HEALTH & HOMELESSNESS Jane Gray Director & Consultant Nurse Inclusion Healthcare Social Enterprise CIC Ltd.
HOMELESSNESS Rough sleeping is the most obvious sign of homelessness but much is hidden Average life expectancy for a rough sleeper is only 42yrs, national averages 77.9 (m) 82 (F) 42 years is less than some African countries where investment in health service provision is much less
HOMELESSNESS • There have been national initiatives to reduce rough sleeping since 1990 & numbers had fallen ~ these are now increasing & Leicester has the highest figures outside of London? • Homelessness is a multiple & complex issue requiring a multidisciplinary co-ordinated approach by health, housing, social care, criminal justice teams & other organisations
IMPACT ON THE HEALTH OF ADULTS • Mental health problems • Loss of self esteem • Skin diseases • Loss of confidence • Chronic Gastrointestinal • Institutionalised problems Multiple needs relate to: • Respiratory diseases • Low income • Musculo-skeletal problems • Inadequate housing • Antenatal and postnatal • Poor health than general problems population • Substance misuse problems (alcohol/drugs) • Reduced life expectancy • Dental problems • Loss of opportunities
IMPACT ON THE HEALTH OF CHILDREN • Respiratory diseases • Developmental delay • Skin problems • Delay in speaking & walking • Dental problems • Bed-wetting • High rates of infectious diseases • Poor sleep and aggressive behaviour • High rates of mental health problems • Increased rates of hospital admission • Low rates of immunisation
ACCESS TO HEALTH CARE Homeless people may have difficulty registering with a GP on either a temporary or permanent basis though the BMA has advised for many years that homelessness should not be a barrier Upto 40% may not be registered at all or not in the area where they currently are Many use walk in or emergency dept. facilities which are not equipped to manage primary care
NATIONAL MODELS OF GOOD PRACTICE • Variety of dedicated services around the country ranging from lone health workers (e.g. nurse or health visitor to full teams in GP surgeries • Some provision may be under threat with changes in the way health services are commissioned • Needs to be a co-ordinated multidisciplinary approach • Needs to be sensitive to your populations needs
NATIONAL MODELS OF GOOD PRACTICE • Queen’s Nursing Institute (QNI) developed a 3 year “Homeless Health Initiative” (2007/2010) to provide expert support to health professionals working in the community looking after homeless people. 600 members. • Now have a 2 year “Opening Doors” initiative focussing on health needs of homeless families & substance misuse
INCLUSION HEALTHCARE Previously known as “Leicester Homeless Healthcare Service”, a service for single homeless people, run by PCT 2000 to 2010 We became “Inclusion Healthcare” 1 st Sept 2010 & are jointly run by a Nurse & Doctor. Ensures service can continue with changing landscape in NHS & commissioning. Our staff are the shareholders.
INCLUSION HEALTHCARE • Work from multiagency “Dawn Centre” & do outreach clinics too • LCC building with 44 place hostel, YMCA drop-in centre & fully equipped health suite • GPs, general & psychiatric nurses, drug & alcohol workers
INCLUSION HEALTHCARE • Patients can fully register • 24/7 healthcare so access to primary care at all times including “out of hours” at BH & W/E • Full range of services delivered by GPs, general nurses, psychiatric nurses, practice therapist, drug workers, alcohol practitioner
INCLUSION HEALTHCARE • Visiting services from specialist Midwife, Podiatrist, Optometrist, Complimentary Therapist • Since becoming a SE we have been able to fund podiatry (including issue of shoes/socks) & complimentary therapy from our surpluses after our grant funding was lost
INCLUSION HEALTHCARE • “New service” ~ Hepatitis C treatment & monitoring clinic • The Future ~ fully integrated healthcare service for ALL homeless people?
CONTACT DETAILS • Jane Gray, Director & Consultant Nurse • Tel: 0116 221 2780 • Email: Jane.Gray@GP-C82670.nhs.uk • www.inclusion-healthcare.co.uk • www.qni.org.uk
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