step Pension Service Smoking Fag Ends Active City Morbidity Clinicians Liverpool Addiction Services Alcohol and drug dependency PCT Health Trainers Liverpool Addiction Services Clinicians Infant mortality Children’s Centres Taste4Life Healthy eating & obesity PCT Health Trainers Clinicians Mental health City Safe Oral health Patient Advisory Liaison Service

  19. Referrals to Partner Agencies

  20. 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 events • Employment - 41 direct staff working on programme • - estimated 30 construction jobs in private sector

  21. Customer Monitoring 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 Ethnicity • 19.6% of service users are not white British compared with 8.1% of population from BME communities

  22. Referrals to partners

  23. Harm / prevalence Housing inspections • 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 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 Hot surfaces (17) - burns and scalds, psychological distress 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 Time / Exposure

  24. 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

  25. 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

  26. Inbound Referrals • 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

  27. 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

  28. Tackling Fuel Poverty Targeted approach by focusing on deprived areas, and inbound referrals

  29. Tackling health inequalities

  30. Impact at population level Population health • 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 • Leadership • Innovative • Stakeholder days • Central hub • Partnership • >16 partners • Customer Focus • Vision • Tackle health inequalities • 100 premature deaths prevented • Target support • Outreach into community • Inbound referrals • Health centre surgeries • Vulnerable groups e.g. • Asylum seekers, BME • Respond e.g. Bilingual • Officers Personal health Community health • Engagement with community • Personal interventions from Advocates • Diverse staff • Relationship with partners e.g. CHATs, NMS

  31. 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

  32. 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.

  33. "A healthy home is a right, not a privilege"

  34. Liverpool City Council 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

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