Abstract
There is a well-developed evidence base outlining the impact of living in cold and damp homes on EWDs (Marmot 2011). The 2017-18 EWDs’ statistics released by the Northern Ireland Statistics and Research Agency (NISRA) reported an increase of 220% since 2015-16 for Belfast Health and Social Care Trust (BHSCT) area, the largest recorded Excess Winter Deaths (EWD's) in this area for almost 30 years.
NICE (2015) has produced guidance on EWDs, and the health risks associated with cold homes (NG6), which identifies populations vulnerable to the negative impacts associated with living in a cold and damp home including; people living with specific health conditions (respiratory, circulatory, mental health) people with a disability, older people (65 & older) and young children (5 & younger).
The initiative engaged organisations and individuals following a community planning ethos. This included statutory, community and voluntary organisations delivering services at city and neighbourhood levels and the direct engagement of people with lived experience. The ‘why’ phase of development focused on building a shared understanding for the need of the initiative and was followed with a ‘what’ phase, allowing people with lived experience to shape and influence an agreed service intervention.
A risk stratification exercise was undertaken to identify geographical areas of Belfast at greater risk during winter. These included prevalence of circulatory and respiratory disease, housing condition, income and age. Ay targeted engagement exercise with organisations and individuals within areas of greater risk to enhance clarity of existing services and gaps in provision to which the initiative could ‘add value’.
A single point of coordination (SPOC) was commissioned as the ‘hub’ for the initiative with a four-step process established. Partners worked together to raise awareness of the initiative and identify individuals at greater risk; a referral pathway to the ‘hub’ was created, including an option for self-referral; a standardised assessment was undertaken on all referrals received and a bespoke service intervention delivered subject to assessment. The service intervention utilised a ‘menu’ of existing services supplemented by the SPOC.
Process evaluation confirmed the initiative delivered on the recommendations of; and supported the at-risk populations as identified in NG6. Geographical areas of greater risk received the highest proportion of referrals for support demonstrating the benefit of spatial analysis for targeting interventions to maximise the effectiveness of service delivery. Qualitative feedback from partners highlighted improvements in the coordination and access of local services.
Action to address health inequalities requires the mobilisation of all relevant assets across health, statutory, community and voluntary sectors. Utilising the strengthens of organisations and individuals as equal partners and harnessing the power of collaboration is critical when acting on ‘wicked’ societal issues which drive inequalities.
Focus continues to intensify on the use of data spatial analysis and identification of populations at greater risk during winter. Organisations are enhancing networking and shared governance to reshape joint working and improve coordination with funding and service implementation. A greater focus is being placed on contributable outcomes the initiative is providing to individuals within the associated at-risk populations.