A targeted approach to identifying and reviewing patients with respiratory conditions at risk of poor health outcomes due to fuel poverty across Cheshire & Merseyside (ID 478)
The Innovation Agency (Academic Health Science Network for the North West Coast)
Funding: This work was in part funded through the NHSE Accelerated Access Collaborative's Innovation for Health Inequalities Programme
Abstract
Introduction/objectives: Fuel poverty is causing, and exacerbating, physical and mental illness across the whole population and further straining already stretched health and care services. Collaborative partnerships with several health and social care providers across Cheshire & Merseyside resulted in individuals most at-risk from poor outcomes being proactively identified using the CIPHA fuel poverty dashboard. This brings together several data sets including GP data, Index Multiple Deprivation, John Hopkins risk of admission and fuel poverty data.The aim of the project is to have a positive impact on the wellbeing of those most at risk of poor health, resulting from fuel poverty. Outcomes evidenced by the following indicators:
• Reduction in hospital admissions
• Reduction in attendances (A&E, GP, other)
• Reduction in exacerbations
• Reduced anxiety related to fuel poverty
Method: Optum were commissioned to run workshops exploring these themes, resulting in detailed cohort definitions:
1. High risk COPD and are at high risk of exacerbation
2. Children with asthma
Multiple stakeholders collaborated at Place (formally CCG) level to review the dashboard and design pathways of holistic support, including medication reviews; referrals to weight-management, pulmonary-rehabilitation; smoking-cessation; housing support; financial support; social prescribing and other wellbeing support.
Work is currently being delivered on cohort 1 patients within 2 Places. Cohort 2 delivery is being planned to start in an additional 2 Places.
Results: The latest referral data from cohort 1 is displayed in figure 1. Figure 2 is a case study.
Conclusions: The project is still in delivery, but early results are encouraging.
A project toolkit is in development. It will be promoted widely across the ICB to encourage areas to adopt. The toolkit includes case-studies, process-maps and SOPs; information on accessing/ using the dashboard; an asset map of organisations, services and projects supporting the fuel poverty agenda and funding opportunities.
An abstract based on this work has been submitted to the BTS Winter Meeting
Conflicts of interest: None
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