Hope, Health, Homelessness and Habits Neil Hamlet – Consultant, Public Health Medicine, NHS Fife -...
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Transcript of Hope, Health, Homelessness and Habits Neil Hamlet – Consultant, Public Health Medicine, NHS Fife -...
Hope, Health, Homelessnes
s and Habits
Neil Hamlet – Consultant, Public Health Medicine, NHS Fife
- National Public Health Lead for Homelessness
HousingADPsNHS
HSCP
Personalised Paths and Potholes
Rafters
Relationships
Proportionate Contribution by Cause - Males
External Causes, Chronic Liver Disease
Proportionate Contribution by Cause - Males
A/E, Mental Health, Orthopaedics
Diseases of
‘dis – ease’
Alcohol Services
Stroke Unit
Respiratory Unit
Cardiology
Cancer Services
‘Despite the common sense… we still categorise people in separate boxes defined by single issues… Each of
these labels triggers a different response from statutory and voluntary systems, different
attitudes from the public and media, different theoretical approaches from
universities, different prescriptions from policy makers’
Hard Edges 2015, Lankelly Chase Foundation
Key Learning• Multiple Exclusion Homelessness – overlap with
mental ill-health, alcohol and substance misuse, offending and prison
• Early childhood trauma often lies at the root• Visible homelessness happens late• The need for ‘psychologically informed practice’• The contribution of housing and ADP actions to
health and social care• Importance of ‘home’ and environment -
Home as bedrock of security, dignity , relationship and opportunity
• High costs of ‘failure demand’ – to individuals, families, services and society
ScotPHN is hosted by
Novel Approach‘Do things differently – do different
things’• Till – Sow – Nurture – Reap – (Repeat)• Boundary Spanning & ‘Housing Speak’ • Wide engagement and conversations• Soaked in evidence – lived and
published• Snowballing the passion• From a ‘Report’ to an ‘Movement’ScotPHN is hosted by
•What other ‘professional’ or ‘service’ languages are you using ?
•What ’boundaries’ have you spanned recently?
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
200
400
600
800
1,000
1,200
1,400
A&E Attendance Rate per 1,000 Popula-tion
Attendances at Queen Margaret Hospital (Dunfermline) and Victoria Hospital
(Kirkcaldy)
MaleFemale
The impact of homelessness on health care – proving the case
‘Insecurely Housed’ ‘Securely Housed’
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
50
100
150
200
250
Patient Multiple Attendance Rate per 1,000 PopulationPatients who have attended A&E more than once within
specified year
Male Female
The FrequentFliers
‘Insecurely Housed’ ‘Securely Housed’
Cryers
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
0%
5%
10%
15%
20%
25%
30%
35%
40%
% New Outpatient Appointments DNANew appointments who Did Not Attend
(excludes cancellations by hospital or patient)
• Changed address• Fearful to open official
mail• Appointment too early• No money for the bus• ‘it won’t do any good’Access / Expectation
‘Insecurely Housed’ ‘Securely Housed’
HL1
Fife
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Age Distribution of A&E Attendances; 2013Age of patient attending A&E
Under 15 15 to 19 20 to 29 30 to 3940 to 49 50 to 64 65+
Over 50% are under 30 yrs
Over 80% are under 40 yrs
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
15
30
45
60
75
90
0%
5%
10%
15%
20%
25%
30%
Alcohol-related Admissions rate per 1,000 and % of AdmissionsAdmissions with diagnosis related to alcohol based on ISD definition
%Rate
Rate
per
1,0
00 P
opul
ation
% of Adm
issions
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
10
20
30
40
50
60
0%
5%
10%
15%
20%
Drug Misuse-related Admissions rate per 1,000 and % of AdmissionsAdmissions with diagnosis related to drug misuse based on ISD def-
inition
%
Rate
Rate
per
1,0
00 P
opul
ation
% of Adm
issions
Clear role for Community Safety Partnerships ?
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)
-
10
20
30
40
50
60
70
80
90
100
Emergency Admission Rate relating to Injury & Poisoning per 1,000 PopPatients admitted as emergency relating to injury and poisoning (ICD10 codes
S00 - T99)
Violence +++& Self Harm
The cost of ‘Churn’
- Source data from Lankelly Chase Foundation 2015.
- Data is English – but directly transferable
- Estimate is considered conservative.
- General estimates of lifetime costs (to society) per individual range from £250k to over £1m.
