Igniting change

As primary care works with fire services, a more health and social-care foused approach has had a greater reach to the people of Hull

As the national spotlight turns on Hull as the UK’s next City of Culture in 2017, nine public organisations led by NHS Hull Clinical Commissioning Group (CCG) are working together on a programme called Hull 2020 to tackle the issues that inform the city’s wider determinants of health – poverty, housing, educational attainment, employment and social isolation.

As primary care works with fire services, a more health and social-care foused approach has had a greater reach to the people of Hull

An 18-month old partnership between NHS Hull CCG and Humberside Fire and Rescue (HFRS) continues to thrive and transform public services for people living in a city that is the tenth most deprived area in the country.

The relationship between HFRS and NHS Hull CCG has attracted its share of media and public interest. Initially people have been curious as to how HFRS would be able to strike the right balance between the operational needs of the service – responding to fires and emergencies – with a more health and social care focused role.

In fact, we have found that HFRS is able to offer a major contribution to improving the health and wellbeing of people in Hull. With a track record of fire prevention that has seen the number of primary fires reduce by 56% during the past 10 years, HFRS’ focus has diversified. The service is active in community safety, particularly in relation to vulnerable older people; and provides structured programmes for children and young people, engaging with local communities in innovative ways.

The CCG is committed to place-based commissioning. Hull 2020 centres on whether we can achieve better outcomes for local people by utilising the public resource we have in Hull in the best possible way and getting the best from the ‘Hull pound’.

We don’t want to focus simply on medical need, but on how we can develop a response that targets some of the wider social issues. We want to ‘make every contact count’; empowering public service workers to provide help directly, rather than having to refer the person on to someone else, or ask them to fill in forms.

Identifying synergies, working together
My initial contact with HFRS was with a local manager, as part of the public sector leadership forum in Hull. This has led to regular strategic meetings with the chief fire officer, and deputy chief fire officer.

We found a number of synergies in our discussions – both the NHS and the fire and rescue service are trusted brands, both are undergoing transformational change, and both work within the public sector to help communities. We identified a range of opportunities to work together strategically to improve health and wellbeing outcomes. Wellbeing support was already taking place, in an informal way, where fire crews undertaking home fire safety checks were already noticing other potential risks and notifying the relevant agencies.

To formalise this arrangement, and enable us to measure its impact, the CCG has commissioned a number of initiatives from HFRS, and its officers chair two Hull 2020 work streams. To support closer working, an HFRS manager has been seconded into the CCG to help the integration of fire with health. Also, to help better understand the day-to-day operations of the service I was privileged to spend a 15-hour night shift in east Hull as part of Green Watch – riding one of HFRS’ busiest fire engines. I had a chance to discuss some of the things we are planning to do in health with the firefighters and asked their views on how they thought we could work better together.

HFRS is leading on the frailty and isolation work stream of Hull 2020. Key elements include fitting, monitoring, and responding to cold alarms; preventative work providing independent living assistive technology; and integrating some of the telecare health services into the HFRS control room.

One of the most exciting developments is the new HFRS-led pilot response service to falls. Last year there were 1,016 people (aged 65 and over) admitted to hospital in Hull with injuries due to falls. Through preventing and responding to falls we can reduce admissions to hospital, or the length of patients’ stay, reducing the cost to the NHS. This additional HFRS response could allow the ambulance service to be protected to prioritise red one calls (the most serious emergency calls – a cardiac arrest or someone who has stopped breathing or is having severe respiratory problems), making sure we have the right resource in the right place to meet peoples’ needs.

HFRS is also looking to relocate a small fire station within the CCG’s proposal for an integrated care centre in east Hull, working together with social care and health, and potentially offering rehabilitation sessions for post-operative patients. Other CCG-commissioned health providers are also working in partnership with the fire service, City Health Care Partnership community interest company, is using HFRS premises for health care delivery and joint development of health intervention programmes.

Supporting the Life Choices work stream of Hull 2020, HFRS is delivering Firefit sessions free to disadvantaged young people, using their qualified fitness instructors in station gyms. Not only does this help to overcome the ‘cost’ barrier that prevents some families in Hull taking exercise, it also means that children can work with mentors on their fitness plans. These mentors act as positive and aspirational role models, providing a supportive and listening ear. Firefighters are trained to signpost and support children needing additional help into some of the other services we commission.

On a broader note, the service is actively supporting health awareness, including the launch of a branded blue fire engine to promote national prostate cancer campaign Men United. On average 40 men die of prostate cancer every year in Hull. The striking blue vehicle visits sports grounds on match days to promote the signs and symptoms among men over 50 – a traditionally hard-to-reach group – where it is hoped the campaign might help prevent unnecessary deaths.

Long-term goals
Feedback in relation to the CCG and HFRS working together has been extremely positive. We are looking beyond one-off projects and see them as a long-term strategic partner and service provider. HFRS provides a unique offering to our traditional partners, but one that fits neatly with the health outcomes that we want to achieve.
Working with Humberside Fire and Rescue has given us an opportunity to see and do things differently with the resources we have. It has been an incredibly rewarding experience to work with them as a health and wellbeing partner in Hull.

Emma Latimer, chief officer, NHS Hull Clinical Commissioning Group.