1. Liverpool Healthy Homes Programme Ian Watson & Neil Johnson

2. Liverpool overall context © Crown copyright and database rights 2012 Ordnance Survey 100018351 Fuel poverty rates across Liverpool  Population: 466,000  148,000 private sector properties: -19,400 present H&S risk (13%) (Excess Cold, Falls, Electrical Safety and Fire) -19,000 fail the energy efficiency requirements of the DHS (13%)  Private-rented sector accounts for highest rates of hazardous housing (18.7%) & highest concentration of poorest thermal efficiency  Among highest mortality rates and lowest levels of life expectancy  Large health inequalities

3. Liverpool Life Expectancy Central 78.6 Riverside 74.9 Kirkdale 73.8 Speke Garston 74.0 Childwall 82. 7 Mossley Hill 81. 4 Woolton 80.7 West Derby 79.6 Knotty Ash 78.4 County 76.6 Anfield 74. 7 Everton 75.0 St Michaels 76.9 Old Swan 75. 5 Croxteth 75.3 Kensington 75.2 Cressington 79.0 Church 82. 6 Tuebrook 77. 3 Fazakerley 77.7 Belle Vale 77.2 Picton 72.9 Northern Line City Line Bus Route 12

4. Overall Context - 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/

5. Distribution of rented housing & health deprivation

6. Housing & Health Health  Rate of excess winter deaths – 280 per year (NHS health profile 2013)  For each winter death, there are 8 emergency admissions  Accidents in the home cause an estimated 70 deaths and 4,000 hospital admissions per year in Liverpool Poor housing conditions are implicated in 500 deaths and around 5,000 illnesses requiring medical attention each year in Liverpool (from national BRE estimates) Commissioning Drivers  Tackling health inequalities  JSNA  Housing, Health and Safety Rating System

7. Making the case Healthy Homes activities Public Health OutcomesLocal Priorities Improving the wider determinants of health Health Improvement Health Protec tion Healthcare, Public Health and preventing premature mortality Mayoral Priorities JSNA Children in poverty Pupil absence 16-18 year olds NEET Sickness absence rate % population affected by noise Fuel poverty Social connectedness Smoking * Infancy** Weight*** Alcohol related admissions Cancer diagnosed at stage 1&2 Self reported wellbeing Falls and injuries in over 65’s Air pollution Population vaccination coverage Infant mortality Tooth decay in children under 5 Mort. from preventable causes Mortality from all CVD Mort. from respiratory disease Emergency readmissions Hip fractures in over 65’s Excess winter deaths Making Liverpool a greener, cleaner and healthier city Create 20,000 New jobs Attract Investment Child Poverty Mental Health Cancer Alcohol Referrals to partners 6 12 6, 9, 11 10 123 4, 5 8 13 8 6, 11 63 4, 5 Campaigns Falls and Accident prevention Child home safety Winter Survival Dental Sign Up Carbon Monoxide Awareness Housing Housing Improvements Reducing Overcrowding Enforcement Fuel Poverty Fuel debt advice Improving energy efficiency Environment Improvements Reducing blight Clean ups Returning vacant properties to use Other CLASS Accreditation Emergency support Workplace Wellbeing Charter *includes indicators; smoking status at time of delivery; smoking prevalence – 15 year olds; smoking prevalence – adult over 18 ** includes indicators; low birth weight of term babies; breastfeeding; smoking status at time of delivery *** includes indicators; excess weight in 4-5 and 10-11 year olds; excess weight in adults 1.FagEnds4. PSST7. Expert patients10. Age Concern 2.SureStart5. Addaction8. Fire Service11. LCC Energy Efficiency. 3.Health trainers6. Benefits Max9. Pension service12. National Careers Service

8. Healthy Homes activities Liverpool Clinical Commissioning Outcome Indicators Preventing People from Dying Prematurely Enhancing Quality of Life for People with Long Term Conditions Helping People to Recover from Episodes of Ill Health or Following Injury Ensuring that People have a Positive Experience of Care Treating and Caring for People in a Safe Environment and Protecting them from Harm Reducing Premature Mortality from Major Causes and reducing deaths in people with SMI, babies and young children Improved Cancer Survival Rates Enhancing quality of life for people with mental illness and dementia Supporting People to Manage their Condition and Enhancing Functional ability in People with Long Term Conditions Reducing Time Spent in Hospital by People with Long Term Conditions Reduction in emergency admissions for acute conditions and children with lower respiratory tract infections Reduction in Emergency Readmissions Improving Outcomes from Planned Treatments Improving Recovery from Stroke Improved Patient Experience of Primary Care, Hospitals and Mental Health Services Delivery of access targets Reduction in the incidence of Avoidable Harm in Hospitals Reducing Health Inequalities and Unnecessary Variation Referrals to partners 1, 3, 4, 53, 73,6, 7, 8, 123, 5, 73, 4, 5, 71, 3 3, 4, 5, 7 1, 3, 4, 5, 7 3, 103, 73 All Campaigns Falls and Accident prevention Child home safety Winter Survival Dental Sign Up Carbon Monoxide Awareness Housing Housing Improvements Reducing Overcrowding Enforcement Fuel Poverty Fuel debt advice Improving energy efficiency Environment Improvements Reducing blight Clean ups Returning vacant properties to use Other CLASS Accreditation Emergency support Workplace Wellbeing Charter 1.FagEnds4. PSST7. Expert patients10. Age Concern 2.SureStart5. Addaction8. Fire Service11. LCC Energy Efficiency. 3.Health trainers6. Benefits Max9. Pension service12. National Careers Service

