PHREE Spring Conference 2014

1. Homeless Health Needs
Assessment in Essex
Tim Elwell-Sutton & Jonathan Fok

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