New Models of Care‘Community Risk Intervention Teams’

Geoff Harris

Assistant County Fire Officer

Greater Manchester Fire and Rescue Service

The Historical Drivers

• 1995 – ‘In The Line Of Fire’

• 1997 – ‘Safe as Houses’

• 1998 – ‘Out Of The Line Of Fire’

• 2002 – ‘IRFS, The Future of the Fire Service: reducing risk, saving lives’ (Bain Review)

• 2002/03 – ‘Industrial dispute’

• 2004 – ‘Fire and Rescue Services Act’

• Duty to promote Fire Safety

• 2013 – The Knight Review

• 2014 – Five Year Forward View (Simon Stevens, Chief Executive, NHS)?

Impact of Home Safety Checks

598

26,241

53,892

71,811

96,085

75,989

70,080 67,628

54,459

3,727

2,833

2,6642,461

2,429 2,3312,268

2,124 2,080

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

0

20,000

40,000

60,000

80,000

100,000

120,000

2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

AD

Fs

HSC

s

GMFRS Accidental Dwelling Fires & Completed HSCs(2005/06 - 2013/14)

HSCs Acc Dwelling Fires

Demand: Fire V Ambulance

43%

8%

16%

4%1%

9%

5%

14%

Accidental deaths in the home

Falls

Fire / Burns

Poisoning by drugs

Other poisoning

Natural factors

Drowning / Suffocation

Other accidents

Undetermined

ROSPA (England & Wales) 1999

Mental Health and the Police

• 75% of calls to Greater Manchester Police are not crime related

• % related to mental health

• % related to concern for welfare

Why the Fire and Rescue Service?

Contributory Factors 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/147 Year

Total

Alcohol 6 2 6 6 5 8 5 38

Recreational Drugs 0 0 2 0 0 3 1 6

Living Alone/Alone 4 4 7 6 8 11 5 45

Smoking Materials 10 4 4 4 3 7 5 37

Physical Disability 3 3 2 5 5 10 5 33

Social Service 4 1 6 3 5 6 6 31

Prescribed Medication 3 1 6 4 6 12 7 39

Mental Health 3 3 4 0 1 1 4 16

Accidental Fire Death Contributory Factors

Common Risk Factors

Age Range 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/147 Year

Total

0 - 10 3 1 0 0 0 0 0 4

11 - 20 0 0 0 0 0 0 0 0

21 - 30 1 0 1 1 0 2 0 5

31 - 40 1 0 1 1 0 1 0 4

41 - 50 1 1 2 1 3 2 1 11

51 - 60 3 0 1 1 2 2 2 11

61 - 70 3 2 2 1 2 1 0 11

71 - 80 2 2 2 2 2 2 2 14

81 - 90 3 4 2 3 0 4 4 20

91 - 100 0 1 0 0 1 2 0 4

100 + 1 0 0 0 0 0 0 1

Total 18 11 11 10 10 16 9 85

Accidental Fire Deaths by Age

Community Risk Intervention

Community Risk Intervention

• Multi-agency/Multi-disciplinary Prevention and Response Teams

• Targeted work based on agreed risk profiles

• Objectives set by GMFRS/NWAS/GMP/LAs

• Falls Prevention & Rescue, Cardiac Rescue, Crime Prevention, Fire & CO Prevention, Health & Well-being advice

• Mental Health First Aid trained and Dementia Friendly

Community Risk Intervention

• Vehicle design includes capacity for specialist equipment stowage e.g. lifting equipment for bariatric patients.

• Vehicles have facility to convey patients to GP Surgeries, Urgent Care, or other Facilities

• Vehicles available for community resilience e.g. Doctor or care worker conveyance in adverse weather

Community Risk Intervention

Community Risk Intervention Team Attendance Data

Borough

Response ActivityTotal

Response

Activity

Prevention Activity Total

Combined

ActivityNorth West Ambulance Service Greater Manchester Police

Home Safety

CheckCardiac ArrestsCommunity First

Responder/other * Falls Mental HealthWelfare

Concern

Bolton 7 12 22 0 3 44 6 50

Bury 3 18 9 0 4 34 2 36

Manchester 35 171 159 20 469 854 445 1299

Rochdale 0 3 5 0 1 9 1 10

Salford 38 267 79 8 249 641 108 749

Stockport 6 17 22 0 1 46 9 55

Tameside 2 4 11 0 0 17 7 24

Trafford 6 49 24 1 6 86 91 177

Wigan 49 135 100 11 434 729 216 945

Oldham 2 0 6 0 0 8 6 14

Total 148 676 437 40 1167 2468 891 3359

Fire as a Health Asset?

• Fire Brigades Union considering a future role in Public Health

• Firefighters and to crew some CRIT vehicles

• Firefighters and other FRS staff to complete Safe and Well Visits

• Safe and Well Training Incorporates Mental Health First Aid and Dementia Awareness

• 13 Fire Stations to respond to ‘Concern for Welfare’ and triaged ‘Mental Health’ calls on behalf of GMP

‘To protect, save and improve the quality of life of the people in Greater Manchester’

Safe and Well Principles

• FRS extending its approach to safety in the home

• The content of a ‘safe and well’ visit should be co-designed

• Shouldn’t be confined to merely signposting to other agencies

• Wherever possible the approach adopted should be:

• A light touch health check of all individuals in the home;

• Identification of risk factors while in the home;

• Provision of brief interventions and advice;

• Provision of appropriate risk reduction equipment e.g. smoke alarms, grab rail;

• Referral to specialist advice and support where appropriate. e.g. health, local authority or voluntary organisations.

Safe and Well Principles

• Referrals to specialist advice and support should be limited to those in need of such

support

• Health, local authority and third sector colleagues should support training

• Consistent referral pathways into specialist services should be developed across

each FRS area.

• The quality of each visit is key to ensuring that they improve quality of life outcomes

and lead to reduced demand for services.

• The number and scope of ‘safe and well’ visits completed will be determined by the

capacity within each organisation, which may differ significantly from area to area.

Safe and Well Visit

• Fire

• Cooking

• Candles

• Electrical Equipment

• Portable heaters and open fires

• Escape plans

• Health

• Winter Warmth

• Extreme weather events

• Weight

• Mobility

• Falls

• Frailty

• Provision of clinical and other equipment in the home that could increase fire risk

• Mental Health

• Memory

• Learning disability

• Sensory impairment

• Loneliness/Social Isolation

• Smoking

• E-Cigarettes

• Alcohol

• Drugs

• Prescription medicines

• Hoarding

• Safety of under 5s

• Employment

• Home security

• Consent to share information

Referral Pathways, Partnerships and Support

• Greater Manchester Mental Health Trusts• GMW• 5 Boroughs• MMH&SC• Pennine Care

• Self-Help Services

• Age UK

• Mental Health Advocate

• Health and Social Care Specialists

• Dementia Buddy Scheme