Inequalities. Discussion Workshop

Transcription

1 Inequalities Discussion Workshop

2 Tracy Williams Clinical Chair NHS Norwich CCG Lead Nurse City Reach Health Services Reducing Inequalities Workshop

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4 The Index of Multiple Deprivation

5 Fair Society, Healthy Lives: 6 Policy Recommendations A.Give every child the best start in life B.Enable all children, young people and adults to maximise their capabilities and have control over their lives C.Create fair employment and good work for all D.Ensure healthy standard of living for all E.Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill health prevention Marmot, 2010

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9 STP Submission June In Good Health Close the inequalities gap A high proportion of residents live in the 20% most deprived areas. If the most deprived areas experienced the same rates as the rest of Norfolk and Waveney then each year more than 400 children would be of healthy weight, there would be 1,000 fewer emergency admissions for older people and there would be 60 fewer deaths due to preventable causes. In 2014 the life expectancy gap across the footprint between the most deprived 20% and least deprived 20% was 7 years for men and 4.5 years for women. For men, deaths due to circulatory conditions, cancer, respiratory conditions and external causes (suicide, drug overdose, accidents etc.) account for about 5 years of the difference. For women they account for about 3 years. Our ambition is to close the Health and Wellbeing Gap!

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12 Our responsibilities We can foresee a better NHS that eliminates discrimination and reduces inequality in care. Liberating the NHS Department of Health Health and Social Care Act 2012 wider social duty to promote equality through the services it provides NHS Constitution

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14 Healthy Norwich Social Prescribing pilot in Tuckswood & Gurney Surgery, linked to wider Health inequality work in Lakenham. Holiday Hunger Programme in Primary schools Smoke-free play parks and Smoke-free youth sport Healthy Norwich Grants programme Whole system approach to Obesity #sugar smart, Daily Mile, Breastfeeding Friendly, Weight Management.

15 Marmot, 2010

16 Key questions What s important for Norfolk and why? What should be in the new Norfolk Health and Wellbeing Strategy?

17 Integrated Care Pilot: Broadland District Council and The Market Surgery, Aylsham Matthew Cross, Deputy Chief Executive Broadland District Council 21 June 2017

18 Issues to cover The area and its health issues Background The pilot (approach, outcomes, feedback, etc.) Next steps and reflections Questions/discussion

19 The Broadland area District of 126,000 population approx. Rural/suburban fringe of Norwich 2 x CCG s/asc localities. Share Children s Services locality with NNDC Relatively affluent, healthy. Deprivation often hidden Older population profile 7.2% of households in fuel poverty (2014); slightly more excess winter deaths than expected. Quality of housing and home environment is important, particularly for vulnerable adults

20 Background to pilot DFG Locality Plan contribution to the BCF objectives, particularly avoidable admissions and support discharge Discussions with Integrated Commissioners in North Norfolk locality (one part of BDC area) Focus on those most at risk of hospital admission and needing ASC services How can this patient group get better access to DC services and other community support? What impact would it have? This is not purely a DFG issue!

21 The Approach BDC Home Improvement Agency Officer Market Surgery, Aylsham: Multi-Disciplinary Team Meeting Referrals to HIA Officer. Those most at risk of hospital admission Benefits: Assess in the home Access to home related support which impact on health outcomes (fuel poverty, ventilation, equipment, hoarding) A different view on what is contributing towards someone s health and wellbeing Scheme ran initially for 3 months August 2016 October interventions initiated in the first 3 months

22 High level outcomes Patient medical condition Type of assessment Outcome Mobility Issues Tel Updated on DFG progress and confirmed appointment Cancer patient with Referral to Stonham Homestay advocacy service. inappropriate housing Tel Self Neglect Visit Adaptions, financial support, medical referral, referral to lifeline, building maintenance, boiler service referral. Age related mobility issues Numerous previous visits - Tel assessment required. Information provided on Housing Options and Housing with care. Age related Mobility Tel Given advice on benefits and housing options Mobility issues and Visit Adaption, New Heating System complex health conditions Younger male with physical Tel Referral to Stonham Homestay disability Neurological Conditions Visit Advice on DFG procedure, PIP application and Home options. Female with Mental Health issues and autistic child and advice to ICC Charity funding received for decorating and house maintenance. two other children. Hyper Mobility Syndrome Tel Referral to charities for personal alarm system. Further visit and Assessment required.