Chief Scientist funded pilot to test Fife approach nationally
The Integration Landscape
• Scottish Government funded initiative
• Support Integration Authorities with Strategic Planning by;
Providing data and analytical support
Help to evaluate services, through providing evidence for change
Help to transform data into evidence for action
A&E Outpatients
InpatientsDay cases
Deaths
Prescribing
Age/gender
CHI
Linked File
SPARRA
Social Care
SIMD
Linked Health and Social care
file at an individual service
user level (Aggregated
Activity & Costs)
Partnership
Access
Via secure
platform
Integrated Data:Health & Social Care Integration and
Information Platform
£costed
CommunityHousing & Homelessness
data
Where are you re sharing ADP
data with partners ?
• Forecasting / Scenario Planning
• Pathway Analysis
• Impact analysis (evaluation)
• Care Group Development
• Continued Dashboard development
The Future
Data Gaps and Data Set Evolution – include linked Community Nursing activity from April 2016
and Homelessness and Housing from April 2017
Links to Other Areas (Third Sector)
• Personal Outcomes
2015 to 2017
We need both knowledge and know-how
• With social interventions:– there is no single method or formula– what is done and achieved will vary from case to case– routinisation often hinders performance– flexibility, responsiveness, and context-specific approaches
are essential
• Know-how “moulds and supports the practice used in a field as performed by those skilled in the art”
(Nelson, 2010)
An alternative ‘solution space’(Wilber’s integral model)
Problem labelling
Service solutions
Inner Trauma
SharingCaring
What Now .......• Iceberg of vulnerability
•Sticky Scotch Pies
•Home as salutogenic ‘Place’
Home
A HOME
Homeless
Problem
Alcohol
Proble
m
Drug
Prob
lem
Domestic
Abuse
Problem
Criminal Justice
Problem
Wounded Lonely Soul
Paddington
Bear
Lonely, Unloved• The most terrible poverty is loneliness, and
the feeling of being unloved. (Mother Teresa)
• When you're surrounded by all these people, it can be lonelier than when you're by yourself. You can be in a huge crowd, but if you don't feel like you can trust anyone or talk to anybody, you feel like you're really alone. (Fiona Apple)
• If one's different, one's bound to be lonely. (Aldous Huxley)
The Enquiry has recognised the size and relatively recent emergence of Scotland’s drug and alcohol problems. Its judgement is that we need to look to the whole of Scottish society – our inequalities, our consumer culture, our failure to protect young people and much else – for the underlying causes.
We heard a strong critique of Scotland’s drugs and alcohol policies in recent years. To date, drug policy in Scotland has swayed between a focus on health and a focus on criminal justice concerns. There is a need to accept that alcohol and drug problems are fundamentally social problems. This means moving beyond medicalised or criminal justice approaches to creating a new holistic response that addresses a much wider agenda. This has to focus on purpose and meaning, child and family welfare, employability, family support and community will.
In the face of complexity and the understandable desire to make a plethora of recommendations, the Enquiry took a conscious decision to limit its suggestions to two major thrusts. The first is the adoption of a ‘whole population approach’ – melt the iceberg of drugs and alcohol by raising the temperature of the water; and the second is a personalised approach to supporting those with ‘overwhelming involvement’ – ‘the circle of care’.
Warm the water
Keep chipping
away
Statutory Homeless
Domestic Abuse
Childhood Trauma
AddictionCriminal Justice
Relational Breakdown
'Houseless and Hungry' by Luke Fildes depicting homeless paupers queuing outside the casual ward of a London
workhouse
Meeting the deep needs of safety, relationship, dignity, belonging and
purpose
What part can ADPs play in helping to change the
causes and consequences of
homelessness in Scotland ?
www.housingandwellbeing.org
http://www.scotphn.net/projects/previous_projects/homelessness_guidance_for_public_health
12 Proposed Actions:1. At-risk population groups,
circumstances and key transition points - for prevention and mitigation
2. Health Inequalities Strategies - to include homelessness underpinned by needs assessments
3. Housing and health literacy - workforce development on risk factors and routes into homelessness
4. Psychologically informed environments and services – accessible person-centred approach
12 Proposed Actions:5. Partnership Pilots – linking housing, ADPs,
mental health, criminal justice and SPS
6. Housing First – spread across Councils and further evidence the Scottish model for MEH community
7. Engagement with early-years, schools and colleges – on awareness of transition points and routes into homelessness
8. Integration of housing into HSCPs – focussing on those with most complex needs
12 Proposed Actions:
9. Data sharing - sign up to pilot data linkage
10. Data analysis - for prevention and mitigation
11. Faculty of Homelessness & Inclusion
Health - workforce development, peer support and
shared learning
12. Executive leadership – to champion the
home as the key salutogenic place factor for
wellbeing