POLICY UPDATE SNAP 2010 (SURVEY OF NEEDS AND PROVISION) HEALTH NEEDS OF HOMELESS PEOPLE OLDER HOMELESSNESS

1. SNAP 2010 What is it? What can it be used for? Key headlines from 2010 –Dramatic improvement in service availability –43,655 bedspaces nationally –The sector's diversity is increasing but clients’ support needs seem to be remaining stable –Funding a key concern for agencies –Mental health and move on also key issues

SNAP 2010: Substance misuse HEADLINES –Overall availability of substance misuse services increased Type of serviceOverall service availability SNAP 2008 Overall service availability SNAP 2009 Overall service availability SNAP 2010 % increase Drug services87%91%95%8% Alcohol services88%94%96%8% Mental health services78%93%96%18% Physical health services71%90%97%26% Meaningful activity61%90%94%33% Education, training and employment (ETE) 66%89%98%32% Advice92%97%99%7% Resettlement59%86%92%33%

Provision of substance misuse services via external agency most common Roughly 1 in 10 agencies provide substances misuse services in house or in partnership However, problems with access remain. Inadequacy of external service and client motivation most commonly reported problems. Type of serviceOf projects where service available… Problems with access [2] [2] % Of projects where there are problems with access… Some clients ineligible % Some clients unsuitable % Sometimes due to client motivation % External service inadequate % Internal service lacks financial/ staff resources % Internal service lacks suitable premises /equipment % Drug services47%5%3%66%32%11%3% Alcohol services53%4%2%62%41%12%2% Mental health services57%8%6%33%62%10%2% Physical health services23%2%1%55%26%16%5% Education, training and employment (ETE) 45%11%6%67%18%16%5% Meaningful activity46%1%2%60%18%34%6% Advice20%0%3%55%32%18%2% Resettlement29%16%12%15%56%19%3% HEADLINES, continued

OTHER FINDINGS Proportion of clients experiencing drug or alcohol problems remained fairly consistent over 3 years 10% respondents cited alcohol and drug services as biggest gap in provision (3 rd most commonly identified gap) ‘Alcohol services for adults. It seems to be very distant for waiting times and referrals. It is because of the different agencies that provide it.’ ‘Having somewhere for chronically excluded people, the rough sleepers who are in and out of hostels, somewhere for the chronic drinkers/drug users, to try and keep them off the streets and support them.’ 6% agencies cite alcohol and drug use as the top issue facing them. This refers to issues around behaviour as well as accessing appropriate services.

2. HOMELESSNESS and HEALTH HEALTH NEEDS AUDIT Project to evidence health needs and feed into commissioning Looks at picture of local health needs. Client, not staff, perspective POLICY CONTEXT LOCAL DRIVERS: needs assessment and delivery at a local level (LAA, JSNA) HEALTH INEQUALITIES: delivering to most excluded -.eg Marmot Review, Inclusion Health, No One left Out

What can it tell us about substance misuse? Levels and type of consumption Health needs relating to substance misuse A&E and hospital admissions relating to drugs and alcohol How clients are currently engaged, if atall, with drug and alcohol services and how effective clients think they are Unmet need/demand for different D&A services (eg reduction, harm minimisation) Access to relevant screening Dual Diagnosis

How will the data be used? Improve dialogue with clients about health Feed clients’ experiences directly to commissioners and JSNA (joint work with JSNA and alcohol teams) Encourage agencies to take action at local level – from across LA, NHS and voluntary sector Inform agenda around health of socially excluded. ‘Inclusion Health’, DH commissioning guidance

3. Older homelessness? SNAP suggests more agencies are working with clients who are over 50. Recent research is showing an increase in hidden heavy drinking among general older population. 37 % of newly homeless older people reported drinking heavily before becoming homeless. Some said this had contributed to the breakdown of a relationship which had then led to homelessness. Estimated 50% older homeless population have alcohol needs. This is often in combination with mental health problems, chronic physical ill health and lack of engagement in support planning Particular challenge of move-on for this group. Sheltered housing reluctant to take alcohol dependent older people and difficult to get funding for a care package for people who continue to drink.

Services and solutions Specialist accommodation projects and floating support Feed issues into JSNA locally – “PCT to take a leading role in JSNA and commission alcohol interventions for the needs of the local population”. E.g make case of high costs of small section of homeless heavy drinking population. New guidance for commissioners and providers on how to assess and meet specific needs of older people and importance of this agenda:

SNAP: Health needs project: More info: