housing seminar collated presentations
TRANSCRIPT
Housing & Health Seminar3 Feb 2015
The case for Social Housing and Health to achieve better outcomes
and opportunities
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Funds 4 U - Spend on approved applications 2014/15 (£) - to 14/01/15
Activity v Effectiveness
Customer centred approach
Opportunity for Agencies to work with Housing
So is the question What can Housing do for Health?OrWhat can Health do for Housing ?
Housing and healthWhat’s the connection?
Gill Leng, Housing and Health LeadHealth Equity and Place Public Health England
Housing?• The ‘bricks and mortar’ house
• Knowing who lives where, and the impact this has on their health and wellbeing is essential;
• Housing-related services (all tenures)• On offer to people to enable them to live in their own
home, or to move from crisis into their own home;
• A sector with an estimated workforce of up to 200,000 people• Regular contacts with households facing some of the
greatest inequalities, living in the most deprived communities
Good health: the work of a lifetimeStarting and developing well Living and working well Ageing well
What makes the difference?
Smoking 10%
Diet/Exercise 10%
Alcohol use 5%
Poor sexual health 5%
Health Behaviours 30%
Education 10%
Employment 10%
Income 10%
Family/Social Support 5%Community Safety 5%
Socioeconomic Factors 40%
Access to care 10%
Quality of care 10%
Clinical Care 20%
Environmental Quality 5%
Built Environment 5%
Built Environment 10%
Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute
Health promoting homes & services
• Starting and developing well• Safe & warm environment in which to learn, play & be
nurtured• Living and working well
• Access to work; well to work• Space to bring up a family
• Ageing well:• Connected to friends and family• Space for: hobbies; changing health; for caring
• All – housing-related services which:• Inform healthy choices• Support transitions in life, and enable independence
Risks to health & wellbeing
1. Unhealthy and unsafe homes• Bricks and mortar impact
2. Unsuitable homes• Home environment does not meet needs eg,
disabled people, changing health and care needs, overcrowding
3. Precarious housing and homelessness• Home is at risk, or household is homeless
Housing related PHOF indicators
17
Overarching 0.1 Healthy life expectancy
1. Improving the wider
determinants of health
1.01 Children in poverty
1.02 School readiness
1.04 First time entrants to youth justice system
1.05 16-18 year NEET
1.06 Adults with a learning disability/in contact with secondary mental health services in settled accommodation 1.09 sickness absence rate
1.11 Domestic abuse
1.13 reoffending levels
1.14 % population affected by noise 1.15 Statutory homelessness
1.17 Fuel poverty
1.18 Social isolation: social care users
1.19 Older people’s perception of community safety
2 Health improvement
2.05 Child development at 2-2.5 years
2.06 Excess weight in 4-5 and 10-11 year olds
2.07 Hospital admissions injuries in children 2.08 Emotional well-being of looked after children
2.11 Diet
2.12 Excess weight in adults
2.14 Smoking prevalence – adults (over 18s)
2.15 Successful completion of drug treatment
2.18 Alcohol-related admissions to hospital
2.23 Self-reported wellbeing
2.24 Falls and injuries in the over 65s
3 Health protection
3.03 Population vaccination coverage
3.05 Treatment completion for Tuberculosis (TB)
4 Healthcare public health
and preventing premature mortality
4.01 Infant mortality
4.03 Mortality from preventable causes 4.04 Mortality from cardiovascular diseases 4.07 Mortality from respiratory diseases 4.08 Mortality rate communicable diseases 4.10 Suicide rate 4.11 Emergency readmissions within 30 days of discharge from hospital 4.13 Health-related quality of life for older people 4.14 Hip fractures in over 65s 4.15 Excess winter deaths 4.16 Dementia and its impacts
Key:
Mental health related indicators in italics
Shared or aligned with NHS Shared or aligned with ASCOF* Relevant to ASCOF*
* Adult Social Care Outcomes Framework
Unhealthy homes
For example• Cold homes & fuel poverty: respiratory problems,
mental health, accidents & injuries; higher mortality• Unsafe: unintentional injuries• Fire: eg, burns, cardio-respiratory problems and
reduced lung function, disability, loss of life• Security: injury, shock, depression, fearWho is affected?• People who are at home the most: children,
disabled people, people with a long term condition, older people, carers
Unsuitable homes
For example• Overcrowding: tuberculosis (TB) and respiratory
infection; mental ill-health, anxiety & depression• Changing health/care needs: falls & fractures;
social isolation and mental ill-health • Shared accommodation: wellbeing and mental ill-
health
Who is affected?• Generally the same as for unhealthy/unsafe
homes
Precarious housing or homeless
• At higher risk from unhealthy & unsuitable homes
• Children: in B & B more likely low birth weight & miss immunisations; greater risk of infection; mental ill-health & development problems
• Rough sleepers/single homeless: high rates of physical health needs & mental illness; higher risk of blood borne viruses
• All: existing health conditions can be exacerbated eg, asthma, depression; new issues can arise eg, substance misuse; wellbeing & mental ill-health
Impact of homes across lifecourse
B & B?
Overcrowded? Sharing? On own & Isolated?
Can’t get upstairs?
Paying the mortgage?
Cold home? Cold home?
Poor PRS?
