HOMELESSNESS: HEALTH POLICY CONTEXT FROM A NATIONAL PERSPECTIVE Martin Gibbs

1. HOMELESSNESS: HEALTH POLICY CONTEXT FROM A NATIONAL PERSPECTIVE Martin Gibbs Health Inequalities Unit Department of Health Public Health Homelessness Session Birmingham 19 October 2011

2. Policy context – Homelessness a key priority • Coalition Government committed to protecting the most vulnerable • Commitment to tackling homelessness and rough sleeping • Ministerial Working Group on homelessness • £400 million over next 4 years to tackle and prevent homelessness - maintained level of investment • £6.5 billion for Supporting People over next 4 years - less than 1 per cent average cash reduction • £37.5 million for Homelessness Change Programme – new hostel investment from April 2012

3. Ministerial Group on Homelessness • Aims to address the complex causes of homelessness and rough sleeping • Clear strategic commitment by Ministers from eight Government departments across Whitehall • Early progress includes clear statements on homelessness in the Public Health White Paper, the OffenderRehabilitation Green Paper and the Drugs and Mental Health Strategies. • Cross-Government reportpublishedin July • Next report Spring 2012

4. Policy context – Homelessness and health Health inequalities: Tackling health inequalities is a Government priority, part of a wider focus on fairness and social justice. Everyone should have the same opportunities to lead a healthy life, no matter where they live or who they are. As well as helping people live longer, healthier and more fulfilling lives, we aim to improve the health of the poorest fastest.

5. Policy context – Homelessness and health Inclusion Health: The health needs of the most vulnerable people are being addressed through the Inclusion Health programme, which will focus on improving access and outcomes for vulnerable groups. Groups include the homeless and rough sleepers.

6. Homeless – their health • Homeless people have significantly higher levels of premature mortality and mental and physical ill health than the general population. • As many as 40% of rough sleepers have multiple concurrent health needs relating to mental, physical health and substance misuse • Of those registered at Cambridge Access Surgery, a homeless specialist GP practice, 2-3% died each year between 2003-2008 and the average age of those who died was 44. • Rough sleepers are 35 times more likely to commit suicide than the general population • Homeless people have higher rates of tuberculosis (TB), bronchitis, foot problems and infections than the general population

7. Homeless – access to services • Street homeless people are 40 times more likely than the general population not to be registered with a GP. • 31 of 125 PCTs surveyed operate an outreach team for homeless people • Homeless people are estimated to consume 8 times more hospital inpatient services than the general population of similar age and make 5 times more A&E visits • During 2007/08, 13,000 NFA patients access hospital services

8. How are we moving ahead? • Health reforms – building into the new system • Inclusion Health • Specific commitments in Vision to end Rough Sleeping

9. Reform agenda - headlines • NHS Commissioning Board • Clinical commissioning groups • Public Health England • Public health role for local authorities • New core role for Dept. Health • Strengthened roles for Monitor, CQC and NICE And underpinning this: • Greater democratic legitimacy and patient involvement And crucially: • Reducing health inequalities will be a priority for the NHS, Public Health England and local authorities

10. NHS reform – health inequalities • Duty on Secretary of State. • Duties on the NHSCB and CCGs to have regard to the need to reduce health inequalities • Outcomes Frameworks for the NHS and Public Health with inequalities and equalities at their heart • Allocations for GP consortia: ACRA to address the issue of unmet need. • Inclusion health – better outcomes for the most excluded

11. Public health reform – health inequalities • Health and Wellbeing Boards • Joint health and wellbeing strategies, drawing on Joint Strategic Needs Assessments • Directors of Public Health in local authorities • Ring-fenced public health grant - based on relative population health need and weighted for inequalities • Health premium - designed to incentivise action to reduce health inequalities

12. Inclusion Health • National Board • Four working groups: Leadership and Workforce Data, research and commissioning Provision, promotion and prevention Assurance and accountability • Workplan

13. Rough sleeping - commitments Access healthcare • Support health and wellbeing boards to ensure that the needs of vulnerable groups are better reflected in Joint Strategic Needs Assessments • The National Inclusion Health Board will work with the NHS, local government and others to identify what more must be done to include the needs of homeless people in the commissioning of health services • Highlight the role of specialist services in treating homeless people, including those with a dual diagnosis of co-existing mental health and drug and alcohol problems

14. Rough sleeping - commitments Help prevent homelessness • The National Inclusion Health Board will work with the NHS, local government and others to identify what more must to be done to prevent people at risk of rough sleeping being discharged from hospital without accommodation.