Health and Homelessness Guidance

Transcription

1 Health and Homelessness Guidance September 2001 Scottish Executive Health Department Working together for a healthy, caring Scotland

2 Health and Homelessness Guidance September 2001 Scottish Executive Health Department

3 FOREWORD The Scottish Executive is pleased to issue this Guidance to NHS Boards as part of our drive to tackle health inequalities and promote social justice. The need to improve the health of homeless people was highlighted in Our National Health: A plan for action, a plan for change as a priority for NHS Scotland. Our Homelessness Task Force has reinforced the need to ensure that local government and NHS Boards work closely to meet the range of needs of homeless people. Our appointment of Sue Irving, Health and Homelessness Co-ordinator, will help to play a lead role in bringing about change in the way our health systems deliver for homeless people. It is therefore vitally important that NHS Scotland works together with the Scottish Executive in our drive towards reducing the need for anyone in Scotland to sleep rough, as well as in tackling homelessness more widely. Homelessness is not simply a housing issue. Those who are homeless are among our most vulnerable citizens and so together we have a responsibility to ensure that their health needs are met. Unmet health needs contribute to trapping people in homelessness, and so in addressing these needs NHS Scotland can assist homeless people to move on and change their circumstances. ii

4 To do this NHS Scotland must look afresh at whether or not it is delivering for homeless people. This may mean that new and creative solutions need to be found, or it may be that service frameworks need changed. Creative solutions will necessitate working in partnership with those who already work with homeless people. It is also essential that NHS Boards find meaningful ways of engaging with homeless people themselves in order to ensure that their services are indeed reaching those for whom they are intended. The key message is that no one sector can achieve success alone partnership is absolutely critical. The Guidance outlines how NHS Boards should tackle this task, how they can assess their performance and report on this to the Scottish Executive. Throughout the country, there are many examples of NHS Boards and local authorities working closely together to tackle the complex problems involved in supporting homeless people. However, we recognise that the challenge for all concerned is to get better at listening to our clients; get better at working more closely with our colleagues; and get better at devising local solutions based on local needs. We have made a commitment to end the need for anyone to sleep rough in Scotland by 2003 and we believe this Guidance will be helpful to NHS Scotland in showing how they can contribute to this goal being achieved. Fundamentally, the Guidance concentrates on achieving results and after all that is what we are all concerned with positive action leading to positive change to improve the health of homeless people in Scotland today. SUSAN DEACON MSP Minister for Health and Community Care JACKIE BAILLIE MSP Minister for Social Justice iii

5 iv

6 HEALTH and HOMELESSNESS GUIDANCE 1. PURPOSE 1.1 Our National Health: A plan for action, a plan for change, made a commitment to issue Guidance to NHS Scotland on its role in improving health and health care services for homeless people. Section 2 of Our National Health: Improving Health, states clearly the Executive's determination to narrow the gap between rich and poor through building a national effort to improve health. 1.2 The purpose therefore of this Guidance is to emphasise to NHS Boards the importance the Executive attaches to delivering not simply on the target of ending the need for people to sleep rough, but on the much broader aim of delivering services to people whose life circumstances undermine their access to stable, continuing care. This Guidance and the appointment of a Health and Homelessness Co-ordinator aim to support NHS Boards in their efforts to address the needs of homeless people as part of their overall drive to reduce inequalities in health. 1.3 This Guidance requires NHS Boards to: Develop a Health and Homelessness Action Plan as an integral part of the Local Health Plan, in partnership with local authorities, the voluntary sector and homeless people. This Action Plan will be effective from April 2002 and will have been agreed with the Scottish Executive Central to the development of the Action Plan will be a clear mechanism for linking the Action Plan with Local Authorities Homelessness Strategies in 2003, and also with Community Plans. This will necessitate constructive engagement with each Local Authority covered by individual NHS Boards. 1.4 NHS Boards should be aware that the Health and Homelessness Co-ordinator, Sue Irving, is a resource and is able to provide support and guidance throughout the planning, implementation and monitoring of Health and Homelessness Action Plans. The Co-ordinator will also work towards building up a database of good practice examples and to develop and deliver training to enhance the capacity of local health care systems to respond to homeless people s needs. NHS Boards are therefore encouraged to work in close partnership with the Co-ordinator. Sue Irving s contact details are as follows: St Andrew s House Regent Road EDINBURGH EH1 3DG Tel: Fax: Aberdeen office tel: sue.irving@scotland.gsi.gov.uk 1

