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Health Inclusion Project
This project aims to reduce inequalities accessing healthcare for homeless people. To this end, it will for the first time, engage strategically with the homeless sector and health bodies, providing a national platform for health and homelessness and brokering relationships between statutory and voluntary sectors. It will identify and promote innovation and good practice in primary and mental health, and substance misuse in a range of homeless service settings, as well as ensuring agencies understand the latest policy and feed into its development. It also aims to increase awareness of homeless people’s issues within the health sector to ensure more equal access.
We intend homeless agencies to have a better understanding of the new National Health Service, the NTA, DATs and the Primary Care Trust structure its policy and practice. We will look at how these structures link with Social Services to ensure the promotion of mental health and to reduce the discrimination and social exclusion of homeless people. The project will ensure through good information, capacity building and relationship brokering that both on a national and local basis we and our members can improve access to health care for homeless people to reduce inequalities. Within this it would have an impact on reducing infant mortality by improving the health of homeless mothers and pregnant women in temporary accommodation, and on increasing life expectancy in improving the general health of homeless people so they live longer (current life expectancy 42 years old). The project will:
- Identify, develop, evaluate and disseminate models of innovative partnership working between homeless agencies and healthcare bodies (to include primary healthcare, mental health and substance misuse) and produce guidance for members.
- Pilot a protocol for appropriate discharge of homeless people, to include early case conferencing and information sharing with homeless agencies. This aims to promote planned discharges and appropriate after care.
- Work for a better understanding amongst GPs of the needs and issues of homeless people, producing a training pack for GPs, Dentists, A&E staff, Chiropodists Paramedics, and their staff.
- Investigate, evaluate and write good practice guidance on homelessness and health care for emergency accommodation, resettlement services, and day centres.
- Broker relationships between homeless agencies and health bodies such as DATs, PCTs and Strategic Health Authorities, through working in partnership with organisations at a national level and running joint events. This work would also include promoting link up between local authority homelessness strategies and HIMPs.
- Promote user involvement in the development and running of health and support services for homeless people.
- Develop and deliver new training on health for agencies working with homeless people.
- Brief homeless organisations on new policy and guidance and use their expertise to inform policy development
At national and regional events and in policy consultations members have consistently reported that they do not understand the new NHS and in a survey of members we conducted this year, less than a quarter had any link with PCTs. Agencies also reported a need for more understanding of homeless people amongst GPs as registration and access to GP surgeries is difficult. This often means homeless people are being dealt with in crisis in A&E rather than in a preventative way, which was also found in the Shelter report, Go Home and Rest (1996). We only know of a handful of discharge protocols between hospitals and homeless agencies. Finally, a report produced by ODPM, stated that the discharge from hospital of homeless people could be more positive with good supportive partnerships between hospitals and local homeless agencies. (Preventing tomorrow’s rough sleepers 2001
Evaluation
We intend at the start of the project to establish a baseline with regards to accessibility of health care for homeless people, in particular GPs, hospital discharge procedures, the understanding of health issues by members and the extent of relationships with health care bodies. This will be revisited over the life of the project to assess how it is achieving its objectives. All outputs, such as the training pack, discharge policy, training and events will solicit feedback from users. The project will offer added value through its partnerships. For example we plan to run a conference with Homed the medical students organisation which aims to increase the education and involvement of medical students in the field of homelessness. We also plan to link with Health Action at Crisis in their work with London boroughs around their HIMPs and homelessness strategies, and with Groundswell UK to develop sources of advice for involving service users in health care. Other departments within Homeless Link will also offer some support to the project, such as training and publicity, and information will be publicised widely through our website. This in addition to our ability to call on the experience of our members means that we are able to offer a comprehensive service built on sharing of best practice at minimal cost.
Dissemination
We will disseminate the work of the project in a variety of ways. A number of the briefings will be published in our magazine Connect and on our website and we provide a monthly mailing to our members where information will be disseminated. The good practice guidance for resettlement services, emergency accommodation and day centres will be published as new sections for our existing handbooks in these areas. We will also use a variety of events both national and local to disseminate information. We will also ensure that we speak at events arranged by other organisations to ensure a wide reach. The training pack will be a published document. For published documents we plan for some of the initial costs to come from the grant, but we will also be seeking sponsorship for these publications.
- The Hospital Admissions and Discharge Protocol has now been published which supports hospitals draw up their own protocols for the admission and discharge of people who are homeless. Also includes four supporting fact sheets.
Partnerships
We will seek to work with a number of other voluntary organisations to maximise our effectiveness, resources and reach, both on good practice and policy work. We have agreed to work with Homed, to address future GPs understanding of homelessness, Groundswell UK to ensure a user involvement aspect to work and publications especially the training pack and models of partnership, and Health Action at Crisis working with London boroughs. We will also seek to work with other organisations on policy and good practice work and will investigate others as the project begins work. We have agreed to work with the RCGP on the GPs training pack, conference and awareness more generally. We will also share information with our sister organisations in Scotland and Northern Ireland members in Wales and European partners through FEANTSA. We have a close relationship with the Homelessness Directorate (ODPM) on the homelessness agenda and would continue to work with them to further this project.