1. London Health & Homelessness Programme working with Haringey C.C.G.
Working together to make London the healthiest city in the world

2. Funded annually by CCGs and NHS England (London Region)
Who are we?
Healthy London Partnership
Formed in May 2015 as a collaboration between London’s 32 CCGs and NHS England (London Region)
Funded annually by CCGs and NHS England (London Region)
To deliver the Five Year Forward View and Better Health for London
We work to deliver the things best done once for London
We believe that collectively we can make London the healthiest global city in the world.
Collaborative Aspirational Strategic Innovative

3. Health for people who are homeless
Issues in London: Over the course of a year some 8,000 sleep rough in the capital. Although numbers have levelled off in the last year, the numbers are double what they were in 2009/10. The term ‘homeless’ is often applied in everyday language to people who sleep rough, however there are also broader definitions covering anyone who does not have a home. Other types of homelessness have also grown in London. Homelessness may be a consequence of health problems, and is very commonly a cause of worsening health. The wellbeing of people who are homeless is at significant risk, especially those who live and sleep on the street. Our vision: Every homeless person should receive care that is consistent in quality and experience with that of the general population and bespoke to meet their specific needs, and the systems which support homeless people will be linked up to reflect the transitory nature of the population and support improved communication and outcomes across the system. The London Homeless Health Programme is delivering a range of products and activities that support commissioners and providers to implement good homeless health practice; develop and promote clinical engagement in relation to homeless health in London and promote good homeless health practice to stakeholders and professional groups in London. Examples of our work in 17/18 include a model Health Needs Assessment toolkit and a range of e-learning modules for key professional groups. Impact Our work is designed to contribute to better access to health care for people who are homeless. Our guidance and products support CCGs to promote access to health services and to work with key stakeholders to reduce health inequalities.

4. L.H.H.P. – what we would like you to do
Know your population who are homeless
Involve people with a lived experience of homelessness
Improve access to all services
Provide training and resources for staff
Review Health Needs Assessments annually
Work in partnership with colleagues in voluntary and statutory services
Services need to be:
Person centred
Holistic
Multi-disciplinary
Integrated
Inclusive
Accessible
Flexible
Equitable
Accountable

