Senior Research Fellow, Dr Michelle Cornes, has been working with NHS England and Improvement on the new Discharge to Assess (D2A) practice guidance, identifying good practice examples that illustrate how this new hospital discharge policy can work effectively for patients who are homeless. Here she provides one example from Cornwall Council. (302 words)
Specialist D2A Reablement for People who are Homeless
Hospital Discharge Service Case Study – KA (Harbour Housing)
Cornwall Council working in partnership with Harbour Housing and Stay at Home have redesigned their out of hospital care services to increase the number of options available to homeless patients leaving hospital on D2A Pathways. For those patients who do not have a home and require more than just a sign-posting service, Harbour Housing provides access to six self-contained units of accessible step-down accommodation. This comes with onsite practical support such as helping people to get to their hospital appointments, as well as holistic ‘enrichment support’ for improved health and wellbeing including counselling and a range of strengths-based activities. Where people have care and support needs including self-neglect and issues linked to drug and alcohol use, a specialist reablement service is provided for up to six weeks. The Stay at Home service provides CQC regulated activities into the step-down accommodation and into the community. Specialist reablement workers are trained in the use trauma informed approaches and can for example, deliver Naloxone to prevent drug related deaths from overdose. During the reablement period, permanent housing is arranged and where necessary a Care Act 2014 assessment is carried out to identify needs for any longer-term care and support. Before these specialist D2A services were in place homeless patients would usually have stayed in hospital for long periods (sometimes up to six weeks) while waiting for various care and housing assessments to be completed.
Hospital Discharge Service Case Study – KA (Harbour Housing)
Dr Michelle Cornes is Senior Research Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London.
Stan Burridge is an ex-rough sleeper and an HSCWRU Peer-researcher. He is Director of Expert Focus, a user-led organisation that supports the involvement of people with lived experience in homelessness research and policy. (1,029 words)
Over the past few weeks, I have been thinking about all the people who have been swept from the streets and into hotels because of the COVID-19 pandemic. The old mantra that it was impossible to house all those sleeping rough has been scotched. This event signifies how, with the right amount political will and financial investment, radical change can happen at scale and pace.
Thinking about the next steps for Everybody in (the policy of offering people sleeping rough a hotel room for duration of the lockdown) I would like to urge policymakers to continue to pursue radical change (i.e. doing the right thing). Looking for a real solution to homelessness means taking note of the ‘overwhelming evidence that highlights the effectiveness of Housing First.’[i]
Housing First affords people a permanent home (their own front door) with no requirements beyond accepting the help of a trusted worker to maintain their tenancy. There is no requirement to ‘move on’ with other areas such as addiction and mental health issues, and even if someone were to lose their home, the trusted worker will continue to work with them. Continue reading
In this blog, Emily Hill from Harbour Housing, a homeless charity in Cornwall, describes how their service has supported people living in temporary accommodation to leave hospital safely during the pandemic. She highlights some of the challenges in making sure everyone has the opportunity to self-isolate when living in a House in Multiple Occupation (HMO) (903 words)
Harbour Housing provides supported accommodation across Cornwall for people with multiple and complex needs, including those who have recent experience of homelessness. The accommodation is provided in what are called Houses in Multiple Occupation (HMOs). Residents have their own rooms but share communal areas such as bathrooms and kitchens.
Clinical advice and guidance on reducing the risk of infection and severe illness among the homeless population as a result of coronavirus (COVID-19) is clear that HMO’s could pose risks. In order to reduce these risks, the guidance suggests that individuals should be provided with their own room and bathroom facilities wherever possible. Where this is not possible, providers should make best use of provision and should undertake regular cleaning of shared facilities.
The first step in Harbour Housing’s response to keeping residents safe from COVID-19 was to provide everyone with an information briefing, ensuring staff had time to talk through any concerns. Video screens in the properties also relayed NHS advice about hygiene and hand washing. Washing facilities and hand dryers were installed in the entrance lobby at each building. This meant that everyone had the opportunity to wash their hands before entering the property. In addition, thermal imaging CCTV cameras were installed to read the temperature of every person entering the building. This was to ensure that symptoms could be caught early. Continue reading
In this post, Stan Burridge, Director of Expert Focus (a user-led consultancy), reports on how COVID-19 is impacting on workers who support people leaving prison to find accommodation and resettle in the community. He speaks to two workers from the Cumbria Offender Service run by Humankind, a medium-sized voluntary sector organisation based in the north of England. (1,388 words)
Thinking about your job before the lockdown, what is your normal role like?
