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Community Support Manager Steve Trevethick reports on the partnership between Hampshire Fire and Rescue Service and the county’s Primary Care Trust, and on how the two agencies are striving to reduce community fire death
Report Context
Identifying the need to establish partnerships between Health Care and the Fire and Rescue Service for the provision of Home Fire Safety Visits. Improving the health and well-being of the community, interpretation of national and local policy and guidance relating to fire injury and death. Looking at the local partnership formed between Hampshire Fire and Rescue Service and Hampshire Primary Care Trust.
Introduction
This article explains how the shared goals of reducing accidental injury and death caused by fire within the local community were identified by the Fire Service, and how a partnership was formed between Hampshire Fire and Rescue Service and Hampshire Primary Care Trust. This document establishes the background information that promoted this partnership, its formation and its function to date.
It also explains how joint protocols established at a strategic level resulted in front line staff of both services collaborating efficiently and effectively. The partnership enables at-risk individuals to be effectively identified, and referrals generated by the primary care trust. These referrals could then be passed to local fire stations which provide home fire safety visits to improve the health and well-being of these groups.
In 2001 a multi-agency task force was established by the government to investigate the amount of deaths and injuries from accidents. It commissioned a paper by Dr Elizabeth Towner (Towner, 2002), focusing on preventable injuries in children. The results were incorporated into a Department of Health document (DH, 2002) that recognised the importance of collaboration between agencies to reduce the incidence of death or injury caused by fire. Improving the health of the population of Hampshire is the responsibility of a wide range of statutory and voluntary agencies, and the Fire and Rescue Service is one body with a key role in preventing injury and early death.
Working Together
The campaign to reduce the incidence of dwelling fires, with its popular slogan ‘Fire does not discriminate, check your smoke alarm’ promoted the use and maintenance of domestic smoke detectors for many years. Today, however, we know that fire can discriminate.
A Health Development Agency document published in 2003 (HDA, 2002) identified that in 1997 and 1998, 71 per cent of all child fatalities were less than five years old and children from the most disadvantaged sectors, social class V, are 15 times more likely to die in a house fire than children in social class I. Fire services have limited resources, so to be effective this knowledge must be used to target activities.
In 2004 the Fire Service National Framework document (ODPM, 2004) issued by the Office of the Deputy Prime Minister (ODPM) was published. One of the targets included in this document was: ‘The reduction by 2010 of the number of accidental firerelated deaths in the home by 20 per cent’.
Together these three documents were the cornerstone of preventative interventions aimed at those most likely to make the greatest health gains. It was identified that joint working between Hampshire Fire and Rescue Service and the Hampshire Primary Care Trust (PCT) was likely to have a significant preventative impact upon the local population. This view is supported by the Fire Service National Framework document. It argues that: ‘Authorities should actively seek to work jointly with local partners in health, social services, housing and education etc to reduce risk to the vulnerable groups in the community’ (ODPM, 2004).
Home Fire Safety Visits
In 2001 Hampshire Fire Service was one of the first in the country to introduce free, domestic, home fire safety visits. This activity has now been directed nationally by Fire Service Circular No 46 Home Fire Risk Checks issued by the then ODPM (ODPM, 2004, b).
For the next five years it is the Service’s ambition to provide 20,000 – increasing to 25,000 – free Home Fire Safety Visits in domestic dwellings per year by:
• Identifying target populations/groups
• Establishing an appointment with householders
• Providing a home visit
• Carrying out a risk assessment of the home with the occupier
• Fitting ten year smoke detection as required
• Identifying risk reduction strategies
• Encouraging the formation of a home escape plan.
Although Hampshire Fire and Rescue Service strives to be integrated within the community it serves, it was recognised that there were significant barriers in accessing those most at need.
A combined Hampshire Fire and Rescue Service and Public Health report by Trevethick, Brown and Doherty (2005) recognised that in order to maximise the effectiveness of this work, the support and collaboration of other agencies was necessary.
Initial Contact
The Community Support Manager from Hampshire Fire and Rescue Service Steve Trevethick, and the Consultant Nurse for Older People from Hampshire Primary Care Trust, Jaki Metcalfe, formed the initial contact to examine a way forward. Presentations were given to key staff groups within the PCT, covering the statistical analysis of the human cost of fire both at a national and local level and the intervention activities of a Home Fire Safety Visit (HFSV). This identified common goals shared between services of increasing the well-being of the local community and motivated a drive for joint working. A multi agency referral form was developed for use by health care practitioners. This was based on objective criteria to notify Hampshire Fire and Rescue Service that a HFSV was required. It was identified that to be successful the form should include information required by the Fire Service but, be designed by health care professionals. The form identifies to the practitioners who the vulnerable people are, and has instruction on the administration process to follow. It is essential that informed consent for the Home Fire Safety Visit is obtained from the patient or their family, who sign the referral form.
