Agenda item - Improving urgent care pathways for homelessness and drugs & alcohol

Report of Surrey & Sussex Integrated Care Board (copy attached)

32.1    This item was presented by Chas Walker, joint NHS and city council Programme Director for Integration and Service Transformation; Dr Nicola Lang, Director of Public Health; Harry Williams, the council’s Director of Housing, People Services; and by Tanya Brown-Griffith, NHS Surrey & Sussex, Director for Joint Commissioning and Integrated Community Teams, Brighton & Hove.

32.2    Mr Walker outlined why it was important to identify people with multiple compound needs (MCN) and to provide focused support, helping them manage health conditions and other issues in community settings and consequently reducing pressures on urgent care. Mr Walker explained how this approach aligns with the NHS Long Term Plan priorities and that it is a core focus of the local Homelessness & Rough Sleeping Strategy. There is a particular focus on supporting people with co-occurring conditions whose combination of mental health and substance misuse problems can make accessing services especially challenging. Initiatives have been developed with the active input of Common Ambition who provide lived experience. Data shows that the programme has had successes to date, with community interventions increasing and acute admissions decreasing over time for some of the most vulnerable communities.

32.3    Cllr Hill asked about the long-term plan to improve flow through the temporary and supported housing pathway. Mr Walker responded that there is a known group of people for whom housing interventions tend not to be effective. The plan is to provide better targeted mental health and drugs & alcohol support to this group, partly via in-reach into hostels. Mr Williams added that there is a long-term vision to provide better integration between support services, initially focused on temporary accommodation but eventually also across general housing.

32.4    Cllr Parrott asked how near the system was to providing a full service, given that relatively few people are covered by pilot initiatives. Mr Walker replied that the multidisciplinary team currently has capacity for around 200 highest priority clients, out of the approximately 1500 people in the city identified as having MCN. However, all people identified with MCN do receive a range of support – the enhanced support provided by the multidisciplinary team is only one type of support on offer.

32.5    Cllr Parrott asked how long people would typically be offered enhanced MCN support. Mr Walker replied that the length of support will vary. People are supported to help engage with mainstream services until they are effectively embedded in the services they need to access. This can be a lengthy process, potentially taking up to 18 months.

32.6    Cllr Evans asked how outcomes will be measured. Mr Walker replied that there will be a number of metrics including avoidable hospital admissions, the number of cases dealt with by multidisciplinary teams, the effectiveness of step-down from hostel beds and the percentage of people accessing the appropriate screening programmes.

32.7    Cllr Lademacher asked whether particular geographies are being targeted. Dr Lang replied that current service provision is patchy across the city and the ambition is to ensure that there is good access everywhere.

32.8    Cllr Parrott asked about steps being taken to prevent people developing MCN. Mr Walker noted this is a major challenge given increasing health inequalities across the city, but it is a priority. Mr Williams added that the council has a good track record of preventing homelessness, but needs to get better at reaching people at risk at an earlier point, for example by working with partners to identify people with drugs & alcohol problems before they reach the point of crisis. Ms Brown-Griffith added that the Drugs & Alcohol Partnership does important work with schools, seeking to identify young people and families in need of support at an early stage.

32.9    Cllr Hogan asked about other measures being taken to reduce avoidable hospital admissions. Dr Lang replied that there are initiatives to reduce admissions for self-harm and also for overdose, for example by ensuring that naloxone is available across a range of community settings. Ms Brown-Griffith added that Integrated Community Teams have also been rolling-out a programme of health checks which will reduce avoidable admissions by identifying people at risk at an early enough stage for them to be more effectively supported in the community.

32.10  Cllr Galvin asked about what is being done to improve communications with GPs around discharge and also to ensure that people leaving hospital have suitable accommodation. Mr Walker replied that homelessness officers are located at both the Royal Sussex and Mill View hospitals. They work closely with Arch GP practice to ensure there is effective post-discharge support and appropriate accommodation for homeless people discharged from hospital.

32.11  The Chair asked whether there is currently enough housing and community care capacity to significantly impact on avoidable hospital admissions and discharge delays. Mr Willaims replied that increasing city housing supply is a priority for the council, as is making significant improvements to the temporary accommodation model. While everyone would like to see more housing and support capacity, the current moves to integrate planning and delivery of support services will reduce pressures on urgent care. There are currently very few discharge delays from the Royal Sussex due to homelessness for Brighton & Hove residents, although the same is not always the case for people resident in other areas.

32.12  Nora Mzaoui asked about poor housing conditions such as damp impacting on health. Mr Williams responded that this is a recognised issue and work is ongoing to improve stock quality in terms of council-owned properties but also across the private rented sector. Dr Lang agreed to provide additional information in writing on how VCS or NHS partners could report damp or mould problems in their clients’ homes. Information and details regarding responding to Damp & Mould related matters for both for council and private rented housing are as follows:

• Council Homes.  Condensation, damp and mould in your council home. 
• Private Rented Sector. Private tenants  & Damp and Mould Action Plan. 
• Housing association residents should follow housing association complaints procedures. Housing associations are subject to the same regulatory provisions as the council with regard to response to damp and mould, including Housing Ombudsman and Regulator of Social Housing.

32.13  Cllr Winder asked about people’s sense of wellbeing and social cohesion. Mr Walker responded that these are important issues which will be addressed through the Neighbourhood Health Programme.

32.14  RESOLVED – that the report be noted.