There are a number of different roles I play supporting offenders who have either been released after serving a prison sentence or as part of a community-based sentence involving probation. All of my work fits into the wider picture of helping them to find a stable platform (securing accommodation and claiming benefits is part of that process) so they can engage with other services as part of their sentencing commitments but also as a way of moving forward and hopefully away from committing crime.
What are the difficulties in finding accommodation for people leaving prison, especially as housing is at a premium?
There is a real difficulty in getting people housed and in an ideal world everyone who was released from prison would have somewhere to go, but that is not the case. Often when accommodation is found it is in areas where there is a lot of crime and drug use, so it seems as though we are often perpetuating people’s problems. Options to place people in less deprived areas are limited and the harsh reality is if I couldn’t get someone housed in those sorts of areas, I probably wouldn’t be able to get them housed anywhere, so they would be homeless. Continue reading
Stan Burridge is an ex-rough sleeper and an HSCWRU Peer-researcher. He is Director of Expert Focus, a user-led organisation that supports the involvement of people with lived experience in homelessness research and policy. Here, Stan talks to four ex-rough sleepers about their experiences of living through the Coronavirus pandemic. Names of participants have been changed. (1,825 words)
Like everyone one else, I have watched in fear as the outbreak of the Coronavirus pandemic has sent shockwaves around the world. In the middle of March, I saw the first glimpse of what appeared to be some good news. Hidden in a small paragraph, in the pages of a tabloid newspaper, a caption read, ‘Homeless people to be moved into hotels’. I questioned if this really could be true. Would every homeless person be given a bed, somewhere warm and a place to hide from the pandemic sweeping the nation? Unbelievably, it wasn’t fiction. When the action began it was swift. There were armies of voluntary sector workers lined up, ready for the task which lay ahead to ‘Test, Triage, Cohort and Treat’. Within days, most were moved from the street. But what is happening to people now they are gone from view? Is life all rosy or are there hidden problems which we are not thinking about, not taking care of? I spoke via telephone to four people with ‘lived experience’ of homelessness about their experiences of the impact of Coronavirus and social distancing. This is what they said.
Jane (living in temporary accommodation) Social distancing means that I am basically on my own all the time now. If I do go out it’s only once a week, maybe twice at a push, to get shopping and my medication. Even then, I am staying as far away from people as I possibly can. I am not talking to anyone when I am out unless I have to. The chemist asked me if I minded him signing my prescription because of the risk of catching the virus, all of the staff have face masks and gloves and there is a plastic screen by the counter. Getting stuff from the shops is getting better this week, but at one point because the supermarket didn’t have any toilet rolls I had to walk to another shop, this was a struggle as I am disabled. It was a worthless walk as they wanted £8.99 for two toilet rolls. How am I supposed to be able to pay those prices for ‘bog roll’ when all I get is benefits? I go out really early, about 6 or 7 in the morning so there is no-one else around. I live in a building with lots of bedsits, and I have to use the lift to get out of my building. If there is someone in the lift, I will wait, I won’t get in the lift with them. Luckily, I am on ‘happy pills’ from my doctor which help a bit, but it is draining, and yesterday I couldn’t even muster up the energy go out and get milk because I am getting more depressed each day. I am far away from anyone I know, feeling totally isolated and if I run out of credit on my phone I don’t know what I would do. I’ve got a key worker who is now on limited hours and when he comes to see me we talk through the closed door; he is on the outside in the corridor. I really trust him, but I can’t talk to him about how I am feeling at the moment because other people can hear, it’s not private. It is simple things like this which people forget. Even though I hate what is happening to me and being alone is really getting me down, it is better than sleeping on the streets again. I have seen a beggar – he had a sign asking people not to give him money but to buy him food. How are homeless people going to get fed if they haven’t got any money? I wonder what will happen to everyone who is now in a hotel; will they just get chucked out again, back to the street? Continue reading
Alan Kilmister is a Peer Researcher and Expert by Experience with HSCWRU’s Homeless Hospital Discharge Project. The project, which is led by Senior Research Fellow at HSCWRU, Dr Michelle Cornes, is due to report shortly. The project researchers last month published an open access article in Wellcome Open Research—‘Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England’. (792 words)
Recent article from the HSCWRU study examining Hospital Discharge of homeless people
Hi, it’s me Alan—yes, I know I am becoming a blogoholic. On Friday 8 March 2019 I attended the Queen’s Nursing Institute event, ‘Better Health for all Women especially those suffering homelessness’. It was held at Birmingham City University South Campus: it was a very good venue and we were well fed and watered, and all the speakers were women who introduced themselves with ‘nice to see you all’ on this International Women’s Day. Us poor menfolk were outnumbered by 20/1.