The referral form separates in to three leaves. One leaf contains contact numbers for the Fire and Rescue Service should the patient or their family have further questions following the referral. The second is retained on the patient’s notes and the third is sent to the Fire and Rescue Service. This third leaf contains the individuals’ contact details and information that assists the Fire Service to prepare for the visit. Referral codes can be added so the PCT can be informed of activity initiated by them. Once the referral request is received on-station, it is given a high priority rating.Referral for a Home Fire Safety Visit on a multi agency form will ensure that the property is professionally assessed, advice given and that smoke detectors can be fitted as soon as possible. Good relationships between health care locality managers and Fire Service managers were essential at a local level to aid understanding and drive this initiative forward. Remarks on the referral form can indicate that contact is required between agencies prior to the HFSV, so the best interest of the patient can be accommodated or a joint visit arranged.
The Way Forward
The partnership agreement was formally signed between the then North Hampshire Primary Care Trust and Hampshire Fire and Rescue Service in May 2006. It was identified that the initial partnership would be focused between selected health teams and Basingstoke Fire Station. This allowed the process to be tested and quickly modified from lessons learnt. The Rapid Response Team and the district nurses provided the initial referrals, thereby exploiting their expertise and providing immediate access to individuals who might be at risk from fire.
The aim now is to develop close working between local fire service and health teams, to ensure a long-term partnership. The project was extended to community hospitals in the locality and is now feeding referrals in to Retained Duty fire stations which are proactive in community safety activities. Health colleagues in the acute sector are also ideally placed to make referrals.
Occupational therapists often undertake a home visit with a patient prior to discharge from hospital and this is an ideal time to make a referral if necessary. The long-term plan is to involve the Ambulance Service in the near future and replicate this partnership across the county. It is hoped that up to 50 per cent of the HFSV referrals may eventually be generated by this process. The early success of this partnership has led to smaller trials starting in Portsmouth and Winchester, initiated by word of mouth within the health community.
Conclusion
It is identified by an evidence briefing document for the Health Development Agency (Millward et al, 2003) that there is good evidence that smoke detector programmes and behavioural change are successful interventions to reduce burn injuries in younger people. The report established that there is strong evidence to reduce burn injuries in older people when smoke detection is hard-wired or has a ten year life battery. It does however recognise that little research has been undertaken in this area.
Smoke detection ownership has increased from eight per cent in 1988 to 80 per cent in 2004/05, while accidental fire fatality rates in dwellings have gradually fallen from 731 in 1988 to 375 in 2004 (ODPM 2006). These figures, although not objectively attributed to the increase in home smoke detection, could be rationale to credit some of the fatality reduction with the increase in domestic smoke detection ownership.
The patients who are referred through the service’s new PCT partnership process are those identified in the normal course of primary health care work activity. The referral process is very quick and simple so there is only a small time cost to the Health Service. All other activity and physical resources are funded by Hampshire Fire and Rescue Service. Enthusiasm and good communication at a local level is essential to establish a partnership of this nature. This example of partnership working demonstrates that the long-term potential benefits can far outweigh the necessary contributions by partners.
As identified previously there is very little cost to the Health Service, who in turn will benefit by the reduction of fire injury admissions. Likewise the committed fiscal and physical resources that are allocated by the Fire and Rescue Service can be directed and efficiently used where most needed. By identifying common goals and working together, both services can support each other to achieve their own aims, with the benefit felt by the most vulnerable members of our community. It is hoped this will be the first step in creating a health alliance that will continue to protect the population of Hampshire.
References:
Milward ML., Morgan A. & Kelly MP 2003. Prevention and reduction of accidental injury in children and older people. Evidence briefing. Health Development Agency.
ODPM. 2006. Fire Statistics, United Kingdom, 2004. Office of the Deputy Prime Minister – now DCLG Department of Communities and Local Government. DH. 2002. Preventing accidental injurypriorities for action: Report to the chief medical officer from the Accidental injury task force. Department of Health. HDA. 2002. Prevention and reduction of accidental injury in children and older people: evidence briefing, first edition. June. Health Development Agency.
ODPM. 2004. The Fire and Rescue Services National Framework Document. 2004/05. Office of the Deputy Prime Minister ODPM. 2004. b. Fire Service Circular No. 46 Home Fire Risk Checks. Office of the Deputy Prime Minister. Towner, E. 2002. The prevention of childhood injury: Background paper for the Accidental injury task force. September. University of Newcastle Trevethick, S. Brown, D. & Doherty, L. 2005. Home Fire Safety Checks. Making Hampshire safer in a partnership approach. Hampshire Fire and Rescue Service. Unpublished |
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