NICOLA ROGERS

1
NICOLA ROGERS

• Environmental Health Development Manager
• Rochdale MBC
• 10 April 2006

2
Action Against Asthma2000 to date

• To improve the quality of life of children with
  asthma and to leave behind a sustainable system
  of effective asthma management.

3
Founding Fathers

• Health Promotion
• Unit
• 
  Environmental
• 
  Health.

4
Features of the project

• Focus on asthma in children and young people 0-16
  years
• Focus on promoting effective SELF-CARE
• Focus on small geographical area of highest need
• Depends on effective partnership working to
  address multiple factors affecting asthma which
  includes environmental allergens

5
Why Wardleworth and Hamer?

• Highest rates of asthma admissions
• Anecdotal evidence for higher rates of attendance
  at outpatients and A and E
• High levels of material deprivation and housing
  conditions which may exacerbate asthma
• High levels of ethnic minorities with anecdotal
  evidence to suggest problems around use of
  medication

6
Housing Characteristics

• Project Centred Around Wardleworth Hamer
  Renewal Area Declared Nov. 1999
• NRA declared following 18 month information
  gathering and consultation
• Rochdales 4th Renewal Area

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Housing Characteristics

• 75 pre 1919 terraced housing
• 63 owner occupied
• Overcrowding 4.5 per household 2.3 Borough
  average
• Socially obsolete
• Lack of maintenance
• Intensity of use
• 75 had grants previously

8
Housing Characteristics

• 10m Investment in Housing in next 7 years
• Clearance
• Block Repair
• Home Improvement Package

9
Housing Characteristics

• NRA showed housing was just one of a number of
  key issues impacting on quality of life in area
• Poverty average household income 5k
• Employment 13 employed
• Environment
• New Approach Needed

10
Pilot Project Utilised the existing.

• Children admitted to hospital
• Joint visit - Asthma Specialist
• - Environmental Health
• Specialist Advice - Treatment / Compliance
  - Environment
• Signposting and reporting to other agencies

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Specialist Advice H.V.

• Audit of prescription medication
• Advice to GP practices
• Changes to prescribed medication
• Advice on inhaler usage
• Advice on compliance with medication
• Advice on logging episodes in a symptom diary
• Advice to schools on inhaler availability

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Specialist Advice E.H.

• Methods to reduce condensation.
• General cleaning practices
• Dust reduction
• Best use of available space
• Gas appliances
• Paint types
• Tobacco Smoke

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Outcome of Pilot Project

• 9 Families / Properties visited
• Pilot concentrated on
• - advice to families
• - minor repairs to alleviate damp,
  cold and dusty environments
• Encountered overcrowding, over capacity of bed
  space and under utilisation of all bedrooms
• Major disrepair dealt with using traditional
  housing funding methods
• Reduction in re-admission of children in the
  pilot

14
Moving forward

• What could we do if we had money to invest in
  the project ?

15
H.A.Z. Innovations Funding

• 1 Specialist Paediatric Nurse employed
• 1 Asthma Specialist Health Visitor employed
• 0.5 fte Environmental Health Officer
• Housing repairs funded through SRB bid
• Referrals from
• Primary Care
• Secondary Care -hospital ward and A E
• Schools

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Aims of the innovations project

• Children / families ultimately able to manage own
  treatment and environment with minimum
  professional input.
• Public Health role of the Health Visitor in
  asthma defined and model of care developed.
• Identify housing and environmental lessons to
  pass onto health care staff and housing
  developers and owners.

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Aims of the innovations project 2

• Develop a group of children with asthma as peer
  educators to encourage and support self-care.
• All schools signed up to active asthma policy.
• Reduce admissions for asthma.
• Reduce days lost from school for asthma.

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The New Partnership

• Housing Health Promotion.
• Users
  Education
• Health
  Rochdale
• Authority
  PCT
• Environmental Building
  Secondary
• Health Trades
  Care
• Agency
  

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Features of the Project

• Close monitoring of effectiveness of treatment
• Close monitoring of compliance
• Prescribing audit and training of primary care
  staff
• Early correction of adverse environmental factors

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Features of the project 2

• Guidance for schools in conjunction with the
  Healthy Schools Initiative
• Assessment of knowledge levels and addressing the
  need for information
• Development of user group, to develop their own
  website and peer education materials
• Monitoring of quality of life of patients in the
  project area

21
Project Structure

• Primary Care Evaluation Schools
  
• Task Group Task Group Task Group
• Steering Group
• Secondary Care Environmental User
• Task Group Task Group Group

22
Some Challenges Encountered

• Working with a complex and diverse sector of the
  population
• Single handed GP practices with no access to
  practice nurses
• Prescribing high volumes of syrup
• Professional protectionism
• Managing contractors for housing repairs
• Evaluating quality of life

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Pleasant Surprises

• Overwhelming enthusiasm for the shared goals
• Willingness of the families to be involved
• Willingness of the children to develop the user
  group
• Willingness of the different professions to learn
  about each others work
• Willingness of Health Visitors to take on the
  assessment of home environments

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Project Extended in Heywood

• Project mirrored in another area of the Borough
• High asthma incidence
• Different demographic profile
• Funding for a Specialist Health Visitor through
  New Deal for Communities

25
External Evaluation of Project

• Undertaken by Salford University
• Carried out in May 2003 final year of funding
• Used both quantitative and qualitative data

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Evaluation Results

• Three factors for success
• Collaboration between Health Promotion and
  Environmental Health
• Role played by the Specialist Asthma Nurses
• Role of the Translators / Interpreters

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Project Mainstreamed within the PCT
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Contact Details

• Nicola Rogers
• Environmental Health Development Manager
• Rochdale MBC
• 01706 924124
• nicola.rogers_at_rochdale.gov.uk