Evaluation of the impact of Fire and Rescue Service interventions to reduce the risk of harm to vulnerable groups of people from winter-related illnesses

September 2016

Prepare for Emergency Services Show 2016

Reuben BalfourConsultant, ICF

Introduction

ICF conducted an evaluation of the Winter Pressures pilot, which ran from 2 November 2015 to 31 March 2016

This presentation highlights key findings and analysis of the pilot process, based on: Interviews with operational leads and key delivery staff (22 interviews in total); Face-to-face interviews with frontline staff (22 in total); Telephone interviews with partner organisations (16 in total); Telephone interviews with beneficiaries (60 in total); Staff e-survey (based on 173 responses); and, Management Information (MI) supplied by the pilot areas and comparator areas.

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Introduction

The extent to which we were able to measure the pilot’s impacts was limited. This was due to: A lack of available data so we have not been able to fully measure:

Impact on healthcare services Risks associated with excess winter deaths Potential health and wellbeing outcomes experienced by beneficiaries Associated costs and benefits to organisations affected by the pilot

The pilot evaluation period took place soon after the pilot was completed: Some of the behavioural changes and impacts have not been realised during the evaluation period Some of the data needed is not yet available

As a consequence, this presentation does not cover the assessment of impact, including a ROI.

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The pilot

The pilot forms part of the Fire and Rescue Service’s new Safe and Well visit. It aimed to address the health risks of people vulnerable to falls, social isolation, cold

homes and flu. A partnership between a number of organisations formed the pilot’s Advisory Group.

This included the following: Public Health England Chief Fire Officers’ Association NHS England Local Government Association Age UK

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The pilot

The pilot consisted of four common elements: Training: a training pack was developed by the advisory group and delivered by the FRS to 1,239 staff,

including firefighters, community safety advocates and watch managers Targeting: the pilot targeted people aged 65 and over using NHS data, past experience of delivering

Home Safety Checks and knowledge of local partners to identify households Home visits: staff conducted home visits in which they assessed risks to falls, cold homes, flu and social

isolation and took appropriate action to mitigate risks (e.g. installation of hand rails, provision of thermometer).

Referrals: where appropriate, referrals were made to partner organisations (e.g. Age UK, Local Authority, NHS Falls teams) to provide further support to those in need.

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Preparatory activities

The pilots delivered training to 1,239 staff to build capacity to deliver home visits Face-to-face training was the most effective form of delivery, compared to webinar training which was

ineffective The pilots identified target households to approach for a home visit

Two pilot areas found analysing local data on at risk households a challenge (e.g. GMFRS found it a time intensive task, whilst GFRS did not use the data)

SFRS found the identification improved their targeting of households Personal approaches to at risk households were often needed to reach agreement to

have a home visit Beneficiaries’ trust in the FRS aided their participation in the pilot

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Delivery of pilot activities

The pilot delivered a total of 6,304 home visits SFRS overachieved their target (by 12%); GFRS

reached 68% of their target; and, GMFRS reached 45% of their target

Rates of home visits were lower in the early months of the pilot GMFRS diverted all resources in reaction to extreme

flooding in December 2015 SFRS increased the scale of delivery incrementally

throughout the early stages of the pilot GFRS experienced delays in establishing data systems

to monitor the pilot which had a knock-on effect on delivery of home visits

Source: Pilot MI data

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Delivery of pilot activities

Characteristics of households visited At least 78% of home visits were delivered to target households – defined as households aged 65 and

over The home visits and interventions

In total, 3,607 households (57%) were identified at risk of either a fall, social isolation or a cold home Winter pressures specific advice and/or home adaptation were provided to 5,166 households (82%) All home visits (100%) carried out under the pilot resulted in actions to improve the fire safety of the

home, including the provision of IAG on fire safety The referral pathways

The pilot led to 3,376 referrals to partner organisations (35% of home visit leading to at least one referral) The pilot also led to 1,526 referrals to FRS prevention teams for further support with fire safety (24% of home visits

leading to referral for further fire safety support)

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Outcomes and impact

Outcomes for beneficiaries The pilot led to improved awareness and support around risk of falls as well as cold homes and social

isolation Outcomes for staff

Around two-fifths improved their knowledge and skills to deliver home interventions addressing issues relating to falls prevention and cold homes

Little under a third improved their knowledge and skills to provide IAG to households regarding flu vaccinations.

Nearly half improved their knowledge and skills to assess the risk of households to social isolation Outcome for partners

Nearly all partners felt the pilot facilitated greater cooperation and collaboration between different services to better meet the demands of people who require support to live independently

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Lessons learned

Transferability: implementation is more effective on a smaller scale, across a single administrative area, compared to large scale implementation in a FRS area

The use of data on local populations to identify and target vulnerable households takes considerable time and resource to utilise efficiency

Existing experience and capacity to deliver home visits, combined with established referral pathways, enabled pilot areas to hit the ground running

Delivering face-to-face training is likely to be more effective to develop workforce skills and facilitate cultural change

Engaging with partners from the preparatory stage of the pilot is important in establishing successful referral pathways

The pilot worked better in areas which had established data systems to support the monitoring of the pilot and information shared with referral pathways prior to delivery

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Recommendations

Sufficient preparation time is required in the lead up to delivering the home visits before winter begins Established data sharing agreements between FRS and partners will support improved targeting of vulnerable

households and will also help the FRS to better assess its role and impact on health and wellbeing outcomes Standardised data collection and monitoring practices would improve data collection systems and ensure that the data

being collected is comparable to enable assessment of impacts Training should reflect the cultural and organisational changes being placed on staff with respect to the delivery of the

activities included in the Winter Pressures pilot, as well as the whole Safe and Well visit. Delivery: incremental roll out of interventions allows for any problems to be overcome and appropriate improvements

and alterations to be made to the approach without too much disruption to the service Engagement: a range of approaches to engaging households in a home visit is needed to achieve positive response

from households Governance: pilot areas should consider a multi-partner steering group to oversee the establishment of the Safe and

Well visit within local areas to build partner engagement Next steps: PHE and FRS should complete the estimation of the pilot’s ROI using data when it becomes available

during 2016/17

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Thank you for listening – any questions?Reuben Balfour – Consultant at ICF reuben.balfour@icf.com