5. Haringey AGM – Homeless health update
Sarah Hart senior commissioner in public health
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6. Overlapping needs All data from CHAIN Mental Health Alcohol Drugs
The problem of rough sleeping is not solved when individuals are moved from the street to a hostel – there are often complex issues to address.
The vast majority (71%) of rough sleepers had a mental health, alcohol or drug problem.
Among those with a problem, half had more than one.
The most common problem among rough sleepers was mental health (46%), followed by alcohol (43%), drug problems were relativity less common (31%)
718
561
900
Mental
Health
Alcohol
713
359
354
279
Drugs
When we are looking at health service provision first thing we need to note 71% rough sleepers have overlapping needs – seen Government concern re mental health add in substance misused and being homeless and your really in trouble!
Rough sleeping definition: unique people seen sleeping rough in London by outreach teams in 2015/16 – recorded on CHAIN
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7. Physical health
From Crisis research “a silent killer”. Based on data on people thought to have died whilst homeless – rough sleeping, in hostels etc
Data on rough sleepers from Homeless Link health audit between 2012 and 2014
Homeless people have much worse health outcomes than the general population
88% of rough sleepers reported a physical health problem
49% had experienced health problems for more than a year – compared to 28% of the general population
Homeless men have a life expectancy of 47, homeless women of 43. For the general population its 77 for men and 83 for women
Joint aches or problems with bones and muscles
Dental/teeth problems
Chest pain/ breathing problems
Problems with feet
Most common health problems
Life expectancy extremely low , with women’s being lower. 88% with physical health issue
58%
48%
47%
43%
Data on rough sleepers from Homeless Link health audit between 2012 and 2014
Source: Homeless Link Health Audit based on responses from 2,590 responses from homeless people accessing services across England.
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8. Health care use 76% of rough sleepers were registered with a GP
All data from Homeless Link health audit between 2012 and 2014
Health care use
Sample is all homeless e.g. Hostels, sofa surfing, rough sleeping
76% of rough sleepers were registered with a GP
20% of rough sleepers had been refused access to a GP
Reasons included: not having identification or proof of address, missing previous appointments or their behaviour
Just rough sleepers
Just rough sleepers
Lot work has gone in to ensuring access to GPs, don work locally and rolll out of new righ right to access card – 2/3 discharged somewhere unsuitable, homeless agencies report a lack appropraigte support on discharge
Two thirds of rough sleepers were not discharged somewhere suitable after being admitted to hospital
Source: Homeless Link Health Audit based on 2,590 responses from homeless people accessing services. Data on reasons for A&E admission is for homeless people in range of settings (hostels, sofa-surfing, rough sleeping etc).
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9. Mental health
Data from Homeless Link health audit between 2012 and sample is of all homeless e.g. Hostels, sofa surfing, rough sleeping
Poor mental health is a cause and a consequence of sleeping rough and people sleeping rough with a mental health problem tend to live on the streets for longer.
CHAIN data shows that 46% of rough sleepers in London had a mental heath problem, rising to more than half among UK nationals and 60% among women
The Homeless Link Health Audit suggest that mental health problems could be more widespread:
91% of participating rough sleepers reported a mental health condition - 45% had a diagnosed condition.
At 34% depression was the most common diagnosed condition.
65% of roughs sleepers reported using drugs or alcohol to cope with their mental health
From CHAIN
Data from Homeless Link health audit between 2012 and just rough sleepers
Just had excellent St Mungo’s ‘stop the scandle’ review using chain data and interviews with outreach workers and homeless people – high prevalence mental health with 45% diagnosable mental illnesss – higher in women – list conditions, see progression
Source: Homeless Link Health Audit based on responses from 2,590 responses from homeless people accessing services. *Data on mental health issues is for homeless people in range of settings (hostels, sofa-surfing, rough sleeping etc).
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10. All from Homeless Link, just rough sleeper sample
Drug and alcohol use
43% of rough sleepers indentified in CHAIN were recorded as having an alcohol problem.
Among rough sleepers in Homeless Links survey more than half drank multiple times in a week, 38% drank everyday
Half of rough sleepers consumed 10 or more units on a drinking day
31% of rough sleepers indentified in CHAIN were recorded as having a drug problem
Most of those with a drug problem also had a mental health and/or alcohol problems
The most common drug used by rough sleepers was cannabis
From CHAIN
From CHAIN
From CHAIN
From Homeless Link
From Homeless Link
From Homeless Link
All from Homeless Link, just rough sleeper sample
Source: Homeless Link Health Audit based on responses from 2,590 responses from homeless people accessing services. Only results for rough sleepers given
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11. The Grove: Local experience
The Grove is a is a free and confidential drug treatment service in Haringey. Of the 602 people presenting for treatment/support in the year to July 2016, 93 (15%) had No Fixed Accommodation (NFA)
93 NFA clients
58% UK-nationals
73% poly drug users
13 had dual diagnosis
9 sex workers
26% on release from prisons
85% no history of supported accom
Setting of those with no fixed accommodation
38 were street homeless 4 were sleeping in garages/on buses,
10 occasionally sofa surfed
602 people up to July % were NFA – 38 street homeless, 4 garages, 10 sofa surfing – prison realse big issue, mental health and sex working
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12. The Grove: Outcomes
Outcomes show the difficulty in providing services to individuals with no fixed accommodation and a problem with drugs.
Housing referrals
39% dropped out before support could be offered (i.e. they did not return after initial triage)
21 referred to emergency housing charities (e.g. St Mungo’s)
16 referred to housing advice agencies
12 referred to the vulnerable adults team
7 rehab
3 housed in other boroughs
2 referred to refuge
Treatment outcomes
63% clients with no fixed accommodation dropped out of treatment (higher than the average of 42%)
All sex workers dropped out of treatment
67% of poly-drug users dropped out of treatment
22% are engaged in or completed treatment
14 are currently engaged in treatment
6 successfully completed treatment
4 were transferred to other services and 2 declined treatment or had their treatment withdrawn
Different support option – 63% drop out
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13. Summary work health and homeless work done
Work done and missing
Doing needs assessments then we know what we do not know
My right to register
Homeless and rough sleeper strategy
Mental health and things like dental care
Peer-led solutions
Rough sleeper coordinator
Community approaches – taking prevention services to hostels
Primary care able to meet complex need
Hospital discharge
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