Homelessness is health inequality Sussex rough sleeping, single homelessness & street community event, 18 July 2016 Gill Leng @gill_leng National lead: housing & health

Why public health interest? “The science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society” Public health is ‘everyone’s business’ Public health outcomes focus on increased healthy life expectancy reduced differences in life expectancy healthy life expectancy between communities As professions Share the same origins Same desire but better quality of life Environmental health is the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health. Response to inquiry into the causes of poverty which concluded that people often became poor because of ill health due to a bad environment Response to 1842 inquiry into the causes of poverty First public health act 1848: public & environmental health Mid 1800’s: social housing 1875: public health act & slum clearance: council housing

Must end homelessness to improve health & reduce inequalities Why PHE interest? PHE mission: to protect and improve the public’s health and wellbeing and reduce health inequalities Homelessness is bad for our health Ill health can lead to homelessness A number of our roles relate to homelessness eg, Emergencies eg, floods Infectious disease eg, TB NHS eg, greater use if homeless Improve health eg, alcohol, smoking, mental health, suicide prevention Must end homelessness to improve health & reduce inequalities

Partnership interest “The right home environment is essential to health and wellbeing, throughout life” Describes Key features of the home Evidence of the difference it can make Contribution to health and social care Context for change Commits national partners to joint action Leadership Evidence Solutions Key features of home (permanent & temporary): Warm & affordable to heat Free from hazards, safe from harm Enables movement around the home and is accessible, including to visitors Promotes a sense of security and stability Support available if needed Evidence suggests it can: Improve health & wellbeing & prevent ill-health Enable people to manage their health and care needs Allow people to remain in their own home for as long as they choose Ensure positive care experiences It contributes to: Delayed & reduced need for primary care & social care interventions, including admission to long-term care Timely discharge & reduced hospital re-admissions Rapid recovery from periods of ill-health or planned admissions

Good health is not just the NHS A home is not just a house Behaviours 30% Socioeconomic Factors 40% Clinical Care 20% Built Environment 10% Smoking 10% Education 10% Access to care 10% Environmental Quality 5% Diet/Exercise 10% Employment 10% Quality of care 10% Built Environment 5% Income 10% Alcohol use 5% Poor sexual health 5% Family/Social Support 5% Community Safety 5% Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute

Good health: work of a life time The house Cold & disrepair Cold & disrepair Overcrowded Paying the mortgage On own & Isolated Living in TA Sharing poor PRS Can’t get upstairs 00-04 31-45 16-30 66-85 46-65 05-15 86+ The home Family experience Individual experience Abuse and neglect Relationship with place, impact on health and wellbeing, and opportunities to influence/intervene to improve outcomes and reduce inequalities changes across lifecourse Examples of evidence Born into homeless family living in bed and breakfast: inequalities from this point onwards in terms of health, wellbeing, educational attainment etc Cold homes: affecting physical and mental health of those who spend a lot of time at home Stress of paying mortgage/being able to pay rent (and often living in poor housing too): mental health & wellbeing Get older and less mobile: home can become prison – can’t move around within it, can’t leave it Drug or alcohol use Mental ill-health Criminal justice Poverty

Beyond integrated care Source: King’s Fund: Population Health; going beyond integrated care, 2015

Good health through the home People Interventions Health, care & other institutional settings End of life care People leaving a health, care or other institutional setting move on to a healthy home environment Hospital discharge, prison resettlement etc, People who become ill, face crisis or other life change manage their health & wellbeing at home Step down, specialist & supported housing Healthy homes and neighbourhoods Integrated ‘health and wealth’ services Information, advice, support in PIE Support from people with lived experience Homeless response People with long term conditions are able to manage their health at home Housing support/tenancy sustainment Use this to communicate the central role of healthy homes and neighbourhoods in everyone’s lives, and the need for information, advice and support to inform decisions and enable control, and the range of housing interventions available for people if and when they have health, care or associated needs eg, face other crisis such as homelessness. Where are communities in this model? What would applying the NICE community engagement guidelines look like? (Next slide) Homeless prevention Everyone’s home promotes good health & prevents ill-health Making every contact count Healthy communities and health equity

Action? Systems leadership Outcome: There is national and local systems leadership and accountability for homelessness and inclusion health PHE: ‘Improving health through the home’ Memorandum Public Health Minister on cross-government group Leadership meetings – first in Feb 2016, next in July Embedded homelessness in related priority areas Drug and alcohol commissioning prompts and data Enabling right home environment for TB treatment (2016) Population health framework for single homeless (2016) Regional support programme in 2016/17 Support small number of areas to lead by example Support other PHE priorities eg, mental health & suicide prevent

Action: intelligent commissioning Outcome: Local commissioning is informed by Full understanding of homeless & inclusion health needs Evidence of effective prevention & response measures Involvement of people with lived experience & agencies which support them PHE: Revised homeless health needs audit (Homeless Link) Rapid review of homeless prevention interventions in health and other community settings Standards of evidence in housing (HACT) Contributing to relevant research eg, KCL health care 16/17 reviewed health data to understand what tells us

Action: homes and services Outcome: High quality services across the system, and homes, are commissioned to enable prevention and support recovery and rehabilitation for men and women, supporting people to improve their own health and wellbeing PHE: we know enough about what works: why not adopted? 2016/17 programme Action to translate models that work eg, hospital discharge Joint work with NHSE to engage CCGs Workforce development with partners eg, HEE, RSPH Supportive of partners approaches Crisis – access to the private rented sector Homeless Link - Housing First model Engaged in future of supported housing review

Local examples of public health engagement DsPH may be responsible for local homelessness & housing related support budgets Specific examples (not exhaustive!) Bradford (BRICCs): Supporting homeless health pathway West Midlands Homelessness Network Regional Offender Housing Protocol Blackburn with Darwen: MEAM approach Brighton and Hove: Systems-based approach to single homelessness LB Richmond: Robust homelessness JSNA London homeless health: Informed response to Health Commission healthcare recommendation

Contact Gill Leng Tel: 07766 660799 @gill_leng Email: gill.leng@phe.gov.uk