23 High level outcomes Wide range of ages 7 less < 60 years and 7 > 75 years 11 BDC telephone assessments 4 BDC home visits Of the 8 patients with health records all had less health support after the housing intervention Of the 7 patients with social care records all had less social care support after the housing intervention ICC outcome indicate that: 3 people at home with only vol. and community support 7 people with mix of community based of health or social care Total Total average per average per month month Before After Nurse appointments GP appointments Home visits Hospital admissions LOS in hospital Ambulance transports -0-0 Total average per Total average month per month Before After Social Care Calls Social care Visits

24 The real impact Mr G lives alone in a semi-detached bungalow he suffers from poor mobility and a multitude of health conditions. His Carer reported to the GP that Mr G s heating wasn t working and hadn t done so in a long time. He would fall asleep in front of an open fire and not have the fireguard on so she had concerns around fire hazard. A level access shower, shower seat and grab rails were installed Referral to British Gas Energy Trust that resulted in the installation of a new gas boiler Issues addressed: Personal Hygiene and a warm and safe environment

25 Feedback from GP Practice Better understanding of services provided from BDC Earlier intervention (before a crisis) Polly s attendance at the meeting allowed us to ask about options for patients

26 Feedback from the ICCs Good working relationship with HIA Officer Learnt about the services available from BDC Generated referrals from non-clinical interventions Supported focus on prevention and increasing resilience by helping residents keep warm and in a home free of tripping hazards

27 Next Steps Measures / cost saving on system Second pilot to start in Drayton (use of Norfolk Public Health funding). Aim is 6 months Evaluation framework being developed Would like pilot in Norwich CCG locality Measure / Sustainability of work Recognition for this model of working

28 Some reflections Good communication and trust Links worked well BDC, integrated commissioners, NCH&C, ASC social care team, GP, CCG (integration or at least alignment!!) Flexibility for HIA Officer A different conversation with resident (what would help you live your life better?) Learning from evaluation e.g. data/info to collect Similarities to social prescribing (discuss!) Builds on arrangements (roles, structures) already in place Two CCGs/ASC localities different connections?

29 Any Questions?

30 Key questions What s important for Norfolk and why? What should be in the new Norfolk Health and Wellbeing Strategy?

31 Norfolk Health and Wellbeing Event, 21 June 2017 Reducing inequalities workshop: Homelessness presentation by Chris Hancock, Housing strategy officer, Norwich City Council

32 Purpose of my presentation Overview of homelessness work in the greater Norwich area Greater Norwich covers the following districts: Broadland district council Norwich City council South Norfolk council

33 Two questions What's important for Norfolk and why? What should be in the new Health and Wellbeing Strategy?

34 Challenges for people who are homeless Their complex needs and chaotic lifestyles can make it difficult to navigate complicated systems Many homeless people lack self esteem and therefore do not value good health or prioritise their health needs Some homeless people may distrust or avoid services as they feel stigmatised

35 Challenges for commissioners To meet the health needs of our homeless population across the 2,074 sq miles of Norfolk. The homeless population is not a homogeneous group. You could argue that this population are people with a range of social, psychological or economic problems who are also experiencing homelessness.

36 What is homelessness? 1. Roofless - People sleeping rough. 2. Houseless a. people in accommodation for homeless people (direct access hostels). b. people due to be released from institutions (prison and hospital) c. people receiving support (due to homelessness i.e. in supported accommodation). 3. Insecure a. people living in insecure accommodation (squatting, sofa surfing).

37 Homelessness kills Main findings From the records of deaths in England between , 1,731 were identified as having been homeless people. Of these 90% were male and 10% female whereas the gender split of deaths of the adult general population is 48% male and 52% female. Homeless people are more likely to die young, with an average age of death of 47 years old and even lower for homeless women at 43, compared to 77 for the general population, 74 for men and 80 for women. It is important to note that this is not life expectancy; it is the average age of death of those who die on the streets or while resident in homeless accommodation. At the ages of 16-24, homeless people are at least twice as likely to die as their housed contemporaries; for year olds the ratio increases to four to five times, and at ages 35-44, to five to six times. Even though the ratio falls back as the population reaches middle age, homeless year olds are still three to four times more likely to die than the general population, and year olds one and a half to nearly three times. Drug and alcohol abuse are particularly common causes of death amongst the homeless population, accounting for just over a third of all deaths. Homeless people have seven to nine times the chance of dying from alcohol-related diseases and twenty times the chance of dying from drugs. Homeless men and women had similar mortality ratios for deaths due to alcohol, while for deaths due to drugs, men were seventeen times, and women thirteen times, more likely to die than the general population. Men were also more likely to die from cardiovascular problems than women.

38 Rough sleeping is increasing Rough sleeping: England & Norwich England Norwich

39 Unknown and known rough sleepers Norwich: Verified rough sleepers Verified

40 Why? 140 Left institution Estimated Left institution

41 Greater Norwich homelessness strategy

42 Coverage

43 Our priorities targeting our resources at those people who are most at risk of homelessness. helping people find affordable, safe, good quality housing. working better together with partners, so that we can work in a coordinated way to prevent homelessness helping people develop independent living skills, maintain or regain their independence to reduce the risk of someone becoming homeless in the future.

