Winter Resilience Programme – support for vulnerable people living in cold homes
Winter Resilience Project
The Winter Resilience project was set up by Citizens Advice in response to guidance from the National Institute for Health and Care Excellence (NICE) on tackling winter mortality and ill health due to cold homes. This recommends that local Health and Wellbeing Boards commission ‘single point of contact’ housing and health referral services. We think local Citizens Advice are well placed to deliver these referral services and over the last couple of months 8 local Citizens Advice have taken part in an innovation programme to design and test services tailored for their local areas. Pilots have just gone live and Kate Ashman from Citizens Advice Manchester talks about their experience so far:
Why Winter Resilience?
Here at Citizens Advice Manchester we have a history of working in partnership with a range of NHS organisations. Being involved in the Winter Resilience pilot has given us a unique opportunity to design a new service to deliver both energy and holistic advice to vulnerable groups as detailed in the NICE guideline . Our key group for the pilot is people with respiratory illnesses, specifically COPD (Chronic Obstructive Pulmonary Disease) since this condition is very common in our locality.
Initial Design Stage
The aim of the project is to reduce the impact of living in a cold home for people with COPD. Through our experience of working with the other pilot LCA’s and the Design Team we quickly understood the importance of user centred research and, rather than relying on our past service delivery, we focused on our users and their wants and needs:
People with COPD: We asked people what they needed to improve their situation and how our intervention could help them. This gave us in depth understanding of the issues people with the condition face.
Specialist Respiratory Health Teams: We met the Lead Respiratory Specialist from our local hospital trust to discuss how living in a cold home people affects people with COPD and how our intervention could improve health outcomes for people with COPD. Rather than our innovative (we thought) digital referral options, we learnt that the easiest way for the NHS teams to refer is via Fax- yes Fax, they still exist! It goes to show that testing and refining service delivery models is vitally important.
The other key learning from our meetings was that the best and most effective method of delivery would be via home visits. The health professionals themselves have tried many variations on appointments and now deliver over 90% of appointments in people’s homes as this has reduced ‘do not attend’ (DNA) rates to 4%. Home visits would also enable us to give practical assistance to people immediately to make their living environment as comfortable as possible.
Service Safari: We contacted a range of agencies to understand the landscape of what support beyond health care was available for the people with COPD living in cold homes- the answer was – Not a lot!
Final preparations for Winter Resilience to go live!
To make sure everyone was clear on the process we went to an (early!) meeting with the nurses and physios who work with people with respiratory conditions, armed with a pile of referral forms and laminated copies of the referral process. We set up the lamented fax machine (the only way to communicate effectively with the NHS!) and were ready to go. We will keep working closely with the NHS teams to make sure things continue to run as smoothly as possible.
The pilot has now run for three weeks and so far we have arranged for pre-payment meters to be changed to credit meters thus preventing self-disconnection and reducing bills; applied for warm home discounts; requested meters are moved to more accessible locations; shown people how to use the timer, thermostat and TRVs on their heating system in a way that is as efficient as possible (but works for them); registered them on their fuel suppliers priority service register and made sure they are getting the best energy deal. We have advised on dealing with damp and condensation in the home and are applying for energy arrears dispensation and white goods from various trust funds. As well as energy advice, each person is given a benefit check and holistic advice on other issues identified during the visit.
We will be attending ‘Breathe Easy’ groups and pulmonary rehab sessions at the hospitals over the next two weeks to get the word out about the project directly to patients. They will then be able to ask their nurses/physios and consultants to refer them to us.
There are bound to be some hiccups and lots of learning to be gained throughout the course of the project but so far, so good. We believe that this pilot will go a long way to enable patients to live in a warmer, healthier more comfortable environment.
David Sloan, who co-chaired the NICE committee which produced the guidance, commented:
“A crucial aim of our guidance was to get people working together and to simplify the process for clients. Citizens Advice Manchester are doing just that through their work with specialist respiratory nurses. When visiting referred clients they can make a big difference, sometimes in very simple ways like helping people get the most out of their heating system, and often saving them substantial amounts of money”
Dr Tim Ballard, Sustainability Lead for the Royal College of GPs, commented:
“Patients with long term respiratory and cardiovascular health problems are particularly vulnerable to the cold. Having an effective hub resource for GPs and other primary care workers to easily refer these patients to in order to match them with available interventions is a point well made in the NICE guideline. Citizens Advice have undertaken a programme of work to see how effective they can be in fulfilling this role. I for one think that wherever there isn’t already a functioning service they are ideally placed to deliver this much needed service. I look forward with great anticipation to see the results of the pilots and wish Citizens Advice the very best in their endeavours.”
We hope that the evaluation will show the real impact of this type of partnership working in terms of reducing the health risks associated with cold homes and the benefit to the overall health and well-being of people helped.
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