23rd February 2021 - Homeless health update - London.gov.uk
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23rd February 2021 - Homeless health update Summary This update: ➢ summarises our shared ambition ➢ describes how London partners have responded to the pandemic and learning from that partnership work ➢ outlines the challenges we have met over the pandemic and current challenges and action ➢ sets out the recovery context and key strategic questions for the next phase in the work
Homeless health and the London Vision
Our joint ambition
▪ No rough sleeper to die on the street
▪ No one is discharged from hospital to street
▪ Equal and fair access to healthcare for all who are
homeless
Poor health 45 years
▪ approximately 1 in 3 clinically
Is the average age of
vulnerable to COVID
death of for those who
▪ high level of undiagnosed and
are homeless
untreated chronic disease
▪ a health age equivalent to a
This group have some
population in their 70s or 80s
of the worst health
inequalitiesThe Introduction
London Homeless health COVID Wave 1 experience
• Together London partners have fast-tracked progress filling gaps in accommodation and services for the
homeless population during Wave one of the COVID-19 response.
• Rapidly forging governance structures and relationships to underpin delivery of an integrated health,
care and housing response at pan-London, ICS/sub-regional and local boroughs levels.
• Enabled by significant COVID-19 investment and securing new national funds for accommodation,
mental health, drug and alcohol services, and for hospital discharge.
As at 10 February, at least 7,800 people who were sleeping rough had been placed in emergency accommodation (2,200 in
in GLA provided accommodation and the rest in accommodation provided by London borough councils). Over 3500 of those
people have already moved into suitable next steps accommodation or support.
Wave 1 measures appear to have been successful, with reductions in rough sleeping and no documented major outbreaks
of COVID-19 in homeless settings, unlike many other major cities. Modelling estimates that the preventive measures
imposed might have avoided 21 092 infections, 266 deaths, 1164 hospital admissions, and 338 ICU admissions among the
homeless population.The Partnership – what made it work?
Finalist for Health and Local
- Strong existing relationships – Work on the London Vision Implementation
Government Partnership award
plan, and Life off the Streets Taskforce
- Pooled effort and resources to protect vulnerable group and take opportunity
to end homelessness where possible – commitment and response at all This meant we were housing people and
system levels to maximise impact able to:
- Range of partners – academic, voluntary sector, as well as statutory involved
➢ Actively plan for ‘move on’
in leading and shaping the response
- Access to expertise and service models that meant it was possible to quickly
➢ Assess health and care needs (MDTs)
mobilise provision, and often be ahead of national policy. ➢ Screen for blood borne viruses (43 people
- Significant new investment combined with rapid redeployment of current now being treated for Hep C, 22
resources – freedom try things/commission at speed. diagnosed with HIV and 5 with HepB)
- Leadership – we went from discussing needing senior leadership across health ➢ Plug into drug and alcohol treatment
and housing for the Vision to having that in place (ICS leads and Directors of
Housing) and working through issues together. Full recognition that an
integrated response only way achieve meaningful long term impact.
- Some partnership issues – data and information sharing, boundaries, who
‘owns’ what, but people left organisational and other constraints at the door
and acted in the clearly defined common good.
- Remote working facilitated getting people together at speed. The user perspectiveHow has wave 1 shaped our thinking : Impact and learning
What worked well Building on progress
Strong partnership and leadership across health and housing – opportunities to
Strong emergency partnership integrate further
New ICS homeless health leads and engagement Embed further in new ICS organisations
Access to accommodation critical to public health response and health going
Accommodation available forward – ongoing conversations (borough, sub-regional) to address gaps identified
Self isolation accommodation – jointly provided Joint health and housing funded and NHS/ vol sector provided – new models of care
in step down and other provision
Testing and infection control advice (funded by GLA
Opportunities to build responsive outreach integrated testing (BBV, TB, COVID) and
and every London Borough Director of Public Health). vaccination models
Drugs/Alcohol stabilisation - pan-London co-ordination Continued co-ordination funding, and pan-London commissioning model for
inpatient detoxification, PHE funding for boroughs
Primary care in-reach support (where available)
Embed in ICS primary care work plans – development and spread of expertise
Clinical needs assessment (CHRISP) and MDT Continuing opportunities to pilot and MDT approach, and ongoing use of assessment
tools (blend of clinical and non-clinical)
Rough sleeping and mental health outreach
programme (RAMHP) learning Move from programme delivery into embedding and sustaining provision
Incentivise action and learning across inclusion health groups to improve health
Issues with inclusion health groups similar equityCOVID-19 The current position and challenges
Action
Current position
➢ Testing and Surveillance : Find and Treat team providing
➢ High vulnerability to COVID and inability to self- outreach testing and infection control advice.
isolate - Potential 200 bed accommodation gap over
➢ Wave one model of COVID positive site clinically staffed
winter. 433 people are rough sleeping (at 4th Feb)
➢ High health and social care needs not be possible, but has opened as a COVID isolation
➢ Increasing number of outbreaks in homeless centre with support from Thamesreach.
