discussion workshop - community action norfolk · • rural/suburban fringe of norwich • 2 x...
TRANSCRIPT
Inequalities
Discussion Workshop
Tracy Williams Clinical Chair NHS Norwich CCG Lead Nurse City Reach Health
Services
Reducing Inequalities Workshop
The Index of Multiple Deprivation
Fair Society, Healthy Lives: 6 Policy Recommendations
A.Give every child the best start in life B.Enable all children, young people and adults to maximise their capabilities and have control over their lives C.Create fair employment and good work for all D.Ensure healthy standard of living for all E.Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill health prevention
Marmot, 2010
STP Submission June 2016 - In Good
Health Close the inequalities gap • A high proportion of residents live in the 20% most deprived areas.
• If the most deprived areas experienced the same rates as the rest of Norfolk and Waveney then each year more than 400 children would be of healthy weight, there would be 1,000 fewer emergency admissions for older people and there would be 60 fewer deaths due to preventable causes.
• In 2014 the life expectancy gap across the footprint between the most deprived 20% and least deprived 20% was 7 years for men and 4.5 years for women. For men, deaths due to circulatory conditions, cancer, respiratory conditions and external causes (suicide, drug overdose, accidents etc.) account for about 5 years of the difference. For women they account for about 3 years.
• Our ambition is to close the Health and Wellbeing Gap!
Our responsibilities • “We can foresee a
better NHS that eliminates discrimination and reduces inequality in care.” Liberating the NHS Department of Health 2012. Health and Social Care Act 2012
• “…wider social duty to promote equality through the services it provides” NHS Constitution
Healthy Norwich • Social Prescribing pilot in Tuckswood & Gurney
Surgery, linked to wider Health inequality work in Lakenham.
• Holiday Hunger Programme in Primary schools • Smoke-free play parks and Smoke-free youth sport • Healthy Norwich Grants programme • Whole system approach to Obesity – #sugar smart, Daily
Mile, Breastfeeding Friendly, Weight Management.
Marmot, 2010
Key questions •What’s important for Norfolk and why? •What should be in the new Norfolk Health and Wellbeing Strategy?
Integrated Care Pilot: Broadland District Council and The Market
Surgery, Aylsham Matthew Cross,
Deputy Chief Executive Broadland District Council
21 June 2017
Issues to cover • The area and its health issues • Background • The pilot (approach, outcomes, feedback, etc.) • Next steps and reflections • Questions/discussion
The Broadland area • District of 126,000 population approx. • Rural/suburban fringe of Norwich • 2 x CCG’s/ASC localities. Share Children’s Services
locality with NNDC • Relatively affluent, healthy. Deprivation often hidden • Older population profile • 7.2% of households in fuel poverty (2014); slightly
more excess winter deaths than expected. • Quality of housing and home environment is important,
particularly for vulnerable adults
Background to pilot • DFG Locality Plan 2016-17 – contribution to the BCF
objectives, particularly avoidable admissions and support discharge
• Discussions with Integrated Commissioners in North Norfolk locality (one part of BDC area)
• Focus on those most at risk of hospital admission and needing ASC services
• How can this patient group get better access to DC services and other community support? What impact would it have?
• This is not purely a DFG issue!
The Approach • BDC Home Improvement Agency Officer • Market Surgery, Aylsham: Multi-Disciplinary Team Meeting • Referrals to HIA Officer. Those most at risk of hospital
admission • Benefits:
– Assess in the home – Access to home related support which impact on health outcomes
(fuel poverty, ventilation, equipment, hoarding) – A different view on what is contributing towards someone’s health
and wellbeing • Scheme ran initially for 3 months August 2016 – October 2016 • 12 interventions initiated in the first 3 months
High level outcomes
Patient medical condition Type of assessment Outcome
Mobility Issues Tel Updated on DFG progress and confirmed appointment
Cancer patient with inappropriate housing
Tel
Referral to Stonham Homestay advocacy service.
Self – Neglect Visit Adaptions, financial support, medical referral, referral to lifeline, building maintenance, boiler service referral.
Age related mobility issues Numerous previous visits - Tel assessment required.
Information provided on Housing Options and Housing with care.
Age related Mobility Tel Given advice on benefits and housing options
Mobility issues and complex health conditions
Visit Adaption, New Heating System
Younger male with physical disability
Tel Referral to Stonham Homestay
Neurological Conditions Visit Advice on DFG procedure, PIP application and Home options.
Female with Mental Health issues and autistic child and two other children.
Email advice to ICC Charity funding received for decorating and house maintenance.
Hyper Mobility Syndrome Tel Referral to charities for personal alarm system. Further visit and Assessment required.