44 Priority: working better together with partners, so that we can work in a co-ordinated way to prevent homelessness. We realised from our homelessness review that we needed to work closer with our partners across the voluntary and statutory sectors. This is why we formed the:

45 Purpose of forum Bring together service providers, stakeholders and other interested parties who want to help identify the factors and causes of homelessness in Greater Norwich and listen to the views of partners and stakeholders. Develop approaches with forum members from identified issues. Share good practice amongst forum members and seek out external examples. Provide a sounding board and work with local authority and statutory partners to help develop local homelessness strategies and action plans. Provide a mechanism for continuous feedback and improvement of homelessness services in Greater Norwich. Promote joint working amongst members of the forum. Celebrate and publicise the forum s achievements and successes. Develop a co-ordinated approach to preventing homelessness in Greater Norwich.

46 Homelessness review 2018/19 It is a statutory requirement that each local housing authority carries out a homelessness review every five years. This review will identify gaps in provision. The Greater Norwich homelessness forum will be an invaluable conduit for this process.

47 Joint strategic needs assessment We identified as part of our work with Public Health that there were gaps in our knowledge of the health needs and inequalities of our homeless population.

48 Who? Back in 2016 we formed a working group of statutory and voluntary agencies who either work with homeless people or are interested in their health needs. The report focuses on six main themes: Socio-demographics of local homeless population Access to health services Physical health Drug and alcohol use Vaccinations and screening Wellbeing

49 Socio-demographics Percentage of population at each age range % of total population GNHHNA Homeless Link GNP

50 Key findings: Access to health care Good points: 90% were registered with a GP (or specialist health care service) similar to the national survey (92%). 9% said that they had been refused registration.

51 Key findings: Access to health care Bad: 46% were registered with a dentist; this is 14% lower than the general population and 12% lower than the national survey.

52 Key findings: Use of emergency services Bad: 32% had used an ambulance in the past 12 months; 22% three or more times. More than three times higher than the general population, higher than the national survey. 46% had visited an A&E service in the past 12 months. Four times higher than the general population and 7 % higher than the national survey. Of those 53% had visited once, 19% twice, 14% three times and 19% more than three times.

53 Key findings: Physical health Bad: 75% said they had a long standing illness, disability or infirmity; this is more than twice the number of people in Norfolk and 31% higher than the national survey

54 Key findings: Mental health Bad: High levels of mental health problems reported in the survey in comparison with the national survey (further evidence needed).

55 Key findings: Hospital discharge Bad Of the 30 people who had been admitted into hospital, more than half said that hospital staff had not ensured suitable discharge. In comparison, the national survey found 70% of people said that staff had ensured that suitable accommodation was available on discharge.

56 Key findings: Healthy eating Bad: 47% of people eat less than two meals per day. Fruit or vegetables per day: 34% normally eat none 41% either 2 or less portions 15% on average eat 3 or more portions

57 Next steps The health needs audit will be shared widely so that commissioners can use it as an evidence base. The document will be placed on Norfolk Insight. The working group will meet again to gather lessons learned and plan for the next survey later this year. Let me know if you would like to be involved in any future survey. Use the results of the survey for your own service planning and funding bids.

58 Before I finish Two questions: What's important for Norfolk and why? What should be in the new Health and Wellbeing Strategy?

59 Voices from the front-line There is a need for expert assessors who respect clients/patients autonomy and have a person centred approach. This applies in particular to Substance misuse and Mental Health assessments in relation to the homeless. There is no dedicated Mental Health nurse for the homeless who could do an outreach assessment. The referral process is too complicated and prolonged for patients with complex needs on the street who have no address or no reliable phone numbers.

60 Voices from the front-line Availability of mental health assessments/access to services for homeless people. 7 out of 10 rough sleepers have a mental health issue which will only worsen whilst they remain on the streets. Theoretically it is possible to conduct a mental health assessment whilst someone is rough sleeper with a view to finding them a suitable placement; in practice it is almost impossible to set up We are also at a low for the support on offer to people addicted to opiates from various specialist agencies (due to the scale of the demand for their services).

61 Voices from the front-line There is a need for expert assessors who are able to assess the needs of drinkers and their capacity to make decisions, attend appointments, and engage with services. Because of a lack of capacity current methods often fail as patients are not able to follow rules/ options they are offered. An outreach service for patients with complex needs e.g. MH and substance misuse problems would be extremely beneficial. Substance misuse support needs to be in conjunction with specialist Mental Health support.

62 The end Do you have any questions? You can contact me: chrishancock@norwich.gov.uk Tel:

63 Key questions What s important for Norfolk and why? What should be in the new Norfolk Health and Wellbeing Strategy?