health and homelessness: the right to the highest attainable standard of health? katy hetherington,...
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Health and Homelessness: the right to the highest attainable standard of
health?
Katy Hetherington, Programme Manager
Neil Hamlet, Consultant in Public Health, NHS Fife
Our vision and mission
Our Strategy 2012-17: “A FAIRER HEALTHIER SCOTLAND”
Jordanhill
Charing Cross
HyndlandPartick
Anderston
Exhibition Centre
CENTRAL
Argyll St.
Bridgeton
QUEEN STREET
Govan
Hillhead St George’s Cross
Buchanan Street
Male life expectancy75.8 years
St Enoch
Male life expectancy61.9 years
Ibrox
Cessnock
Each stop on the Argyll line travelling East represents a drop of 2 years in male life expectancy
Source: McCartney G. Illustrating Glasgow’s health inequalities. JECH 2010; doi 10.1136/jech.2010.120451
What do we mean by health inequalities?
Health inequalities are:
•Unfair differences in health within the population across social classes and between different populations
These unfair differences:
•Are not random, or by chance, but largely socially determined
•Are not inevitable.
What causes health inequalities?
Wider environmen
tal influences
Economic & work
Physical
Educ & learning
Social & cultural
Services
Individual experiences
Economic & work
Physical
Educ & learning
Social & cultural
Services
Fundamental causes
Global forces, political
priorities, societal values
leading to:
Unequal distribution of power, money and resources
INEQUALITIES
Effects
Inequalities in the
distribution of health and
wellbeing
HEALTH INEQUALITIE
SUndo MitigatePrevent
What is most and least effective in reducing health inequalities?
Least likely to be effective
Interventions reliant on people opting in; information based campaigns; written materials; messages designed for the whole population; interventions that involve significant price or other barrier
Most likely to be effective
Structural changes to the environment; legislation, regulatory and fiscal policies; income support, reduced price barriers; accessibility of public services, prioritising disadvantaged groups and individuals; intensive support for disadvantaged population groups; starting young.
Substance Misuse
Dental Care
Foot and skin careAlcohol Abuse
Mental HealthIssues Nutrition and diet
HomelessnessHomelessness
Homelessness - a Homelessness - a cross-cutting cross-cutting agendaagenda
Community HealthPartnerships Social Work
NHSAcute Services
Registered SocialLandlords
Council HousingDepartments
Third Sector Agencies
Health & Social Health & Social Care Care
Integration Integration BodiesBodies
Alcohol and DrugPartnerships (ADPs)
Employment
Family nurturing(conflict resolution)
Education & skillsIncome maximisation
Honour and purposeCoping & resilience
Homelessness - a Homelessness - a prevention agenda agenda
Social Work
NHSOutreach Services
Registered SocialLandlords
Council HousingDepartments
Third Sector Agencies
Health & Social Health & Social Care Care
Integration Integration BodiesBodies
Alcohol and DrugPartnerships (ADPs)
HousingHousingVol Vol
SectorSectorNHSNHS
HSCPHSCP
Homelessness as a public health issue – ScotPHN Report
•‘Re-energise’ the health and homelessness agenda•Set it in the current policy context – health and social care, focus on inequalities, prevention agenda, homelessness policy and legislative•2005 Health and Homelessness standards•Discussion and engagement – housing, voluntary sector, SG, academics, NHS Boards•Gaps? •What do we want to recommend to Directors of Public Health?
Severe and multiple disadvantage
•‘Hard Edges’ 2015 – Mapping severe and multiple disadvantage in England
“services still categorise people in separate boxes, defined by simple issues…different approaches from services and from policy”
•Understanding complex lives – Joseph Rowntree Foundation, 2011
‘There needs to be an integrated response across health, housing and social care’
•Early childhood experiences – the roots of many people’s experiences lay within very troubled childhoods.
Linkage of Hospital data and Homelessness data in the Kingdom of Fife
Bryan Archibald, Senior Information Officer [email protected]
Bryan [email protected]
The Data Sources
Fife CouncilFife Council• HL1• National data set for
each homeless application
• Based on the application (not the number of homeless individuals)
NHS Fife Acute NHS Fife Acute HospitalsHospitals
• eOASIS (patient administration system)
• SMR data submitted to ISD (information Services Division of NHS Scotland)
• Based on Patient Episodes
http://www.scotland.gov.uk/Topics/Statistics/15257/22833
NHS Data (OASIS)• A&E (and Minor Injuries Unit [MIU])• Inpatients & Day cases• Obstetrics• Mental Health Inpatients• Outpatients• Mental Health Outpatients
So far so good but what does this mean?So far so good but what does this mean?
• We need a comparator for the homeless We need a comparator for the homeless populationpopulation
• Fife’s ‘securely - housed’ populationFife’s ‘securely - housed’ population• Try to compare by similar age profileTry to compare by similar age profile• Started with Fife population 15-64 as our Started with Fife population 15-64 as our
crude method of ‘standardisation’crude method of ‘standardisation’• Further refinements planned in Further refinements planned in
‘standardisation process’ ‘standardisation process’ • Aiming to compare ‘apples’ with ‘apples’ by Aiming to compare ‘apples’ with ‘apples’ by
security of housing as defined by HL1 security of housing as defined by HL1 registrationregistration
The value of shared data analysis
‘Insecurely Housed’ ‘Securely Housed’
Abuse ?
Pragmatic ?
££££££
Over 50% are under 30 yrsOver 50% are under 30 yrs
Over 80% are under 40 yrsOver 80% are under 40 yrs
£
Revolving Revolving Hospital Hospital Door effect Door effect
Clear role for Community Clear role for Community Safety Partnerships ?Safety Partnerships ?
•Changed address•Fearful to open official mail•Appointment too early•No money for the bus•‘it won’t do any good’
Access / ExpectationAccess / Expectation
What is most and least effective in reducing health inequalities?
Least likely to be effective
Interventions reliant on people opting in; information based campaigns; written materials; messages designed for the whole population; interventions that involve significant price or other barrier
Most likely to be effective
Structural changes to the environment; legislation, regulatory and fiscal policies; income support, reduced price barriers; accessibility of public services, prioritising disadvantaged groups and individuals; intensive support for disadvantaged population groups; starting young.
Making a DifferenceMaking a Difference On call nurse manager gets a text alert on her On call nurse manager gets a text alert on her
work phone when a homeless person is seen work phone when a homeless person is seen in Accident and Emergency Dept. in Accident and Emergency Dept.
A daily report is now generated listing all the A daily report is now generated listing all the patients in the hospital at 8am who have a patients in the hospital at 8am who have a temporary homeless accommodation temporary homeless accommodation address. address.
'Houseless and Hungry' by Luke Fildes depicting homeless paupers queuing outside the casual ward of a London workhouse
Meet needs of safety, nurture, belonging and purpose
“We believe that health and homelessness services can work better together to ensure that an individual's health needs are identified and addressed as quickly as possible. NHS acute services currently bear the brunt of the health and other complex problems experienced by those who are homeless. A&E visits per homeless person are four times higher than that of the general public and over a quarter of those surveyed had been admitted to hospital in the previous six months” Rick Henderson, chief executive of Homeless Link