Presentation by Mike Larking, Prevention Policy Manager, Cheshire Fire and Rescue: Innovative partnerships at The future of innovation in AF and stroke prevention in the NWC, 27 June 2018, Haydock Park Racecourse

1. Cheshire Fire and Rescue Service
Safe and Well Visits
Atrial Fibrillation

2. Fire prevention in the home – a policy
success story
• Steady downward trend in fire deaths and injuries in England
since early 2000s
Home Office Fire Statistics (1st April 2016 to 31st March 2017)
showed:
• 69% of all fire fatalities were in accidental dwelling fires – 183
in 2016-2017 which is 8 fewer (4%) than previous year and
18% lower than ten years ago.
• 3,125 non-fatal fire hospital casualties. This was 5% and 51%
lower than one year and ten years earlier respectively.
• 90% of households in England had at least one working smoke
alarm – up from 89% in 2015-16 and 84% in 2008-09
(source – ‘English Housing Survey 2016-17 Headline Report’).

3. Health and fire – a natural partner
“The NHS has a golden opportunity to
piggyback off the fire service’s vital
670,000 home-safety visits, to help
prevent falls, broken hips and hospital
admissions. This is precisely the kind of
joint working between local public
services that makes sense for patients
and saves money for taxpayers.”
Simon Stephens Chief Executive NHS

4. Safe and Well Visits – Cheshire and
Merseyside Health and Fire Summit – 15 July
2015
• National, regional and local discussions with partners in the National Health
Service highlighted the potential for the Service to expand scope of Home
Safety Assessments.
• National Consensus statement agreed between NHS England, Public Health
England, and Chief Fire Officers Association – Fire to be a natural partner of
health.
• Cheshire and Merseyside fire and rescue services’ keen to support national
programme of work to assist health agenda.
• Chaired jointly by Clare Duggan (NHS England, Director of Commissioning
Operations, Cheshire and Merseyside), and Paul Hancock (CFO Cheshire FRS).
• Attendees: PHE and Commissioners of health care services; Chairs and
Accountable Officers of CCGs; SRG Chairs, and Provider Operations Directors.
• Discussed and agreed the type of interventions both Services can deliver to
support the health and winter mortality agendas as part of Safe and Well visits
for people over 65 years.

5. Cheshire and Merseyside – supporting health
agenda through ‘Safe and Well’ visits
The Health and Fire Summit identified the following issues to be
considered and worked up:
• Slips, trips and falls
• Supporting hospital discharge for over 65s admitted to ward
for a fall
• Supporting bowel cancer screening
• Supporting smoking cessation and alcohol reduction

6. Cheshire and Merseyside – supporting health
agenda through ‘Safe and Well’ visits
• Following the Summit, the CHAMPS (Directors of Public
Health) network asked that hypertension and blood pressure
also be added to the initiative.
• Agreed to also work with Halton CCG area to support work to
identify people at risk from Atrial Fibrillation.
Designed to deliver a consistent and impactful intervention and
support to NHS across the whole of Cheshire and Merseyside.

7. Implementing Safe and Well
• Using Exeter Health data, the Service continues to focus on
those most at risk from fire but we now work with health
partners to identify those households which also face
additional health risks.
• The Service increased the previous level of 25,000 home visits
a year to around 40,000 from 2016/17.

8. Implementing Safe and Well
• Worked through not insignificant information governance
issues with NHS colleagues – outcome: referral with
householders consent.
• Identified training for Cheshire FRS staff as key to
implementation. All operational and advocates staff received
appropriate training in some elements of Safe and Well during
May through to late July 2016 – developing an e-learning
module for on-going training needs.
• Phased introduction for Safe and Well. Phase 1 commenced
on 1 February 2017, and comprise: slips, trips and falls; bowel
cancer screening; smoking cessation, alcohol reduction, and
atrial fibrillation (Halton only).

9. Implementing Safe and Well (cont)
• Legal Agreement – signed by NHS England, Chair of CFRS FRA,
and Directors of Public Health on 16 December 2016.
• Communications strategy.
• Evaluation.

10. Cheshire Fire and Rescue Service and Halton
CCG – Screening for Atrial Fibrillation
•Halton has a population of approximately 20,500 people over
65 years. Around 500 people in Halton have undiagnosed AF.
•Halton CCG considered Cheshire FRS Safe and Well visits as an
opportunity to identify people with undiagnosed AF.
•Halton CCG received funding from the Innovation Agency –
Academic Health Science Network for the North West Coast to
purchase supplies of the MyDiagnostick, a Mobile ECG screening
tool.
•Halton CCG trained CFRS staff including information on the
causes of AF and the use of the mobile ECG device. CFRS
conduct a simple ECG test to assess whether the householder
has an irregular heartbeat.

11. Cheshire Fire and Rescue Service and Halton
CCG – Screening for Atrial Fibrillation
• For those who test positive on the ECG device, the householder is given a
leaflet to explain they have been screened for AF by a trained firefighter,
provides basic information on AF, and advises them to make an urgent GP
appointment.
Outcomes
• CFRS has conducted 1356 AF screenings, resulting in 34 persons
signposted to make a GP appointment (February 1st 2017- 26 January
2018. Halton CCG has confirmed these people are now presenting to
primary care and are now receiving treatment to reduce the risk of a
future medical episode. On average, CFRS conduct around 85 Safe and
Well visits per week, delivered by operational firefighters.
• This model is replicable: from 15 January 2018, rolled out initiative across
West Cheshire CCG, South Cheshire CCG and Vale Royal CCG areas. EMIS
code being deployed to track people presenting to primary care.

13. Safe and Well – Phase 2
• Atrial Fibrillation – West Cheshire CCG, South
Cheshire CCG and Vale Royal CCG areas
• Affordable Warmth Screening (helping to address
Excess Winter Deaths) – pan Cheshire
Phase 2 went live on 15 January 2018
Phase 3 – Hypertension and Blood Pressure.
Currently piloting BP checks in Chester and
Macclesfield.

14. Safe and Well – Impact so far

15. Safe and Well – Impact so far

16. Safe and Well
Impact so Far
Since 1 April 2018 to 17th June 2018, conducted 8,564 Safe and Well visits resulting in:
• 557 referrals to the NHS Hub at Rugby for Bowel Cancer Screening Kits;
• 162 referrals to LA falls teams
• 6 referrals to LA smoking cessation teams
• 1 referral to alcohol reduction teams
• 898 Atrial Fibrillation screenings (Halton, W.Cheshire, S.Cheshire, Vale Royal only),
resulting in 54 persons being signposted to make a GP appointment.
• 90 Affordable Warmth referrals (count of 1 per household)
• 38 Blood Pressure tests taken (pilot in Macclesfield & Chester only) – as yet 0
Signposted
Since the 1st April 2018, 10.2% of Safe and Well visits have resulted in a referral to
health agencies

17. Thank you