9. Healthy Homes Programme - objectives Phase 1  At scale to make a real population difference  Identify 25,000 properties in priority neighbourhoods  Assess the health and housing needs of each occupant  Engage residents into health and well-being related services  Carry out full health and safety inspection in worst 4,400 properties and secure necessary improvements  Home Safety promotion (particularly under 11’s and over 65’s) 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

10.  40,384 initial assessments  20,934 surveys completed  28,689 referrals to partners Progress - April 2009 to January 2015

11. Referrals to Partner agencies Doctors Mental Wellbeing Pension Service Energy Efficiency/ Fuel poverty Housing condition Career Advice Sure Start Lifestyle Advisor Alcohol and drugs Fire Service Smoking Case Support Food and Nutrition Dentists Healthy Homes 2,317 1,487 2,869 1,131 897 3,579 116 1,411 533 1,188 5,297 1533 1,259 1,900 148 1,134 407 1,571 Total: 28,689 >2001 1000- 2000 500- 999 <499 Fuel Debt Benefit Max Careline Age Concern

12. Progress – Housing conditions  5,736 Health & Safety inspections carried out  4,166 serious housing hazards identified  £5.2M Private sector investment  30 construction jobs supported (estimate)  1,846 referrals to social housing providers for repair issues

13. Common home hazards to February 2015

14. Health Promotion Working with landlords  Provide information about key contacts  Ensure annual checks of gas appliances carried out. Assisting landlords gain access using enforcement powers  Healthy Homes Property Standard  Contribute to ‘rogue landlords hit squad’ Housing and health campaigns  CO Awareness  Child Accident Safety  Falls prevention  Winter Survival

15. Reaching Out Healthy Homes on Prescription  55 practices taken up GP clinical system to identify ‘vulnerable’ patients  GP ‘alerted’ and prompted to ask vulnerable patient about housing conditions during consultation  Simple referral made from clinical system to Healthy Homes  Healthy Homes visit and provide feedback Health Centres Regularly visit 32 centres to provide Healthy Homes surgeries

16. Emergency accommodation pilot  To reduce hospital admissions and delayed discharges associated with sub standard housing £1750 per week £192 per week Partnership with Dying to Keep Warm charity to  Provide emergency heating for vulnerable residents  Install gas isolation valves  Provide microwaves where dangerous cooking appliances  Provide and fit CO detectors through Handy Person Scheme

17. Value for Money? BRE evaluation of first year’s operation shows:  861 HHSRS inspections removing 725 Cat1 hazards  Total project cost £1.07M (Inspection cost £300K)  On-going annual NHS savings £440K (£4.4M over 10 years)  Excess cold hazard alone £341,000 (£3.41M over 10 years)  Wider Society annual savings £1.1M (£11M over 10 years)  Excess cold hazard alone £852,000 (£8.52M over 10 years) Total anticipated savings by HHP: £55 Million (£42M from excess cold) (Building Research Establishment Jan 2011)

18. Evaluation ( Ongoing, but..)  Reduction in health deprivation since 2007  47% reduction in excess winter deaths (36% North West)  Dental rates increased ‘…the highest NHS dental access rate Liverpool PCT has had for over two years…. innovative ways of improving dentistry access through the ‘Healthy Homes Dental Scheme ’ NHS Operational Plan 2011/12 YearExcess WD 11/12170 10/11220 09/10300 08/09320

19. Evaluation  EQ5D – measuring health outcome  Tagging referrals to partner organisations  28 day call back  Customer Satisfaction (10% of all surveys)  RadioCity – “most successful online microsite in the history of the station ”

20. Remember, it costs to do nothing! Thank you for listening watsoni@bre.co.uk Neil.Johnson@liverpool.gov.uk