Who lives where? Dementia example
• Most people with dementia live in the community• Most want to live in their own home for as long as
possible• The alternatives of residential care, or hospital, are
more costly. • 2/3 of people with dementia live in community, 1/3 alone;• 85% would want to stay at home for as long as possible• For every person who is able to live at home rather than
in residential care there is a saving of £11,296 p.a. • Delay of just 5% of admissions to res. care would create
a net saving of £55 million per annum (E, W & NI)
The problem? Dementia example
• Majority of older people own their home (82%)• A disproportionate number of owner-occupied
homes are• Poor condition and/or • Unsuitable for changing health & care needs (one
in three)• There are few alternatives
• Many older households are low income (two thirds are owner occupiers)
• Shortfall of purpose-built specialist homes (240k)
The problem? Dementia example
• There are inequalities in access to homes and housing services for many older people
• Older people experiencing the greatest inequalities in this respect are• Rural communities
• BME
• Disabled people
• Offenders
• Gypsies and Travellers
• LGBT
• People with a learning disability
• People with a mental health problem
• Homeless people
The solution? Dementia example
• ‘Who lives where’ locally• Home Truths recommendations • Reforms in health and social care
• The Health and Social Care Act 2012 • The Care Act 2014 • The Better Care Fund• Partnership working with the housing sector
MECC overview
Holly EaslickHealth Development OfficerPublic Health Portsmouth
Public Health Portsmouth
What is MECC?
Using appropriate opportunities to talk about health & wellbeing
Taking into account lifestyle choices and wider influencing factors
Professional duty of care to adopt client-centred ways of working
Supporting people to improve their own health & wellbeing
Public Health Portsmouth
MECC levels/process
All servic
e-users
All staff
Fewer servic
e-users
Fewer staff
Stage/level onePromote the benefits of healthy living. Ask an
individual about their lifestyle, if they want to make a change and respond with appropriate action.
Stage/level twoIdentify the focus of a change by
supporting an individual to review their lifestyle.
Stage/level threeIncrease motivation and
clarify the support needed
Stage/level four
1:1 using SMART goals /
specialist support
i. Enable people to access appropriate information to manage their self-care needs
ii. Empower people to make informed choices to manage their health & wellbeing
iii. Feel confident in providing opportunistic brief advice
Learning Outcomes (L1)
30 - PHP & IWT
Determinants of health
31 - Public Health Portsmouth
Public Health Portsmouth
Housing link…
Holistic approach to addressing health inequalities
Many opportunities to Make Every Contact Count
Housing has a huge impact on health & wellbeing
Public health is everybody’s responsibility!
Somerstown pilot (phase 1)
Holistic approach
Links with MECC approach
The new wellbeing service
Good practice examples from housing sector…
Challenges & opportunities
Innovative!
Examples
Jane Leech - Programme Manager
Somerstown Neighbourhood Health & Wellbeing Programme
The Somerstown Programme is Phase 1 of a wider Public Health initiative – piloting, creating, learning…
To consolidate key current public health improvement services into one integrated service so that lifestyle and behavioural issues can be co-ordinated and provided on an individual basis.
The Wellbeing Service will be a locality based service focusing on the most deprived areas of the city, close to the people that need them most.
The Somerstown Programme context:Integrated Health & Wellbeing Service
A key worker role - Health & Wellbeing workers - The service will support individual residents and their families with lifestyle issues, e.g. smoking, alcohol misuse, poor diet and lack of exercise as well as emotional wellbeing.
Underpinned by Community development initiatives and activity to stimulate and support participation - "without citizen participation and community engagement fostered by public service organisations it will be difficult to improve penetration of interventions and to impact on health inequalities". Marmot Report 2014
The Health & Wellbeing Service
The Somerstown Programme team. The model in action -
In addition, this service will work with other council services to provide help and support with issues that are interrelated and tend to be contributory or underlying causes of poor lifestyle including debt, housing and unemployment
October 2014 - our programme team have been busy building the relationships and mechanisms necessary to facilitate interrelated working based on the MECC model of making every contact count.
We have been able to secure a hot desk arrangement in the Somerstown housing office. We have also created a referral and assessment process specific to this Housing office.
Building on the assumption that our Programme could ultimately support their work, improve the quality of life for their customers –
The Somerstown model & Housing – sharing outcomes: A case study
December 2014 - our Health & Wellbeing workers and many of the Somerstown Housing officers began to work together in earnest. Referrals from Housing into the programme stands at c.10 Somerstown residents
One such referral came through to Julie, one of our Health & wellbeing workers whose specialism is in health eating/weight
What is clear this that the Housing officer in question, in their meeting with their
customer identified that she may need additional support and that our programme may well be able to support her (opportunistic)
They offered her our service and she accepted the invite to engage (appropriate)
(Holistic) She started work on a 1:1 basis with Julie, incidentally it was the national Change4life 'Sugar Swaps' that started her thinking about her levels of sugar consumption. (In the business we call this pre-contemplation).
Together Julie and her client they have created an action plan to take small steps in reducing the amount of smoking (with the help of Pompey Quits) and drinking sugary drinks and she has also agreed to gradually increase her level of physical activity (walking).
She can work with achieving these targets with Julie up to 12 months.
Meanwhile…Julie has also been working with Marshada - the Programme’s Community development lead who has been instrumental in brokering many of the professional relationships required to pilot and test a collaborative and integrated outcomes way of working
One of these relationships has been with Housing’s resident participation team (rpt)
Julie is now collaborating with Racheal from the rpt as they share outcomes for this customer/client - Racheal is working with her customer on her employability skills. Julie, with her client identified that as a result of all the sugary drinks and smoking her teeth are stained, this is impacting on her confidence, in turn impacting on her confidence and ability at interview
Julie & her client have identified a dentist who is taking clients. Racheal is prepared to fund her clients’ descaling as extra with this dentist, working in tandem towards a shared outcome