1. The Health Needs Audit Toolkit www.homeless.org.ukLet’s end homelessness together Francesca Albanese, Research Manager Homeless Link

2. How it works What is a Health Needs Audit? A free tool to assess the health needs of people who are homeless in a local area A means to use this evidence to inform strategic and practical change to improve health outcomes and reduce health inequalities Developed in 2011: To date, 31 audits undertaken by 27 areas with 3,355 respondents www.homeless.org.ukLet’s end homelessness together

3. The aims of the audit What is a Health Needs Audit? Provide an evidence base on the health needs of homeless people Improve service access and delivery by bringing statutory and voluntary services together To increase the involvement and voice of homeless people Ultimate aim – to improve the health of homeless people www.homeless.org.ukLet’s end homelessness together

4. What can it help achieve? Why do a Health Needs Audit? It will help you assess local need and redesign services to meet need Local areas have increased responsibility for assessing and improving the health of their local population (e.g. JSNA) and to ensure needs and voice of whole population included in the process: the audit gives you the tools to do this. It will help identify and address health inequalities Homeless people experience poor health outcomes and face inequalities in accessing services. The audit helps understand and evidence levels of need and service usage. It will help you reduce financial & personal cost DH report: homeless people use x4 acute health services and x8 inpatient services than general population (totalling £85m p.a.) Current financial pressures make addressing health needs appropriately and avoiding wider impacts of poor health even more important: the audit can help identify how resources can be more effectively spent. www.homeless.org.ukLet’s end homelessness together

5. How does the process work? Carrying out a Health Needs Audit www.homeless.org.ukLet’s end homelessness together Partnership of representatives from health, housing and voluntary sector come together to plan an audit Agencies recruited to take part – e.g. day centres, hostels, supported accommodation projects, outreach services Audit conducted with clients Analysis and action planning Data directly inputted onto online tool and analysis generated at local level for you and your local partners

6. How does the process work? Carrying out a Health Needs Audit www.homeless.org.ukLet’s end homelessness together PLAN: Set up group of partners COLLECT DATA: Client surveys by agencies over agreed time period INTERPRET DATA: Use LimeSurvey Collect further evidence USE THE DATA: Disseminate findings Agree action in partnership IMPLEMENT & REVIEW: Review & map trends Work with clients

7. What does the survey cover? What can a Health Needs Audit tell you? www.homeless.org.ukLet’s end homelessness together Client background Physical health needs Mental health needs Levels of substance use, including dual diagnosis Access to services Vaccinations and Screening

8. 45% prevented from training, volunteering or working due to ill- health Profile of 3,355 respondents Homeless health in England www.homeless.org.ukLet’s end homelessness together 71% male 9% rough sleepers 17% training / education 6% in employment 32% <25 69% in supported/hostel accommodation

9. Physical health problems >12 months Identify and address health inequalities Joint and muscular Chest and breathing Stomach Eyes Skin www.homeless.org.ukLet’s end homelessness together 22 % 15% 11% 14% 8% 14% 7% 4% 2% Reported health problems

10. Mental health issues Identify and address health inequalities Depression Schizophrenia Personality disorder Bipolar disorder PTSD www.homeless.org.ukLet’s end homelessness together 34% 6% 7% 5% 7% 3% 1 – 3% 3 – 5% 1 – 3% 3% Reported health problems

11. High use of secondary healthcare services among homeless people Reduce financial and personal cost www.homeless.org.ukLet’s end homelessness together 27% visited A&E 1- 2 times in past 6 months Rough sleepers use GPs the least 24% in the last 6 months (71% total population) 21% admitted to hospital in past 6 months

12. Contextualizing the data Additional types of evidence Qualitative techniques Focus groups or follow up in-depth interviews clients who have completed the survey explore a specific topic in depth Things to consider: size of group, ethics, topic area and sensitivity i.e. mixed gender may not be appropriate Additional quantitative data Mapping health needs audit data against other sources of information Opinions & Lifestyle survey and Health Survey for England Are health agencies aware of homelessness and housing data? Statutory homelessness stats Prevention and relief stats Housing stock condition survey Local health needs assessment www.homeless.org.ukLet’s end homelessness together

13. Making changes based on the audit How can the data be used? www.homeless.org.ukLet’s end homelessness together Improvements to services: Help develop services in line with what works and where unmet need exists Encourage agencies to take practical action at local level in partnership Improve dialogue with clients about health and understanding of their needs Strategy and planning: Feed clients’ experiences and needs directly to commissioners Inform JSNA development to include homeless people’s needs Inform wider agenda around health of homeless people

14. What changes have been made? How has the data been used by local areas? www.homeless.org.ukLet’s end homelessness together Improved access to services: Clients and workers trained to become Health Champions A new service specification for TB screening services at NFA practice Training sessions for GPs to raise awareness Service improvement: Hostel staff trained on mental health issues Improving clients’ understanding about health: Film to highlight available services and how to access them Section on health added to pre-tenancy training Informing the wider agenda: Launch event for findings Findings fed back to key stakeholders (HWB, CCG, etc.) Findings incorporated into JSNA portfolio

15. Over to you Further information and advice www.homeless.org.ukLet’s end homelessness together Further resources: Toolkit and guidance http://www.homeless.org.uk/health-needs-audit-toolkit Interactive web tool for national data http://www.homeless.org.uk/facts/homelessness-in-numbers/health-needs- audit-explore-datahttp://www.homeless.org.uk/facts/homelessness-in-numbers/health-needs- audit-explore-data The unhealthy state of homelessness http://www.homeless.org.uk/sites/default/files/site- attachments/The%20unhealthy%20state%20of%20homelessness%20FINAL.p dfhttp://www.homeless.org.uk/sites/default/files/site- attachments/The%20unhealthy%20state%20of%20homelessness%20FINAL.p df JSNA guidance http://www.homeless.org.uk/sites/default/files/site- attachments/20141009%20JSNA%20Briefing.pdfhttp://www.homeless.org.uk/sites/default/files/site- attachments/20141009%20JSNA%20Briefing.pdf

16. We’re here to help Contact us if you are thinking about doing an audit: Email: homelesshealth@homelesslink.org.uk Francesca Albanese: francesca.albanese@homelesslink.org.u k 020 7840 4411 Rachel Hurcombe: rachel.hurcombe@homelesslink.org.uk 020 7840 4418 www.homeless.org.ukLet’s end homelessness together

17. What we do Homeless Link is the national membership charity for organisations working directly with people who become homeless in England. We work to make services better and campaign for policy change that will help end homelessness. © Homeless Link 2014. All rights reserved. Homeless Link is a charity no. 1089173 and a company no. 04313826. Homeless Link Gateway House, Milverton Street, London SE11 4AP 020 7840 4430 Twitter: @Homelesslink Facebook: www.facebook.com/homelesslink www.homeless.org.ukLet’s end homelessness together