Title: Health and Homelessness: the right to the highest attainable standard of health?
1Health and Homelessness the right to the highest
attainable standard of health?
- Katy Hetherington, Programme Manager
- Katy.Hetherington_at_nhs.net
- Neil Hamlet, Consultant in Public Health, NHS
Fife - Neil.Hamlet_at_nhs.net
2Our vision and mission
Our Strategy 2012-17 A FAIRER HEALTHIER
SCOTLAND
3Each stop on the Argyll line travelling East
represents a drop of 2 years in male life
expectancy
Source McCartney G. Illustrating Glasgows
health inequalities. JECH 2010 doi
10.1136/jech.2010.120451
4What do we mean by health inequalities?
- Health inequalities are
- Unfair differences in health within the
population across social classes and between
different populations - These unfair differences
- Are not random, or by chance, but largely
socially determined - Are not inevitable.
5What causes health inequalities?
Undo
Mitigate
Prevent
6What is most and least effective in reducing
health inequalities?
- Least likely to be effective
- Interventions reliant on people opting in
information based campaigns written materials
messages designed for the whole population
interventions that involve significant price or
other barrier - Most likely to be effective
- Structural changes to the environment
legislation, regulatory and fiscal policies
income support, reduced price barriers
accessibility of public services, prioritising
disadvantaged groups and individuals intensive
support for disadvantaged population groups
starting young.
7Homelessness - a cross-cutting agenda
Third Sector Agencies
Council HousingDepartments
Health Social Care Integration Bodies
Community HealthPartnerships
Alcohol and DrugPartnerships (ADPs)
Social Work
Registered SocialLandlords
NHSAcute Services
8Homelessness - a prevention agenda
Third Sector Agencies
Council HousingDepartments
Health Social Care Integration Bodies
Alcohol and DrugPartnerships (ADPs)
Social Work
Registered SocialLandlords
NHSOutreach Services
9NHS
Vol Sector
Housing
HSCP
10Homelessness as a public health issue ScotPHN
Report
- Re-energise the health and homelessness agenda
- Set it in the current policy context health and
social care, focus on inequalities, prevention
agenda, homelessness policy and legislative - 2005 Health and Homelessness standards
- Discussion and engagement housing, voluntary
sector, SG, academics, NHS Boards - Gaps?
- What do we want to recommend to Directors of
Public Health?
11Severe and multiple disadvantage
- Hard Edges 2015 Mapping severe and multiple
disadvantage in England - services still categorise people in separate
boxes, defined by simple issuesdifferent
approaches from services and from policy - Understanding complex lives Joseph Rowntree
Foundation, 2011 - There needs to be an integrated response across
health, housing and social care - Early childhood experiences the roots of many
peoples experiences lay within very troubled
childhoods.
12Linkage of Hospital data and Homelessness data
in the Kingdom of Fife
- Bryan Archibald, Senior Information Officer
barchibald_at_nhs.net - Bryan Archibald
- barchibald_at_nhs.net
13The Data Sources
- Fife Council
- HL1
- National data set for each homeless application
- Based on the application (not the number of
homeless individuals)
- NHS Fife Acute Hospitals
- eOASIS (patient administration system)
- SMR data submitted to ISD (information Services
Division of NHS Scotland) - Based on Patient Episodes
http//www.scotland.gov.uk/Topics/Statistics/15257
/22833
14NHS Data (OASIS)
- AE (and Minor Injuries Unit MIU)
- Inpatients Day cases
- Obstetrics
- Mental Health Inpatients
- Outpatients
- Mental Health Outpatients
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19So far so good but what does this mean?
- We need a comparator for the homeless population
- Fifes securely - housed population
- Try to compare by similar age profile
- Started with Fife population 15-64 as our crude
method of standardisation - Further refinements planned in standardisation
process - Aiming to compare apples with apples by
security of housing as defined by HL1 registration
20 The value of shared data analysis
21Abuse ?
Pragmatic ?
22Over 50 are under 30 yrs
Over 80 are under 40 yrs
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24 25Revolving Hospital Door effect
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28Clear role for Community Safety Partnerships ?
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32- Changed address
- Fearful to open official mail
- Appointment too early
- No money for the bus
- it wont do any good
- Access / Expectation
33Inverse Care Law
- The availability of good medical care tends to
vary inversely with the need for it in the
population served. - Those who need healthcare least use the services
more, and more effectively, than those with the
greatest need and those people in the worst
health receive the least services. - Julian Tudor Hart 1971
34What is most and least effective in reducing
health inequalities?
- Least likely to be effective
- Interventions reliant on people opting in
information based campaigns written materials
messages designed for the whole population
interventions that involve significant price or
other barrier - Most likely to be effective
- Structural changes to the environment
legislation, regulatory and fiscal policies
income support, reduced price barriers
accessibility of public services, prioritising
disadvantaged groups and individuals intensive
support for disadvantaged population groups
starting young.
35Making a Difference
- On call nurse manager gets a text alert on her
work phone when a homeless person is seen in
Accident and Emergency Dept. - A daily report is now generated listing all the
patients in the hospital at 8am who have a
temporary homeless accommodation address.
36'Houseless and Hungry' by Luke Fildes depicting
homeless paupers queuing outside the casual ward
of a London workhouse
We believe that health and homelessness services
can work better together to ensure that an
individual's health needs are identified and
addressed as quickly as possible. NHS acute
services currently bear the brunt of the health
and other complex problems experienced by those
who are homeless. AE visits per homeless person
are four times higher than that of the general
public and over a quarter of those surveyed had
been admitted to hospital in the previous six
months Rick Henderson, chief executive
of Homeless Link
Meet needs of safety, nurture, belonging and
purpose