In a previous article I wrote that, homelessness is rarely fully solved by just finding someone a place to live. It may solve the immediate practical issue but it doesn’t address the underlying problem.
Another dimension to homelessness is the way it can impact on the National Health Service. There are 2 broad areas that can drive cost in the service:
- People delayed from hospital discharge as they are homeless, or at risk of being homeless – i.e. a “bed-blocking
- People who disproportionately use acute services e.g. A&E e. “High Impact Users”.
These represent a drain on NHS resources but the health service is not well-placed to mitigate the impact. The sociological root causes have tentacles across many disciplines, public bodies, and societal issues.
Derventio Housing Trust is a Derby based registered Social Landlord providing accommodation to those who are homeless, or at risk of being homeless. In October 2013 they started a project called “Healthy Futures” initially funded by the Department of Health’s Homeless Hospital Discharge Fund. Its basic objective was to make a measurable reduction in the level of “bed-blocking” and the cost to the NHS of “High Impact Users”. Although this was initially Derby focussed, it now covers the whole of Derbyshire, excluding High Peak. The service is staffed by 2.5 people plus 1 manager, Helen Repton, who, between them, have experience in a range of services including homelessness, Women’s Refuge, Domestic Violence, working with offenders, Drug and Alcohol treatment, supported housing to name just a few.
I spoke with Helen to understand more about the project.
In the last 2 years, they have provided a service to 265 people, all of whom were different and demanding in their own unique ways. They benefited from a range of services from brief intervention with limited support, signposting and a helping hand to those who were very complex cases requiring a 3 month + intensive support. The people had a wide range of physical and mental health issues.
People who were helped by the project are referred principally by the NHS, but sometimes by social services. Helen is the first contact point and will visit the hospital to make the initial assessment and formulate a plan. She will review all aspects of the client’s finances, housing status, offending history, and medical situation, whilst considering their future needs and aspirations. This is not always easy to establish as many of the clients had mental health issues and/or an alcohol dependency. Diligence in gathering the information is critical to ensuring that the options considered result in favourable outcomes for the client.
As Healthy Futures is part of Derventio, identifying housing is a smoother process. Recently, the project has been allocated 10 dedicated homes for it to use as bridging accommodation. It is also connected to a wider population of properties through its links in the housing networks. In many ways this is the easy bit – ensuring that it is a sustainable solution for the client is the aspect which requires an on-going, individual support which is agile enough to respond to the swings and movements in the client’s personal circumstances.
Helen told me a story of a woman in her late 50s. Her long-term relationship had broken down, her children had grown up and left, and she was unwell. She was very depressed and tried to commit suicide, and was very difficult to engage with, with little eye contact. They continued to work with her, and gradually, progress was made. Initially she had no house, no income, no benefits, no furniture and so the task for Healthy Futures was to recreate her life.
The case worker helped her to get benefits, and a property through a Housing Association. Then, through a Local Assistance Scheme managed to get some funds to help with basic furniture and belongings. The woman used to have a very busy life, and a full social calendar. They helped her to re-engage with the community, joining groups and addressing her depression. The initial hand-holding guided her through this and, as her health started to improve, they pulled away and now see less of her as she has recovered her confidence, and her former self.
Another woman that they helped was in a very bad way when Helen first met her.
“The first time I went to assess her, she was in hospital, and I explained to her who I was, and what I was there to do…and she was crying, and she just looked at me and said ‘Why would you want to help me?’ – that shows how low she was”
She had physical and mental health problems. Post traumatic stress disorder from an historic incident, depression and anxiety from her conditions, chronic lung disease and a broken sternum. She was in rented accommodation but had got into arrears as a result of the bedroom tax . She understood that she would have to leave and would be homeless. Helen’s first action was to negotiate with the landlord to allow the woman to stay while she was sorting herself out. She applied to a private fund to get the rent arrears paid.
When that was resolved she took her to the Council to register as homeless. They arranged a ground floor property for her, secured Housing Benefits, and then had a dialogue with social services about her teenage daughter.
Part of the woman’s anxiety and depression came from her lung condition and the equipment she had to wear and the effect it had on her lifestyle. Helen worked with the respiratory team to obtain more modern solutions which negated the need for the machinery.
And, gradually, over a long period of time the woman was able to start functioning normally and manage her life in her new home.
The “High Impact User” cases can result from a simple misunderstanding the purpose of A&E. Some people see it is an opportunity to be given attention, warm surroundings, and some can’t avoid it as they are chronically ill from alcohol dependency. For the latter, Healthy Futures will support the client in engaging with the appropriate support groups. The attention seeking / personality disorders are difficult to get diagnosed and therefore unlikely to be well-treated in the mainstream. Healthy Futures / Derventio have a number of schemes which help people work through some of their issues, and allow them to focus on something else:
“A lot of it is about finding people something meaningful to do with their time and very often that is a barrier against what we’re trying to achieve, as people are bored or haven’t got a goal or anything to get up for in the morning.”
The benefits to the individuals are obvious and beyond what can be measured. The project has in place a number of methods of measuring and monitoring the benefits to the NHS, and specifically on its declared priority areas. Within the population of people they have helped they have
- Reduced avoidable admissions by 88%
- Reduced hospital stay, after re-admission, by 16 days
- Reduced harmful alcohol consumption by 90%
- Improved mental health and well-being by 66%
The Healthy Futures evaluation report highlights the story of a man, David, who had been admitted to A&E via 999 ambulance 22 times in a 12 month period, and been in hospital for 4 de-toxes, committed theft amongst other issues. This chaotic lifestyle was significantly reduced by Healthy Futures with a financial benefit to the various services calculated at £50,686.
One of the ways Healthy Futures helped David was by linking in to another Derventio Project, Growing Lives. The “Men in Sheds” concept which underpins aspects of their projects is based around peer-based support which brings men together in an environment where they can be supportive in the pursuit of a project/task that they agree to do. The Growing Lives project gives people the opportunity to be involved in gardening, cooking and arts & crafts which is designed to improve confidence, and provide mutual support.
The skill, and art, of the small Healthy Futures project team is using their combined years of experience and intuition in a variety of disciplines to shape a carefully considered series of steps which are needed to achieve each individual person’s needs and aspirations. Although it would be desirable to have high quantities of successes, each one must be delivered thoroughly and with patience to ensure that it is sustainable. Only time will tell on that for all clients. But there is one thing that is certain, and that is that without this type of approach the majority of the clients would have been destined to a miserable life, battling with their demons, constantly in fear of homelessness, and being a constant burden on the heavily stretched NHS.
Categories: Homelessness / poverty