2. Background – how it began
• Started with reading the JSNA
• Permission to do the work
• Defining the problem:
– How many homeless people are there?
– What is the health status of homeless people?
– What services do homeless people use?
– How could the health of homeless people be improved?
• Recruiting a team
• Planning the project
3. Homeless health ‘audit’
• Survey ran from August - Sept 2013
• Distributed across Essex in homeless shelters
• Four local areas were included:
– Chelmsford Colchester Harlow Basildon
• Survey provided by tertiary organization (Homeless Link)
– Consisted of 7 main sections
– Provided information across Essex and by individual
boroughs and councils
– National comparisons where available
3
4. • Getting complete survey information in the homeless population
is often difficult. Fortunate that we have received 152 surveys
• Limitations:
– responses varied per question so could only report on those
who completed the question
– Obtaining a random sample
– Geographical limitations
– Time of year: done in summer
– Subjective methods: may underreport or over report
4
5. 5
Demographics
• Majority of individuals were 18-35 years of age
• Predominantly male (66%), white (93%) and of UK origin (90%)
• The duration of time spent homeless ranged from 1 week to 9
years
– Average time was 1 years and 4 months*
– 20% spent at least 25 weeks to 1 year homeless
Duration
Homeless
Number of
Participants
Percent
0 - 3 weeks 10 11%
4 - 7 weeks 12 13%
8 - 11 weeks 5 6%
12 - 15 weeks 10 11%
16 - 19 weeks 8 9%
20 - 24 weeks 3 3%
25 weeks - 1 year 18 20%
>1 - 2 years 9 10%
2+ years 15 17%
6. 6
Access to Services
• Top service used in the past 6
months (73%)
– Rates similar to Essex
• 86% currently registered
– 84% in Essex pop.
• 17% have been refused GP or
dentist due to having No Fixed
Abode currently or in the past
GP
7. Access to Services 2
• Mental illness was the largest
reason for both AE use,
ambulance use and hospital
admissions
• 22% admitted in the past 6
months
– In a full year only 8% of Essex
admitted
• 65% reported staff did not
check if they had a place to
go on discharge
7
A&E/
Ambulance
Hospital
Admission and
Discharge
8. Physical Health
Smoking : prevalence (75%) was roughly 3 times that of the
general population. 40% wanted to quit
Nutrition: nearly HALF of participants ate only 1 meal or
less per day
8
Main physical health problems:
- Joint and Muscle Pain - Dental Problems
- Skin and Wound Infx - Podiatry related
9. Mental Health
• Stress, anxiety , depression were main symptoms experienced
– 84% experienced at least one, 67% all three
– 41% formally diagnosed (0.7% of Essex population diagnosed)
• Only around a third with mental health issues were receiving support
- Problem with accessing care despite individuals finding it
useful
• Worryingly, roughly half of individuals used drugs or alcohol to cope
9
10. Summary of homeless health audit
• Good response in a hard to reach population
• Reconfirms findings in global literature
• Shows major health problems and gaps in the services
currently provided
• Currently researching all homeless surveys carried out across
England, specifically focusing on health care utilisation and GP
registration
10
11. JSNA findings: how many homeless people
are there?
Homeless Category Estimated
number
Statutory homeless in temporary
accommodation
2,500
Rough sleepers 57
Night shelters 53
Refuges 118
Floating support 108
Other hidden homeless ?
Total 2,836
12. JSNA findings: service gaps
• Accessibility of mainstream services (e.g. GP) to homeless
people
• Integration between services – e.g. mental health and drug and
alcohol services.
• Information on the homeless people
13. Recommendations
ECC
1. Floating support
2. Joint working for mental health and drug & alcohol services
3. Critical time interventions & Assertive Community Treatment
4. Update JSNA every 2 – 3 years
5. Include homelessness in ECC equality impact assessments
6. Set up Commissioning Outcome Group for homelessness
Other organisations
1. Specialist homeless health care clinics (CCGs/NHS England)
2. Discharge protocols (hospitals, mental health, CCGs)
3. Targeted Hep B and influenza vaccination (NHS England)
14. Reflections
• Working with ‘hard to reach’ groups is difficult but can be done in
partnership.
• Assembling and managing a needs assessment team
– Allow time to manage the team
– Be realistic about what can be achieved in time available
• The pros and cons of scope creep
• Needs assessment for information versus needs assessment for
action
15. Thank you
Acknowledgments
Partner organisations for the homeless health needs audit:
Basildon District Council, Family Mosaic, Beacon House, Harlow
Council, Chelmsford City Council, Harlow Foyer, CHESS, NACRO,
Colchester Borough Council, One Support, Streets2Homes
ECC contributors to the JSNA:
Tim Elwell-Sutton, Jonathan Fok, Phillip Elliott, Karen Dawson, Debra
Wyrill-Ryan, Alison Amstutz, Jean Broadbent, Colin Seward, Salman
Uddin, Zara Saith
Our thanks go to all those who took part.
http://www.essexinsight.org.uk/Resource.aspx?ResourceID=913
15
Editor's Notes
I will talk more about the process of the JSNA with a focus on the process and lessons learned from conducting it more than the technical details of what we concluded. I hope that will be of interest and may be helpful to others who might consider doing similar pieces of work in future.
Jon will talk about one particularly interesting part of what became a large and fairly complex project.
Ran with the help of the Public Health team- Survey provided by Homeless Link, then distributed across Essex to local homeless shelters and food kitchens- workers from the homeless shelters sat down with the individual to go over the survey.
Difficulty with comparisons as questions were not similar
Eg. Hospital use in the past 6 months, compared to national hospital use per year
Advantages and disadvantages to this survey.
Very hard to reach population and getting information is often quite difficult with high numbers of attrition and lack of completion of surveys
152 surveys for the most part well filled out
7 Main areas focused on will focus on a few
Mean was not a good indication of time spent. Discuss various forms of homeless sleeping situation – single homeless with accomodation, rough sleepers, hidden homeless
Double check mental health conditions
I sent the report round internally first.
Then homelessness got some interest from 2 councillors. The timing was extremely fortuitous.
This led on a to meetings with elected members and senior officers including DPH.
At the final meeting I presented not a report with recommendations but a 2 page summary of what we are currently doing and a proposed strategy. Out of first meeting with officers came an extra recommendation which was actually the most important one for getting it implemented: set up a COG.