High level outcomes • Wide range of ages
– 7 less < 60 years and 7 > 75 years • 11 BDC telephone assessments 4 BDC home visits • Of the 8 patients with health records all
had less health support after the housing intervention
• Of the 7 patients with social care records all had less social care support after the housing intervention
• ICC outcome indicate that: – 3 people at home with only vol. and
community support – 7 people with mix of community based
of health or social care
Total average per month
Total average per month
Before After Nurse appointments 0.74 0.34 GP appointments 1.54 0.82 Home visits 4.97 3.22 Hospital admissions 0.21 - LOS in hospital 0.63 - Ambulance transports -0 - 0
Total average per month
Total average per month
Before After Social Care Calls 2.62 1.12 Social care Visits 4.25 1.12
The real impact Mr G lives alone in a semi-detached bungalow he suffers from poor mobility and a multitude of health conditions. His Carer reported to the GP that Mr G’s heating wasn’t working and hadn’t done so in a long time. He would fall asleep in front of an open fire and not have the fireguard on so she had concerns around fire hazard.
A level access shower, shower seat and grab rails were installed
Referral to British Gas Energy Trust that resulted in the installation of a new gas boiler
Issues addressed: Personal Hygiene and a warm and safe environment
Feedback from GP Practice • Better understanding of services provided from
BDC • Earlier intervention (before a crisis) • Polly’s attendance at the meeting allowed us to
ask about options for patients
Feedback from the ICCs • Good working relationship with HIA Officer • Learnt about the services available from BDC • Generated referrals from non-clinical
interventions • Supported focus on prevention and increasing
resilience by helping residents keep warm and in a home free of tripping hazards
Next Steps • Measures / cost saving on system • Second pilot to start in Drayton (use of Norfolk
Public Health funding). Aim is 6 months • Evaluation framework being developed • Would like pilot in Norwich CCG locality • Measure / Sustainability of work • Recognition for this model of working
Some reflections • Good communication and trust • Links worked well – BDC, integrated commissioners, NCH&C,
ASC social care team, GP, CCG (integration or at least alignment!!)
• Flexibility for HIA Officer • A different conversation with resident (what would help you
live your life better?) • Learning from evaluation e.g. data/info to collect • Similarities to social prescribing (discuss!) • Builds on arrangements (roles, structures) already in place • Two CCGs/ASC localities – different connections?
Any Questions?
Key questions •What’s important for Norfolk and why? •What should be in the new Norfolk Health and Wellbeing Strategy?
Norfolk Health and Wellbeing Event, 21 June 2017
“Reducing inequalities” workshop: Homelessness presentation by Chris Hancock, Housing strategy
officer, Norwich City Council
Purpose of my presentation
• Overview of homelessness work in the greater Norwich area • Greater Norwich covers the following districts: Broadland district council Norwich City council South Norfolk council
Two questions
• What's important for Norfolk and why?
• What should be in the new Health and Wellbeing Strategy?
Challenges for people who are homeless
• Their complex needs and chaotic lifestyles can make it difficult to navigate complicated systems • Many homeless people lack self esteem and therefore do not value “good health” or prioritise their health needs • Some homeless people may distrust or avoid services as they feel stigmatised
Challenges for commissioners
To meet the health needs of our homeless population across the 2,074 sq miles of Norfolk. The homeless population is not a homogeneous group. You could argue that this population are people with a range of social, psychological or economic problems who are also experiencing homelessness.
What is homelessness?
1. Roofless - People sleeping rough. 2. Houseless – a. people in accommodation for homeless people (direct access hostels). b. people due to be released from institutions (prison and hospital) c. people receiving support (due to homelessness i.e. in supported accommodation). 3. Insecure – a. people living in insecure accommodation (squatting, sofa surfing).
Homelessness kills • Main findings • From the records of deaths in England between 2001-2009, 1,731 were identified as having been homeless people. Of these 90% were
male and 10% female whereas the gender split of deaths of the adult general population is 48% male and 52% female. • 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,
compared to 77 for the general population, 74 for men and 80 for women. It is important to note that this is not life expectancy; it is the average age of death of those who die on the streets or while resident in homeless accommodation.
• At the ages of 16-24, homeless people are at least twice as likely to die as their housed contemporaries; for 25-34 year olds the ratio increases to four to five times, and at ages 35-44, to five to six times. Even though the ratio falls back as the population reaches middle age, homeless 45-54 year olds are still three to four times more likely to die than the general population, and 55-64 year olds one and a half to nearly three times.
• Drug and alcohol abuse are particularly common causes of death amongst the homeless population, accounting for just over a third of all deaths. Homeless people have seven to nine times the chance of dying from alcohol-related diseases and twenty times the chance of dying from drugs.
• Homeless men and women had similar mortality ratios for deaths due to alcohol, while for deaths due to drugs, men were seventeen times, and women thirteen times, more likely to die than the general population. Men were also more likely to die from cardiovascular problems than women.
Rough sleeping is increasing
1768
2181 2309
2414
2744
3569
4134
4 6 6
5
13 13
34
0
5
10
15
20
25
30
35
40
0
500
1000
1500
2000
2500
3000
3500
4000
4500
2010 2011 2012 2013 2014 2015 2016
Rough sleeping: England & Norwich
England
Norwich
Unknown and known rough sleepers
0
50
100
150
200
250
300
350
2011-12 2012-13 2013-14 2014-15 2015-16 2016-17
Norwich: Verified rough sleepers
Verified
Why?
