Tim Anfilogoff, Herts Valleys Clinical Commissioning Group

1. Commissioning to Prevent Excess
Winter Deaths through Cold
Tim Anfilogoff
Programme Manager Older People

2. Herts Valleys CCG
The Strategic Context
• 600k population
• single CCG plan delivered through four distinct
localities
• strong joint working with LA
• £626m income - £22.5m QIPP challenge
• Ageing population
• Life expectancy difference of 8 years
• Largely good health outcomes but low patient
satisfaction, rising trend in admissions

3. Our Vision
• Commissioning health care for the people of
West Hertfordshire with:
– No inequality in service delivery
– No needless pain, disease or death
– No feelings of helplessness amongst users and
staff
– No unwanted delay or waste

4. Sequence of health effects
It can take over a month for death rates to return to normal after a cold spell

5. Health Costs of Cold Dwellings
• Estimate of dwellings associated with excess
cold in EoE = 68,000
• Cost to the NHS of NOT improving these
dwellings = £15m
• Discussing methodologies with District
Councils on demonstrating impact of Keep
Warm and other interventions in terms of cost
benefit

6. A Classic Whole System Issue
• Prevention (vulnerability to cold of older
people, stroke, cardiovascular, COPD)
• Issues around admission to hospital (and
readmission if discharged into cold homes)
• Fuel Poverty
• Cultural issues (healthy to have window open)
• Complex range of types of support without a
co-ordinating function
• Private home ownership
• New responsibilities for wellbeing

7. Health and Wellbeing Strategy

8. 2011-13
• Hertfordshire County
Council led partnership
which accessed warm
homes funding for the
last two winters
• Trying to build in some
sustainability while
system changes
• Winter comes every
year!

9. What happened last year in West
Hertfordshire…
• £400K from DH for the county
• More planning possible than
for winter 2011/12
• CABx in Hertfordshire gave
extra 9,249 clients energy
saving benefits and debt
advice and helped them
access about £233k extra
income in West Herts
KEEP
WARM STAY WELL

10. What happened last year in West
Hertfordshire (2)…
• Groundwork visits 462
homes for energy checks
(twice as many as whole
county in 11/12)
• 70 older people got £130
rebates energy providers
• Hertfordshire Community
Foundation made 186
emergency grants
• 2004 referrals to other
community and preventive
services

11. Helping those with Long Term
Conditions in 2012-13
District
Households with
longterm conditions
Dacorum 89
Hertsmere 69
St Albans 49
Three
Rivers 20
Watford 61
288
• Visits by
Groundworks in
W Herts = 462
• 288 were to
people with at
least one long
term condition or
disability
reside

12. Case study, Mr & Mrs Ryder
• Mr and Mrs Ryder, Stevenage
(real names and photo of couple,
happy to be identified)
• In their 70s and live in own home in
Stevenage. Mr Ryder has mobility
issues and registered disabled
• Mrs Ryder early stage dementia
• Home very draughty so referred for
free draught proofing which has
helped enormously
• Groundwork Hertfordshire explained
energy bills and tariffs and helped
them save money
• They also received a Warm Pack with
thermal mugs and hot water bottles
they now regularly use.

13. Our Target Groups
• Over 75
• Frail
• Young children
• Living in deprived circumstances
• Elderly people living on their own
• Homeless or people sleeping rough
• Pre-existing cardiovascular or respiratory illness
+ other chronic medical conditions
• Severe mental illness
• Dementia
• Learning difficulties
• Arthritis, limited mobility or otherwise at risk from falls
• Living in homes with mould
• Fuel poor (needing to spend 10% or more of household income
on heating their home)
• Carers
• The rurally isolated
• BME Groups

14. Simplifying the message
• Worked with Public Health at the
DH to simplify key message
• We recommend that all vulnerable
people
heat their living room to 21ºC
during the day and their bedroom
to 18ºC at night
• Promotion by thermometer cards
which
• Media focus on fuel price rises
doesn’t help
• Public perception that it is extreme
cold that kills
• Anyone that needs help or
assistance to heat their home is
advised to call HertsHelp.

15. Support includes…
• Extra working capacity amongst
all CABx in Herts
• Home energy visits from
Groundwork Hertfordshire
• Extended opening hours in
homeless shelters etc
• Small grant scheme via the
Community Foundation
• ‘Blue light’ response service –
heat for those without, draught-
proofing, warm packs, etc.
• Frontline staff awareness training
+ engagement of GPs and other
professionals over the impact of
cold and about this project

16. Home visits – what we do
• Checking residents heating systems
• Supplying emergency radiators
• Checking loft and cavity wall insulation
• Referring for draught proofing
• Referrals for boiler replacements
• Applying for grants

17. Home visits – what we do
• Explaining energy bills
• Applying for the Warm Home Rebate of £120
• Explaining how to use thermostats
• Advice on ideal temperatures
• Energy saving tips and advice
• Advice on avoiding condensation and mould

18. Referrals… referrals
• All referrals routed via
HertsHelp via a call or simple
tick-box card completed and
mailed Freepost for a call-back
• Web
www.hertsdirect.org/hertshelp
• Email info@hertshelp.net
• Telephone 0300 1234 044
• Minicom 0300 456 2364
• Via Skype Skype – HertsHelp
• Text 81025
• FREEPOST RSAK-JZGA-UJSJ,
Keep Warm, Stay Well,
HertsHelp, Hertlands House
Primett Road, Stevenage SG1
3EE

19. • Primary Care
awareness of
HertsHelp improving
• CCG focus on
prevention and self
care
• Signposting by busy
primary care to local
community groups
needs further
development

20. Next Steps
• Discussions between
Public Health, Social
Care and CCG to put
together funding
package
• One off basis this
year – more
sustainable
approach thereafter

21. tim.anfilogoff@hertsvalleysccg.nhs.uk
07900 161673