the home & health relationship 28th february 2017 · charter for homeless health in december...
TRANSCRIPT
The Home & Health Relationship 28th February 2017
Sarah McGrady & Laura Paterson
Agenda for Today Overview of our (PBR based) commissioned service for Homeless people and Rough Sleepers in Cheshire West and Chester (CWAC)
Briefly identify our service product, range and types
Homeless health ~ what's happening nationally
Discuss trends and emergent themes
Our response in Cheshire West & Chester
Practical implementation, what’s promising and emergent
Question and answer session
Provide an opportunity for Questions & Answers
All about us ......
◊ Cheshire West & Chester’s commissioned service for rough sleepers and single homeless
◊ In contract since November 2012 working across 350 sq miles including urban and rural areas
◊ Commissioned after extensive research and dialogue with key stakeholders
◊ Blend of Core and PBR based payments – outcome based
◊ Different approach ...... Progressive, transactional, non-dependant, sector move away from palliative .....
Our Service combines ◊ 24 hour hub and spoke
◊ High quality places of change with service tolerances to leave #nooneoutinthecold
◊ Assertive, persistent outreach involving foot, cycle and state of the art vehicle
◊ PBR across sustainability outcomes .... complex needs, meaningful activity and throughput
◊ Housing First, female only, dispersed and pets@home
Progress ......... • PBR performance of 93% for 2016; • High level performance relating to reconnection outcomes; • Complex Needs Service now sub regional and delivering
against the MEAM coalition model with high level outcomes;
• ‘’This is the best homeless service in the North West *’’
* Kris Hopkins Minister for Homelessness Site Visit 2015
What do we know about Homeless Health
◊ Significant health inequalities exist .....
◊ Cost of unscheduled care is x 8 times higher than the housed pop.
◊ Homeless people attend A and E five times as often as housed pop.
◊ Mortality rates are 47 (m) and 43 (f)
◊ Low expectations from cohort (not involved/inflexible/can’t engage/stigmatised)
And also ............
• Many homeless people experience long term and chronic conditions including wound infections, respiratory and CVH issues • Over-represented as ‘frequent flyers’ in A & E but attrition rates are high at 40% plus after triage and before treatment • Disproportionate rates of TB, Hep C and HIV • Provided limited choice in respect of end of life planning
Increasing number of homeless deaths in the area CWAC’s Health and Wellbeing Board signed up to the St Mungo’s Charter for Homeless Health in December 2015. Gave commitment to: • identify health needs amongst homeless people; • provide leadership on addressing homeless health, commission for inclusion & ensure that local health services meet the needs of people and are accessible
Rationale for a CWAC Health Needs Audit
CWAC Health Needs Audit
• National Homeless Link audit used and adapted • Extensive Hard copy survey used directly with 69 homeless service users • Additional soft testing through focus groups, interactive sessions and online completions • Steering Group formed with LA, Providers, service user Input and Graduate Researcher
HNA Findings (1/2) • 94% registered with a GP – indictment of specialist service in
Chester • 69% of respondents identified a mental health issue compared with
44% nationally • Higher prevalence when compared with other LA’s in homeless
people who have previous institutional backgrounds
• 41% with an identified alcohol problem that was affecting day to day living of the individual
HNA Findings (2/2) • At the point of survey 50% of sample group had reached
average mortality peak for rough sleepers • 70% had frequent contact with A and E • 40% of respondents with physical health issues stated they
would like more help than is provided
• 54% had been admitted to hospital in the last twelve months
Our Survey Group said .... (1/2) ◊ ‘Health care professionals don't always understand our needs
and don't always listen’.
◊ ‘Its impossible to prioritise your health when surviving on the streets’
◊ ‘Drugs and Alcohol are used as coping mechanisms – why change’
◊ ‘We find it difficult to fit in to the systems, ways, .....’
◊ ‘Can feel like one size needs to fit all .....’
Our Service users @ FENW said .... (2/2)
◊ ‘If I was approaching end of life I would like to die in comfort, in my home ........’
◊ ‘I would like to die with my gang not a hospice, I think this might extend my life ........’
◊ ‘I reckon quality of life is better here in my home, where staff know me and I can trust them .......’
Taking our work forwards ...
We were already on our own end of life journey .....
Worked with (so far?) London Pathway, CCG, Public Health, Local Hospices, Specialist GP and our customers
We hit some obstacles .......... Thresholds between care/housing support/clinical risk/ethics/fit/appetite ....... We are resilient! We have developed a Service Specification, MOU’s And SLA’s ..........
Time Targeted (trackable, not too much, not too little)
We are still on the journey but now have ....
Service Specification detailing: - Partnerships, policy, process, risk management, governance,
pathways, outcomes and vision 21st Century Medical Room for: - access to treatment, Skype to GP, Health Needs MOT, Screening for
BBV, Immunisations, Visits from Optical, Dental, Sexual Health End of Life Suite providing: - state of the art facilities equipped with sluice, medical bed,
medication storage, level access wet room, kitchen, overnight visitor facility, rest areas and a very tranquil panorama
Medical Health Suite & Respite • Provision of step up & step down medical respite
• Aims are to:
– Reduce future hospital admissions
– Reduce inpatient days
– Reduce hospital readmissions
– Improve housing outcomes
– Improve health outcomes
“A good idea, I would have benefitted from it after my head injury”
Contact Details:
Sarah McGrady [email protected]
www.fenw.co.uk Tweet us @Foundation_NW
Laura Paterson Freelance Housing Consultant
For Rob
01.12.53 – 17.02.17