The four key themes of the meeting were: Improve quality of local health; and housing systems; improve access to healthcare; and, increasing knowledge and awareness. This was followed by six key recommendations: Accommodation, Collaborate, Together, Initiative and Intelligence, Ownership, and no Gaps in care. The main point out of these six to my mind was to foster collaborative working for homeless prevention and reduction and to ensure all health services understand their responsibilities regarding care and treatment of those that are homeless. Continue reading
James Fuller reports on the ‘Housing First: Ending homelessness across Finland and the UK’ seminar at the Finnish Ambassador’s residence in London, 6 March 2019. The event was organised in co-operation with the Finnish Institute in London and Crisis UK. (1,070 words)
Kensington Palace Gardens, or Ambassadors Avenue as it might as well be called, is a private, heavily guarded boulevard nestled behind the sedate royal dwelling from which it takes its name that is packed with official residences. Not an obvious venue for a series of presentations, organised by the Finnish Institute, about how to house some of the most marginalised and multiply excluded members of society, even if the Finnish building is typically modest.
After a brief word from the Ambassador and the same from Jon Sparkes, Chief Executive of Crisis, we heard from Anita Birchall, Head of the Threshold Housing Project, a specialist housing first, five-year pilot project working with female homeless ex-offenders. As is generally the case for such pilots, Anita reeled off a succession of impressive outcomes for the fifty or so residents THP is helping, although she was clearly anxious about the renewal of her funding, as the end of term is fast approaching. She also revealed that whilst it had been possible to house people within about four weeks during the early stages of the pilot, at present it takes some 71 days on average. This is frustrating for her team, she said and is causing some distress to users of the service, who imagine an application will lead almost directly to accommodation. The idea that this is a ‘from the prison gate’ operation is way short of the mark. Continue reading
Alan Kilmister (Peer Researcher and Expert by Experience with the Policy Institute’s Homeless Hospital Discharge Project) describes proceedings at recent conference organised by the London Drug and Alcohol Forum. (534 words)
Michelle Cornes with Alan Kilmister
I had the pleasure of attending the ‘Addressing Complexity: Homelessness and Addiction’ conference on Friday 18 January 2019 at the Guildhall in London. I arrived at this beautiful venue a little tired after my early start. My first train was at 06:24. However, a few cups of coffee soon warmed me up. It was an excellent event with a wide range of subjects and very good speakers. I was most impressed by the talk by Kevin Dooley (Recovery Programme Consultant) who at one time had been an armed robber, alcoholic and heroin addict with extensive experience of the ‘criminal justice system’! He spoke very truthfully and emotionally about his time on the streets and how when he was in prison his son had died, he received little in the way of compassion and understanding from the system. Some of the other people at the conference with lived experience commented how they were able to fully connect with what Kevin was saying especially with regard to the shame and stigma that goes hand in hand with homelessness and addiction. Kevin made the point that coming to events like these and talking about ‘our’ experiences takes that shame away. I am a firm believer in involving people with lived experience (“nothing about us without us”) and Kevin made the point that we were are still too few in numbers at events like these. The keynote address by Professor Alex Stevens also made this point, highlighting how, a structurally advantaged social group can dominate the cultural, intellectual landscape, while the people most affected by drug deaths have little say (or in the jargon “corporate agency”). I asked the expert panel in the morning session about this topic and there was consensus about the importance of involvement and engagement, and us all doing more to enable this.
