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Health policy update and what this means for the homelessness sector Gill Leng @gill_leng National advisor: homes and health Homeless Link 21 September 2016
PHE vision and role • 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
Our position in the system
What does the future hold? By 2020 economic & national security • Returned to surplus • Higher wages, lower welfare • More people able to pay to meet their own needs • Devolution to rebalance the economy • Integrated health and social care • Self sufficient local government • Reformed and modernised public services
Good health is not just the NHS A home is not just a house Health Behaviours 30% Socioeconomic Factors 40% Clinical Care 20% Built Environment 10% Smoking 10% Education 10% Diet/Exercise 10% Employment 10% Access to care 10% Environmental Quality 5% Alcohol use 5% Poor sexual health 5% Income 10% Quality of care 10% Built Environment 5% Family/Social Support 5% Community Safety 5% Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute
Who will pay for the public’s health tomorrow? • NHSE Five Year Forward View • • A ‘radical shift to prevention’ BUT In-year reduction to public health grant & reducing • By 2020 local government self financing, devolved and integrated • • Ring-fence until 2018 then business rates retention? Cost of statutory duties – social care? • Economic security • More in better paid employment – self-financing? • Crucial opportunities taken now but challenges • Pace of change and culture change
Good health: work of a life time The house Cold home Living in TA 00 -04 On own & Isolated Paying the mortgage Overcrowded Sharing poor PRS 05 -15 16 -30 31 -45 The home Family experience Individual experience Abuse and neglect Drug or alcohol use Mental ill-health Criminal justice Poverty 46 -65 Can’t get upstairs 66 -85 86+
Distance to travel? Source: King’s Fund: Population Health; going beyond integrated care, 2015
Our vision – your vision? A home in which to ‘start, live & age well’ Described in the ‘improving health through the home’ memorandum of understanding • • • Over 20 national health and housing agencies signed in 2014 Including Government departments, Public Health England NHS England Annual plan to support local areas Signatories commit to enabling the right home environment for health and wellbeing, throughout life
Sustainability and transformation • NHS Shared Planning Guidance • Local plan for accelerating implementation of the 5 YFV to 2021 • 44 ‘STP’ footprints • Place based, built around needs of local populations • Completed end of June for Oct 2016 • Transformation Fund £ 2. 1 bn 16/17 • Local authorities must be engaged • Support to the system - quick guides • Importance of the home cited in urgent and emergency care guide • Prevention?
NHS urgent & emergency care review • For urgent but non-life threatening needs: • Highly responsive, effective and personalised services outside of hospital, and • Deliver care in or as close to people’s homes as possible • Nine programmes incl. ‘independent care sector’ • Four work streams – ‘better use of care at home’ • Brought together health, social care and housing eg, Care & Repair England & SITRA, Homecare providers, College of OTs, NHSE and PHE • Quick guides www. nhs. uk/quickguides • 2016/17 CCG housing and health engagement programme • Also, local Urgent & Emergency Care Network?
Health from within communities • Part of basis for returning public health to local government • • Many opportunities to play an active part in supporting and enabling others to improve their housing • • • Connected & empowered communities are healthy Community mobilisation can lead to positive change Involvement in community can increase resilience Peer information and support eg, Silver Links Role in identifying improvement needs eg, Liverpool Sharing homes eg, Shared Lives Volunteers connected to home improvement agencies Healthy home community ‘connectors’ or ‘champions’ PHE (2015) A guide to community centred approaches to health and wellbeing
No health without mental health • • Known relationship between home & mental health Evidence that improvements have positive impact For people who experience mental health problems safe, secure and affordable housing essential 2016 NHS England Mental Health Taskforce recommendations – role of home recognised • • Better understanding of relationship locally for NHS commissioning by 2020/21 All HWBs should update JSNAs & joint prevention plans that include mental health and housing Action to address existing fragmented pathways 2016/17 PHE developing prevention concordat to include housing & homelessness
What might we see locally? People Interventions Everyone’s home promotes good health & prevents ill-health Support from people with lived experience People with long term conditions are able to manage their health at home Information, advice, support in PIE People who become ill, face crisis or other life change manage their health & wellbeing at home Integrated ‘health and wealth’ services People leaving a health, care or other institutional setting move on to a healthy home environment Healthy homes and neighbourhoods Health, care & other institutional settings End of life care Hospital discharge, prison resettlement etc, Step down, specialist & supported housing Homeless response Housing support/tenancy sustainment Homeless prevention Making every contact count Healthy communities and health equity
Contact • Gill Leng • Tel: 07766 660799 • @gill_leng • Email: gill. [email protected] gov. uk