The DHSC’s Out-of-Hospital Care Models Programme provided £16m of funding to 17 test sites across England to improve discharge arrangements for people experiencing homelessness. The programme affords opportunities to develop new services and workforce roles that aim to integrate health, housing and social care at key transition points. In this blog, Shevon Simon describes her work as a ‘Homeless Health Team Leader’ at the Princess Royal University Hospital in South East London.
What is your job role?
In my new role as Homeless Health Team Leader, I am assigned to PRUH (Princess Royal University Hospital) in South East London to support the hospital with facilitating the discharge of homeless patients – primarily the discharge of single homeless people with complex needs. I am also responsible for developing discharge pathways and upskilling Discharge Teams to understand key homelessness legislation.
Can you tell us about why your role is needed?
My background is in local authority homelessness assessments and 14 years ago people rarely presented as homeless with more than one medical condition.
Today, many people have more than one condition – so they are multi-symptomatic and this in itself creates complexities around health management and means that they are sicker than in earlier times. In addition, chronic homelessness usually features at least three multiple long-term conditions – meaning people are more likely to suffer mental health problems, physical health problems and substance misuse and are not accessing the health services they need. COVID–19 and multiple lockdowns have not helped with healthcare accessibility, with many services not being as accessible as they were prior to the first lockdown in March 2020. Two years on and most local authority housing departments are still closed for face-to-face/office appointments, requiring patients to complete lengthy online forms or telephone assessments. As you can imagine, this is a huge barrier for someone who is homeless. Continue reading
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.
Darren O’Shea in London, February 2019
It is with great sadness that we share the news that Darren O’Shea passed away in hospital in London on 17 January 2021. Darren was a long-standing and much valued member of our Homeless Research Programme here at HSCWRU. He worked on the National Institute for Health Research (NIHR) study about improving hospital discharge arrangements for people who are homeless, sharing his lived experiences and giving presentations at many conferences and events. He was also a member of the Department of Health and Social Care’s Rough Sleeping Advisory Group, and advised the Healthy London Partnership based at City Hall. He was influential in campaigning for ‘step-down’ care so that people who are homeless have somewhere to stay when they leave hospital and it is now government policy that these services are developed across England. We are grateful for all Darren did to improve homeless health services and to contribute to our research at HSCWRU.
Stan Burridge, an Involvement specialist and another member of HSCWRU’s Homeless Research Programme, writes:
‘I was fortunate to work with Darren on many occasions over the past few years, and the value he brought to the work is almost beyond measure. We can forget that researching homelessness and social exclusion issues is dependent on capturing the harsh reality of people’s lives. Darren, who was often floating in and out of his own chaos, was a stark reminder that we were working to make a difference to real people with real lives and that our work goes beyond datasets. Darren had an incredibly valuable skill in that he was able to step out of his own difficult world and focus on the plight of others around him, and this brought a richness to the work we did together. His ability to talk openly, often when the rawness of his own journey was very evident, brought vividness to the research from a rich life, sadly now cut short. Darren’s death leaves a void and although we are saddened we are also enriched by the time he gave us. We will ensure his legacy lives on.’
Darren O’Shea (1977-2021)
At the NIHR Policy Research Unit in Health and Social Care Workforce we are undertaking two studies examining self-neglect, both funded by the NIHR School for Social Care Research. In an article published in The Journal of Adult Protection, for the project examining Adult Safeguarding Responses to Homelessness and Self-neglect, Stephen Martineau goes back to three pioneering research papers on self-neglect to consider what, if anything, they can feed into current debates. (787 words)
Patricia Shaw’s contribution in the 1957 paper on ‘social breakdown in the elderly’
While conducting a review of the self-neglect literature during this year, references to two early papers on the topic have come up repeatedly. The first, published in the British Medical Journal in 1966, by Macmillan and Shaw, is often described as the seminal academic paper in this field and drew on cases in Nottingham. The other is the Diogenes Syndrome article, by Clark, Mankikar and Gray, published in The Lancet in 1975; it derived from a study conducted in a Brighton hospital. Our new Journal of Adult Protection article examines these two articles plus a third, again by Shaw and Macmillan. This one dates from 1957 and, though it did not use the term self-neglect (rather, social breakdown in the elderly), it is the most vivid and interesting of the three.
There is a good deal of research interest in self-neglect at present. Following consultation with, and a survey of, practitioners, carers and service users (suggested by our Unit), the James Lind Alliance (2018) Priority Setting Research Partnership on Adult Social Work recommended that the topic should be a research priority. As well as the Unit’s two studies (details below), the NIHR has a call out for a study of self-neglect in the community (closing 28 January 2021). The need for such research is reinforced by Michael Preston-Shoot and colleagues’ new national study of Safeguarding Adults Reviews that were conducted between April 2017 – March 2019. SARs are commissioned where questions are raised about the way agencies involved in safeguarding have worked together in individual cases: among the 231 reviews the authors analysed, self-neglect constituted the most common type of abuse/neglect (featuring in 45% of the reviews). 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. (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