What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

“Squalid housing is having a profoundly negative impact on the nation’s health and worsening the crisis in the NHS… 31,000 children are admitted per year with 80% developing acute bronchiolitis. Britain’s housing is now a critical issue for child health.” (RCPCH, The Guardian, November 2023).

Because we lack data on the scale of housing issues nationally, and tenants don’t speak up due to fear of eviction. Often the first-time inadequate housing is witnessed is when a child attends the Emergency Department for breathing problems. There are limits to what an NHS doctor can do beyond the hospital walls in addressing the wider determinants of health.

An integrated model of health, voluntary sector and housing is a solution to reduce, and prevent, worsening health for children. This project will work across system boundaries to boost capabilities and understanding of impact of housing and inequalities by embedding a housing working into ED.

What does your project aim to achieve?

Barnardo’s want to reduce the impact of poor housing on children’s health and limit the worsening NHS crisis. We see the daily impact on families.

The funding will enable us to embed a housing worker into ED to work directly with families presenting with children under 12 with respiratory illnesses. This role will bridge the gap between NHS and housing associations to reduce the health impacts of damp, black mould, and poor air quality in rented/social housing.

For families/children, the aim is improved health by delivering immediate interventions to address inequalities including, home assessments, behaviour change, asthma plans, advocacy.

For the NHS, the aim is to reduce demand on ED by addressing the causes of attendance. Poor housing costs the NHS £1.4b PA (BREGroup, 2021).

For the system, the aim is to reduce negative health impacts by influencing change through advocating, building professional networks and sharing data.

How will the project be delivered?

This funding is timely because it enhances an existing NHSE 12-month pilot. Barnardo’s has been commissioned by NHS England to embed 21 family support workers across seven ED sites. The aim is to redirect families, with non-critical health needs, to more-suitable community provision. The pilot will hopefully lead to sustainable funding.

This means partnerships with ED Consultants and ICB Transformation Leads are already established, NHSE have oversight, mechanisms are in place for sharing learning quickly with NHSE regions, no additional funding required for management/infrastructure and timeframes align.

Of the seven ED sites, we propose to work with Bradford General. There is an established, cross-system collaborative ‘task & finish’ group including ED Consultants, Matron, Data Leads, NHSE Regional Leads and Barnardo’s. The group is responsible for integrating teams, managing risk, sharing data, and achieving NHSE KPIs. KPIs for this project will form the overarching NHSE framework.

How is your project going to share learning?

As Barnardo’s and NHSE already have established partnerships with seven acute trusts through the family support worker pilot there is extensive potential to share learning systematically across the system.

Learning will be shared via:

• Community of Practice: A network of practitioners delivering community-based support in ED to share learning, challenges, and the day-to-day practicalities of integrating the VCSE sector into emergency care.
• Professional Network: A network of ED consultants, matrons, nurses, paediatricians, and ICB CYP system and transformation leads across the seven ED sites to share their experiences and challenges on VCSE integration, outcomes, and impact.
• NHSE Regional CYP Networks: Quarterly updates at every NHSE CYP regional leads meeting to share learning wider across the system, outside of the pilot sites.
• External evaluation/events/publications: NHSE will support wider learning through their commissioned external evaluation and maximising visibility at relevant conferences.