55
86
77
116
0
20
40
60
80
100
120
140
2013-14 2014-15 2015-16 2016-17
Left institution
Left institution
Estimated
Greater Norwich homelessness strategy
Coverage
Our priorities • targeting our resources at those people who are most at risk of
homelessness. • helping people find affordable, safe, good quality housing. • working better together with partners, so that we can work in a co-
ordinated way to prevent homelessness • helping people develop independent living skills, maintain or regain their
independence to reduce the risk of someone becoming homeless in the future.
Priority: “working better together with partners, so that we can work in a co-ordinated way to prevent homelessness.”
We realised from our homelessness review that we needed to work closer with our partners across the voluntary and statutory sectors. This is why we formed the:
Purpose of forum • Bring together service providers, stakeholders and other interested parties who want to
help identify the factors and causes of homelessness in Greater Norwich and listen to the views of partners and stakeholders.
• Develop approaches with forum members from identified issues. • Share good practice amongst forum members and seek out external examples. • Provide a sounding board and work with local authority and statutory partners to help
develop local homelessness strategies and action plans. • Provide a mechanism for continuous feedback and improvement of homelessness services
in Greater Norwich. • Promote joint working amongst members of the forum. • Celebrate and publicise the forum’s achievements and successes. • Develop a co-ordinated approach to preventing homelessness in Greater Norwich.
Homelessness review 2018/19
It is a statutory requirement that each local housing authority carries out a homelessness review every five years. This review will identify gaps in provision. The Greater Norwich homelessness forum will be an invaluable conduit for this process.
Joint strategic needs assessment
We identified as part of our work with Public Health that there were gaps in our knowledge of the health needs and inequalities of our homeless population.
Who?
Back in 2016 we formed a working group of statutory and voluntary agencies who either work with homeless people or are interested in their health needs. The report focuses on six main themes: • Socio-demographics of local homeless population • Access to health services • Physical health • Drug and alcohol use • Vaccinations and screening • Wellbeing
Socio-demographics
0
5
10
15
20
25
30
35
40
15-17 18-25 26-35 36-45 46-55 56-65 66+
% o
f tot
al p
opul
atio
n
Percentage of population at each age range
GNHHNA Homeless Link GNP
Key findings: Access to health care
Good points: 90% were registered with a GP (or specialist health care service) similar to the national survey (92%). 9% said that they had been refused registration.
Key findings: Access to health care
Bad: 46% were registered with a dentist; this is 14% lower than the general population and 12% lower than the national survey.
Key findings: Use of emergency services
Bad: 32% had used an ambulance in the past 12 months; 22% three or more times. More than three times higher than the general population, higher than the national survey. 46% had visited an A&E service in the past 12 months. Four times higher than the general population and 7 % higher than the national survey. Of those 53% had visited once, 19% twice, 14% three times and 19% more than three times.
Key findings: Physical health
Bad: 75% said they had a long standing illness, disability or infirmity; this is more than twice the number of people in Norfolk and 31% higher than the national survey
Key findings: Mental health
Bad: High levels of mental health problems reported in the survey in comparison with the national survey (further evidence needed).
Key findings: Hospital discharge
Bad Of the 30 people who had been admitted into hospital, more than half said that hospital staff had not ensured suitable discharge. In comparison, the national survey found 70% of people said that staff had ensured that suitable accommodation was available on discharge.
Key findings: Healthy eating
Bad: 47% of people eat less than two meals per day. Fruit or vegetables per day: 34% normally eat none 41% either 2 or less portions 15% on average eat 3 or more portions
Next steps
The health needs audit will be shared widely so that commissioners can use it as an evidence base. The document will be placed on Norfolk Insight. The working group will meet again to gather lessons learned and plan for the next survey later this year. Let me know if you would like to be involved in any future survey. Use the results of the survey for your own service planning and funding bids.
Before I finish
Two questions: • What's important for Norfolk and why?
• What should be in the new Health and Wellbeing Strategy?
Voices from the front-line
“There is a need for expert assessors who respect clients/patients autonomy and have a person centred approach. This applies in particular to Substance misuse and Mental Health assessments in relation to the homeless. There is no dedicated Mental Health nurse for the homeless who could do an outreach assessment. The referral process is too complicated and prolonged for patients with complex needs on the street who have no address or no reliable phone numbers.”
Voices from the front-line
“Availability of mental health assessments/access to services for homeless people. 7 out of 10 rough sleepers have a mental health issue which will only worsen whilst they remain on the streets. Theoretically it is possible to conduct a mental health assessment whilst someone is rough sleeper with a view to finding them a suitable placement; in practice it is almost impossible to set up… We are also at a low for the support on offer to people addicted to opiates from various specialist agencies (due to the scale of the demand for their services).”
Voices from the front-line
“There is a need for expert assessors who are able to assess the needs of drinkers and their capacity to make decisions, attend appointments, and engage with services. Because of a lack of capacity current methods often fail as patients are not able to follow rules/ options they are offered. An outreach service for patients with complex needs e.g. MH and substance misuse problems would be extremely beneficial. Substance misuse support needs to be in conjunction with specialist Mental Health support.”
Key questions •What’s important for Norfolk and why? •What should be in the new Norfolk Health and Wellbeing Strategy?