I found the talk by Dr Steve Sharman who presented case studies of people’s experiences of homelessness and gambling very interesting. It reminded me of my time in a Hostel in Wolverhampton. A few of the clients living there were addicted to gambling and just around the corner from the Hostel was a big Casino. This made me wonder if they were addicted to gambling before becoming homeless or took to gambling after becoming homeless.
I found the street drinking in East London talk by Dr Allan Tyler interesting too and wondered about boundaries – would the researchers have learned more had they participated in the actual drinking? There was also a very good talk by our very own Dr Michelle Cornes ably assisted by Darren O’Shea and Jo Coombes.
Michelle presented a case study called the Gutter Frame challenge which tells of the barriers people have to overcome if they want to access services following discharge to the street. Finally, I must also offer my compliments on the superb buffet provided at lunch time, and of course the chance for some networking too. This is really important for us, and I was thrilled to be approached by a research manager from a leading charity who invited me to join a new advisory group being set up on peer research. All in all, a very worthwhile and enjoyable day.
Alan Kilmister is a Peer Researcher and Expert by Experience with the Policy Institute’s Homeless Hospital Discharge Project
James Fuller is a Peer Researcher, Expert by Experience and a Support Worker at a Day Centre for people who are homeless in London. (1,200 words)
Brighton and Hove Safeguarding Adults Board recently published the key messages arising from a review. A Safeguarding Adults Review is held when an adult in the local authority areas dies as a result of abuse or neglect. In this case, the adult was sleeping rough and had been identified as ‘difficult to engage’. Chris Scanlon and John Adlam have written extensively about Diogenes, homelessness and what to do about people whose refusal to be included remains a problem for themselves and society as a whole. This review brought into sharp focus some of these same issues. Namely how can we safeguard Diogenes? According to the essayist Plutarch, the philosopher Diogenes the Cynic (412-323BC) lived in a barrel in Corinth and spent his time pouring vitriol on his fellow beings, who he roundly despised. One day, Alexander the Great invited Diogenes to a gathering, but the drum-dweller declined. Instead of having Diogenes executed, the usual outcome for disrespecting world conquerors, Alexander went down to see him. Having greeted Diogenes, Alexander asked him if he wanted anything. Diogenes replied: “Yes, stand a little out of my sunshine” (Plutarch, Alexander, 14 Cf.). Continue reading
Peer research is a distinct type of service user involvement extending the expertise of lived experience into research. In peer research people with direct experience are involved in designing, delivering and shaping research (Revolving Doors, 2016).The Homelessness Research Programme at the Social Care Workforce Research Unit is currently running two research projects involving peer researchers. The first is looking at specialist primary care and the second at hospital discharge arrangements for homeless people. Both projects recently ran training and induction days for their peer researchers. In this blog James Fuller and Alan Kilmister (Peer Researchers on the Hospital Discharge Project) describe how they became involved in peer research, how their experience can make a difference and why striving for impact and change must be at the heart of this kind of participatory methodology. (1,372 words)
James: I am currently working as a support worker in a ‘day centre’ for homeless people in London. The main motive for throwing myself into the hospital discharge research project is a strong sense of righteous indignation at the way the people who use our service are routinely returned there by hospital staff who should know we have no accommodation – the clue is in our title!
One man has been delivered to our car park three times this year, on two occasions in a taxi, always clutching his transparent bag of medicines and still wearing his ward wristband. All we can do is get him to see our wonderful specialist nurse at the earliest opportunity (she can only fit us in one day a week) and use our best first-aiding to tend any wounds.
In the dark days I was myself discharged from hospital detox onto the street, which meant I couldn’t access even daytime rehabs, not having a secure address in what had been my local borough for more than five years. I was back in detox six months later. In the interim I was put out of the Emergency Investigation Unit of a well-known London hospital in pretty short order and with nowhere to go. Such experiences stick in the mind. Continue reading