➢ 4 x COVID positive beds at the Mildmay Hospital
settings
➢ 10 pan-London step-down beds for high complex needs
➢ More positive cases in January than at the peak of at discharge from hospital fully utilized. Beds are funded
wave one
➢ Lack of primary care workforce capacity for the and contracted to the end of March 2021.
➢ £1.5m national funding for Out of Hospital available for
homeless population
➢ Lack of step-down capacity for homeless at step down with Borough/ICS bids made against it.
➢ Ring fenced GLA hotel beds for hospital discharge.
discharge from hospital, particularly an issue for
➢ ICS COVID19 vaccination plans – joint work with
those who are not verified rough sleepers and have
boroughs, NHSE and other on ‘outreach’ vaccination.
no clear local connection.
➢ Boroughs and GLA operating severe weather response
➢ Flu uptake low and larger scale outreach delivery (SWEP) on an ‘in for good basis’
model needed
➢ Borough and GLA work to bring forward units for long
➢ COVID vaccination challenging term support with new government investment.COVID does not change our direction of travel
The Conservative Party
manifesto pledges to fully
enforce the Homelessness
Reduction Act and end rough
sleeping by the end of the next
Parliament.
Downward trend in
Delivering deaths of homeless Improved life
our London
Workstreams Safe discharge from Improved health and expectancy and Ending
Visionto….
contribute NHS organisations housing outcomes healthy life Homelessness
expectancy
ambition Equal access to
healthcare
Process
measures
milestones & Less than 10% of people
baseline classified as homeless in London
are identified as rough sleepers
Our original hypothesis was that if we focus on the action set out we will reduce deaths on the street, improve discharge and access and
therefore improve health and housing for those who are homeless leading to healthier and longer lives for those who have experienced
homelessness.
The COVID response has helped us fast track our progress. London will have gone a significant way towards delivering the London Vision of
no discharge to street by March 2021 and maximising the opportunity of this progress will require continued prioritisation in 21/22 .2020 has altered the context, progress and future potential
What will the recovery context be for Building on 2020 progress… Strategic questions?
homeless health? • Increased joint partnership and planning for • As our joint work becomes more strategic how
An ongoing national commitment to ending Housing & Health with greater collaboration can we maintain the momentum of the COVID
homelessness by 2030. pan-London to resolve issues response?
• Work to support joint partnerships at sub- • How can we build on the existing close
A continuing shortage of supported housing and regional and borough level, building on ICS partnership and move towards integrated health
accommodation options. A number remaining in development and local authority housing governance for this
hotels with high health and care need. • Health needs work informing the design of programme?
support for people according to need • How can we bring the homeless health
Large numbers of rough sleepers have moved into • New funding for drug and alcohol including programme closer to the ICSs and ICPs and
accommodation and had a housing offer but inpatient detoxification address gaps in provision?
require support to maintain their housed status. • Out of hospital funding to close the gap in • Where do we want to focus as a regional
step-down beds combined with increased partnership for maximum impact?
A proportion will return to the street and in a understanding of housing status issues and • What collective action can we take to address
worsening economic situation we anticipate a rise solutions the shortfall in specialist housing
in new homeless. Government action, such as the • Opportunity to scale and sustain new outreach accommodation options?
eviction ban and extension to eviction notice model for mental health • There are high numbers of those who are
period likely to delay risk of homelessness not But considerable challenges: homeless and have no recourse to public funds
avert it. - Continued gaps in health and housing – is there more we can do jointly with the
provision (mental health, social care, primary charitable sector to support this group off the
The challenges of facilitating transitions and care, supported housing, suitable hostel streets and engage national government on
access for those with NRPF is likely to return as environments) costs to boroughs?
COVID-19 measures are relaxed. - Large numbers of those with NRPF • How can we deliver a trauma informed
- Housing status challenges at the point of approach to care and support alongside
NHS and Local Authority return to business as discharge from hospital. accommodation offers?
usual. - Continued management of COVID • What can we do to move from addressing rough
sleeping to preventing homelessness?Within one year we will need a reassessment of priorities
Emergency Response Recovery
Accelerated Unlock joint Agree
Embed changes in Reassess London
London Vision barriers to Joint
local systems Priorities
Delivery hospital discharge Ambition
COVID has galvanised all • COVID (current wave) • COVID continued • COVID management • COVID management
London partners to prioritise • Vaccination response • Moved on from • Joint Health and
the homeless. • Continue to accelerate • Establish housing and emergency Housing Priorities
delivery of London’s health joint accommodation • Preventing
Vision programme leadership • Stocktake London’s homelessness
Through collective action as a
• Address gaps in arrangements new position • Population health
partnership we have
discharge provision for • Support joint housing • Updated picture of management approach
demonstrated the art of the
people with no local + health arrangements homelessness in • Improving the quality
possible. in each ICS
connection/not London of care
verified rough sleepers • Case for joint health
We cannot allow this progress
• Address gaps in and housing action
to reverse and must maintain
discharge provision for
momentum. people with high level
health and care needsYou can also read
