Issue - items at meetings - Update on Homeless Healthcare

33.1    Alistair Hill, Consultant in Public Health, Sue Forrest, Project Manager, Homelessness, Better Care  and Dr Tim Worthley, GP from Morley Street, spoke to members about homeless healthcare.

33.2    The update had been requested following a scrutiny panel looking at homelessness, which had developed a homeless healthcare workstream.  This was part of the Better Care Fund work focussing on the local frail population, which includes homeless people particularly the single homeless population.

            Dr Hill gave some context about the homeless situation locally, and some of the healthcare models that had been put into place to try and address a high level of need. Brighton and Hove is very lucky to have a dedicated homeless GP practice at Morley St.

            The team have involved service users as much as possible in designing services so that they are the most user friendly and person-centred.

33.3    Members asked questions and commented on the paper:

·         Is the funding sufficient to provide the service needed? Dr Hill said that the homeless services were being set up to deal with other gaps in the support system, but they were focussing on prevention where possible.

·         What different client groups make up the homeless population? Dr Worthley said that Morley St practice had approximately 1200 people on their books, all who were in some state of homelessness. There was a minority of ex-forces personnel. There was a very high percentage of ex-offenders – Dr Worthley felt that for a lot of people, offending was part of the homeless journey as you may well have to commit an offence in order to survive. GPs are unable to access medical records from prison so the GP has to start medical notes from the beginning. There have been many attempts to address this with the local prison but more efforts will be made. Sharing information is a national issue. Dr Worthley said that he also deals with one or two new bail hostel residents every day. They have a lot of support in the early weeks to minimise re-offending rates, and then they are moved on, so they take a lot of resource.

·         Members asked how services worked together- Dr Worthley said that he worked very closely with BHT and Equinox, he received 20-30 emails daily asking for GP support or involvement. They also have weekly meetings with clinicians in hospital who work with homeless clients. Brighton is the first city outside of London to have a Pathway team working in this way. The Pathway Plus team work to support people into temporary accommodation and attend health appointments. This has had huge benefits in reducing A&E callouts.

·         Members asked for clarification on rough sleeper figures; Ms Forrest said there were two different ways of assessing figures, the rough sleepers’ count in November where people go out and physically count people who are rough sleeping – but this may not be the most accurate way of gauging levels; it found 40 people rough sleeping last November. The second way is an estimated level, which is carried out by agencies in the city working with rough sleeper. This estimated 136 rough sleepers, 17% were female.

·         Members asked about the average age of death for the local homeless population. Dr Worthley said that local ages were in line with national averages, ranfign between 44 and 48 years of age. There had been 50 deaths out of approximately 1200 people in three years that he was aware of.

·         Members asked about service user involvement- they heard that there was a group of 15 service users who had formed a group which was used to provide feedback to providers about proposals for new services.

·         What changes were due to be made first? Dr Hill said that one example of a change that had already been made was the expansion of the Sussex Community Trust Team from two to five clinicians, plus a link worker. This would be co-located with Morley Street. They were taking opportunities as they arise.

·         Were there different support services for ex-offenders? Dr Worthley said some people pass through homeless services very quickly, particularly if they have good support networks or are able to navigate the services available. For others who do not find it so easy to move on, hostels have effectively become wards in the community with residents with complex multiple needs. Until the resident has their physical/ mental health needs addressed, they will find it very difficult to move on.

33.4    The Chair thanked all of the officers for presenting the information and for all of the services that they have put in place. It is of huge interest to everyone and it is great to see the work that is underway across the city.