Health and Homelessness Effective interactions Lesley Dewhurst Chief Executive Oxford Homeless Pathways

Homelessness is BAD for health! 80% have one or more physical health problem 70% have at least one mental health problem 40% will end up in A&E in any six month period, and nearly a third will be admitted to hospital Yet health care is NOT prioritised by most homeless people

So, what works? Services must be accessible Emphasis on preventative services (screening and immunisation) There must be a coherent network of services across health, social care and housing Homelessness issues should be part of core training for health professionals

Luther Street Medical Centre Makes a huge difference to delivery of effective health care to homeless people Located in the heart of homeless services Holistic approach, including: Podiatry Dentistry Mental health Substance misuse services

LSMC continued………. Full health checks, including BBVs Immunisation – Hep A and B, Flu Periodic TB screening Training module for medics

Partnership work O’Hanlon House – staff encourage registration on entry Daily liaison with LSMC staff Interaction with Street Services Outreach team PATHS project – enabling patients to attend hospital and other medical appointments Needle exchange at O’Hanlon House

Case study – Lizzie Mid 30’s Previous history of long term drug use – now on Subutex script Excessive alcohol use – liver problems Brain injury – affecting vision and short term memory Epilepsy In and out of prison all her life. Very chaotic

Lizzie……how partnership worked Slow but sure approach Putting responsibility back onto Lizzie Presenting options and highlighting risks Liaising with LSMC Being there at the right time - DETOX Coordination of hospital admission and discharge Still doing well in Simon House – clean and dry

Recent research (Homeless Link) tells us… Oversight of local H & WB Board is essential H & WB Board must work with housing and related support agencies – integration not competition

Some practical steps Homeless people’s needs should be included in every JSNA, H&WB strategy and commissioning plans (Health Needs Audit Toolkit) Service users can be involved in this process (Homelessness and Health Peer Activity Toolkit)

Final message Homeless people can be very expensive if problems are not nipped in the bud Keep us involved! We want to help with the planning and delivery of health services