Presentation delivered with Voices and Expert Citizens at CHAD = Feb 2017

1. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Gatekeepers

2. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Contents
• Partnership
• Tips for health
• Health of homeless people
• Gatekeepers report and findings
• Lived experience testimony
• Impact
• Acknowledgements

3. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Working in partnership
• All organisations involved have similar
aims & philosophies
• Have a remit/commissioned to
influence service change/design
• Tradition of bottom up design,
ensuring the input of service users
• Service Design built around
experiences

4. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Developing outcomes
• More than a research project in
that this requires outputs to be
applied
• Publication of paper is merely
part of the journey
• Expertise in the field – “lived
experience”
• Staff Experiences
• Knowledge of the broader
sector
• Project Management with clear
goals from outset
• Ability to access and negotiate
with health and care leadership

5. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k

6. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Top tips for health
1. Don’t be poor
2. Don’t live in a deprived area
3. Don’t be disabled
4. Don’t work in a stressful, low paid,
manual job
5. Don’t live in damp, low quality
housing or be homeless

7. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Top tips for health
6. Be able to afford social activities
and holidays
7. Don’t be a lone parent
8. Claim all the benefits to which you
are entitled
9. Be able to afford and own a car
10. Use education to improve your
socio economic position

8. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
HEALTH OF THE
HOMELESS

9. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
“Homeless people are more likely to die young,
with an average age of death of 47 years old
and even lower for homeless women at 43.”
Crisis & University of Sheffield (2012), “Homelessness Kills”, page 4.

10. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Homeless people aged 16 to 24 are twice
as likely to die as their housed peers.
Crisis & University of Sheffield (2012), “Homelessness Kills”

11. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Homeless people aged 35 to 44 are
between five and six times more likely
to die as their housed peers.
Crisis & University of Sheffield (2012), “Homelessness Kills”

12. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
GENERAL POPULATION HOMELESS PEOPLE
Cause of death
Source: Crisis and University of Sheffield (2012), “Homelessness Kills”, page 7.

13. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Hospital interactions

14. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k

15. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
NHS England guidance
A patient residing in the practice
area does not need identification
• Specific examples cited in the
guidance include
• People that are street homeless or
in unstable accommodation
• People fleeing domestic violence
https://www.england.nhs.uk/commissioning/wp-
content/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf
Gateway Reference 04448, November 2015.

16. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Situation we tested
• Anecdotal information that
registration was a problem
• Support workers and others in the
sector
• Signposting was directed at a
specialist practice or walk-in
centres
• Limited choice for homeless
people

17. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
What we did
• Expert Citizens conducted a mystery
shop
• 47 practices across
Stoke-on-Trent contacted
• Scenario presented was registration of
a homeless person with no ID
• No other details were given
• Also considered case studies and
testimony from stakeholders

18. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
The results
48%
26% 26%

19. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
TESTIMONY

20. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
IMPACT

21. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
What£s happening
• CCG and Public Health have
responded positively and are
taking action
• Group met twice
• Director of Public Health
• Clinical Director of the CCG
• Portfolio Holder
• CCG Commissioning

22. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Key actions
• CCG written to all GPs reminding
them of the NHS England
guidance
• Assurances
• Key staff will receive training
• Involvement of people with lived
experience
• Incorporation of this customer
group in to equality delivery
system
• Action on hospital discharge

23. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Hard Edges in Stoke
Impact on use of services for 22 customers 12-month prior vs. 12-months since

24. v o i c e s o f s t o k e . o r g . u k
e x p e r t c i t i z e n s . o r g . u k
Acknowledgments
• Authors
• Paul Astley, Healthwatch Stoke
• Ben Wilson, VOICES
• Expert Citizen researchers
• Joanne Cutts
• Rachele Hine
• Karen McCall
• Susan Perry
• Contributors
• Jane Morton, Staffordshire University
• Responders
• Cllr Ann James
• Dr Lesley Mountford
• Dr John Gilby
• CCG Commissioning
• Ruth Smeeth MP
• BBC Radio Stoke
• BBC Radio 5 Live