The link between homelessness and poor health is well documented, with data indicating that the number of A&E visits and hospital admissions per homeless person is four times higher than for the general public. But what part can housing associations play in breaking that link?
Homes for Cathy recently caught up with Rebecca Whittle, Neighbourhoods Strategic Lead at ForHousing, to find out more about its new housing-led ‘Homeless Discharge Support’ pilot, a collaborative project with Salford Primary Care Together (SPCT), Salford City Council, Greater Manchester Housing and Social Care Partnership and Greater Manchester Mental Health Service that aims to improve health outcomes for rough sleepers leaving hospital.
There’s clear evidence that good quality housing is not only critical for good health but also reduces demand for NHS services, so it’s great to see an example of joined up working between housing and health providers. How did the partnership with SPCT come about?
The initial idea came from discussions with the GP Clinical Lead for the SPCT Inclusion Service, Dr Wan-Ley Yeung, who provides a GP inclusion service for homeless patients within Salford. We were both concerned that individuals were being discharged from hospital and weren’t engaging with ongoing medical treatment, because they were either returning to the streets or being placed into temporary accommodation which wasn’t wholly suitable given their on-going medical needs.
We’re quite fortunate in Salford in terms of homelessness provision; Reducing homelessness is a priority for Salford City Council and they are very successful in attracting government funding to end homelessness, with lots of different initiatives in place to prevent people from having no option other than to sleep on the streets. What’s important is that we make sure that the provision is suitable for all individuals. In the past, people with no fixed abode and ongoing medical needs would have either been unable to be discharged from hospital, or picked up by the local authority and put in a provision that wasn’t entirely suitable for their ongoing medical treatment and rehabilitation.
In partnership with SPCT and Salford City Council’s associated departments including adult social care, housing options and supported tenancies, we successfully applied for funding through Greater Manchester Health and Social Care Partnership to the Department of Health and Social Care’s (DHSC) shared outcomes fund. We were awarded approximately £450,000, which covers accommodation costs as well as a support element.
The whole concept is to take a test and learn approach to inform future commissioning and future service delivery, to ensure safe discharge from Salford Royal Hospital for those people that are either;
- medically optimised for discharge but would be returning to the streets or
- going to accommodation that wouldn’t be able to meet their needs adequately or
- For those who are medically fit for discharge but have ongoing health needs requiring further clinical support
How is the scheme working in practice?
ForHousing is the landlord and we are providing eight self-contained properties that are all accessible for individuals with mobility difficulties. The aim is not only that individuals can be safe within that accommodation but that we can work closely with them for a greater chance of securing settled accommodation. Health, social care and housing services work closely in partnership to provide wrap around intensive support for each person to improve their health outcomes and also their life skills and tenancy skills, so they have more likelihood of being able to move on to more secure, permanent accommodation in the long term.
In terms of the support, there’s a dedicated housing support officer for the eight properties and they work alongside Salford City Council’s Supported Housing Service who provide two dedicated support workers to support the individuals both in this accommodation and in their future move on home. The reason why we’ve taken that combined approach is we know it’s really important to have the engagement of housing options for move-on to suitable long-term housing. They have access to a full range of accommodation, particularly if that individual has aspirations to move to a locality where ForHousing doesn’t have properties.
With regards to move-on, there’s a guiding principle of three months but all the partners are extremely committed to the fundamental principle that the service priority is about supporting individuals, so we won’t necessarily be working to timescales – ultimately we need to go at the individual’s own pace. We’ve also been very clear from the outset that if a tenant moves into a property, develops a really good support network within the local community and is thriving where they are, we won’t uproot them to another area for long-term housing. We’ll convert the accommodation into a general needs tenancy and identify another property to bring into the scheme.
Are there any particular barriers that you have had to overcome in setting up the scheme?
It’s still very early days but one difficulty has been around the availability of social care support in the community. There have been situations where people were medically ready to be discharged, and we had a home available for them, but the care support wasn’t in place, so the person was effectively classified as a delayed discharge. It’s for this reason that the pilot is being evaluated by King’s College London, in order to inform further research into the delays in hospital discharge that are occurring nationally.
The launch of integrated care systems (ICSs) in 2018 was intended to deepen the relationship between NHS, local councils and other strategic partners. How easy has it been for you to get housing’s voice heard in local health commissioning?
For a number of years it’s been quite difficult for us to get engagement with health partners; it’s taken a lot of tenacity, banging on doors and literally turning up to every event possible saying ‘Hi, we’re here’. Ultimately, this project has come about through our shared passion for supporting people. SPCT recognises that, as an organisation, ForHousing is really committed to ending homelessness; consequently, they see us as an equal partner. We’re open to exploring opportunities and taking risks, and because SPCT can see our passion, they’ve been happy to bring us along on the journey.
What advice would you give to other Homes for Cathy members seeking to forge stronger partnerships with their local health agencies?
As an organisation, ForHousing is quite bold in the way we articulate our ambition around wellbeing; social housing is not just about bricks and mortar, it’s about improving people’s lives. We’re not a housing association that gives people a set of keys and only contacts them when they need to pay their rent. Because we articulate our vision and are prepared to take risks, other agencies such as health are willing to partner with us. We’re also open to the fact that sometimes things won’t always work; the key is to learn and adapt from that.
Find out more about how the Discharge to Assess scheme has helped Tom here.
ForHousing is a progressive landlord that owns and manages more than 24,000 homes and delivers housing management services for other landlords across the North West.