7 2. BACKGROUND INFORMATION 2.1 NHS Scotland has already done much to develop frameworks to promote better services and greater social inclusion for groups at risk of marginalisation, for example through the Framework for Mental Health and the Learning Disabilities Review. Much of the annual 26 million spend on the Health Improvement Fund will tackle social exclusion, particularly relating to child poverty. Partnership initiatives are also critical Social Inclusion Partnerships, Sure Start Scotland, Healthy Living Centres and the award-winning Scottish Community Diet project all contribute to improved health. Drug Action Teams have made a good start in co-ordinating multi-agency action to implement the Drugs Strategy. The Executive has set a number of drug misuse targets that are relevant to homeless people. These include increasing the number of drug misusers in contact with treatment and care services in the community, by at least 10% every year until The Scottish Executive will also publish a Plan for Action on alcohol misuse by the end of This will address, amongst other things, the range of services required, and how agencies should work together to deliver these. 2.2 The Scottish Executive is committed to end the need for anyone to sleep rough by It has established the Homelessness Task Force to bring forward recommendations on how homelessness can be prevented, and where it does occur, tackled effectively. 2.3 Other Scottish Executive initiatives that will influence the health and homelessness agenda include Supporting People. This new integrated policy and funding framework will be utilised to support vulnerable people in different types of accommodation and will need a health input in each local area to ensure its success. Supporting People will also present opportunities to consider the support needs of homeless people in a multi-disciplinary way. 3. REQUIREMENTS OF NHS BOARDS 3.1 Following on from these developments, there is now a requirement of NHS Scotland to tackle the specific health needs of homeless people. Much of the work already undertaken by NHS Boards will be relevant to homeless people. However, the role of NHS Boards was considered as part of the 1999 interim review of the Rough Sleepers Initiative which highlighted that rough sleeping was not just about housing, but about the need to provide a range of services to people with complex and often health-related needs. In this context the review recorded criticisms of NHS Boards for failing to address adequately the primary [care] and mental health issues which disproportionately affect homeless people, many of whom were unable to access mainstream services. 3.2 There are many forms of homelessness and homeless people themselves have a wide range of health-related needs. Defining homelessness is also not simple. 2

8 The Homelessness Task Force has agreed a description of homelessness for the purpose of its work, and this working description is attached at Annex A. It embraces those defined in statute as homeless, those who are roofless including people sleeping rough, those who are houseless, those in insecure accommodation and those having to share housing involuntarily in unreasonable circumstances. NHS Boards may find this working definition helpful in the development of their plans. The Task Force s final definition will be made available on completion of its work. 3.3 Individuals and families, in particular those with young children, in a range of homeless circumstances will have distinct health and health care needs. To respond to these needs most effectively, services need to be targeted. In addition, a key priority for all those involved in tackling homelessness is the prevention of people becoming homeless. 3.4 People sleeping rough are in the most extreme circumstances. Rough sleeping may be defined as sleeping outside in the open air (such as on the streets, or in doorways, parks or bus shelters) or sleeping in a building or other place not designed for habitation (such as barns, sheds, cars, derelict boats, car parks, stations, etc.). 3.5 In supporting The Scottish Executive s commitment to end the need for rough sleeping and to tackle the problems of homelessness, NHS Boards need to take a fresh and rigorous look at whether their social inclusion strategies are delivering for homeless people, with their frequently complex health and support needs. This will take the form of a Health and Homelessness Action Plan, which should be integrated into the overall Local Health Plan. 3.6 In so doing there is a need to reflect the understanding of the interaction between health and homelessness and more widely demonstrate awareness that homelessness is not only, and frequently not primarily, a housing issue. It is important that consideration is given to the widest definition of health in order to reflect that homeless people s health needs are not only in relation to poor health. The promotion of healthier lifestyles and improved wellbeing, for example through the need for a healthy diet, is also critical. 3.7 Local authorities are now statutorily required to carry out an assessment of homelessness in their area, and to develop strategies to address the identified problem. Initial Guidance on carrying out assessments will be issued to Local Authorities over the summer Further Guidance on the development of strategies will follow, taking account of the conclusions and recommendations of the Homelessness Task Force, which is due to report by the end of NHS Boards Action Plans will also be expected to take account of relevant Task Force recommendations. 3

9 3.8 The Health and Homelessness Action Plan will therefore form an integral part of the Local Health Plan and the homelessness strategy and so joint working with local authorities and other stakeholders is central to the development of the Action Plan. Community Planning frameworks that are in place in each Local Authority area should greatly assist in the development of joined up service planning, resourcing and delivery. The Health and Homelessness Action Plan 3.9 The Scottish Executive attaches considerable importance to ensuring that this work is carried out. Each NHS Board is required to demonstrate, through the Performance Assessment Framework, that the Health and Homelessness Action Plan is effective and also an integral component of the homelessness strategy of the Local Authority. The Action Plan must therefore be included in the Local Health Plan NHS Boards Action Plans will be for three years covering and must be delivered in partnership with local stakeholders. It is expected that the first version of the Plan will focus on with a forward look to the following two years. This should enable NHS Boards to create effective linkages with Local Authorities homelessness strategies The Action Plan will address the following: (a) A demonstrable knowledge base on homelessness within each NHS Board. This will be evidenced by: (i) (ii) The provision of a profile of homelessness within the Board area, using the definition outlined in Annex A. A comprehensive assessment of homeless people s health and health-care needs. Clear links should be established with Local Authorities needs assessments under the Housing (Scotland) Act (b) (c) (d) An understanding of the network of health care services within primary and secondary care currently supporting homeless people. Consideration should be given to what services are being used and which are not, together with their accessibility. An evaluation of the strengths, weaknesses and gaps in current provision, including a plan for addressing weaknesses and gaps. A plan for addressing service improvements together with an implementation programme. In so doing consideration should be 4

10 given to the importance of continuity of care, including admission and discharge arrangements, to meet the needs of homeless people. (e) Arrangements to ensure that action on homelessness is linked with the social inclusion strategies of partners in the statutory and voluntary sectors Critically the Action Plan must be completed in partnership with other stakeholder groups, including the local authority, voluntary sector and homeless people themselves. The effectiveness of this partnership working will be an integral component of the performance assessment. NHS Boards have participated in Community Care planning processes and these experiences should be drawn upon in agreeing at a local level the mechanisms of the planning process. A comprehensive planning framework should therefore ensure that all the key players are involved including the police, prison service and other relevant sections of the criminal justice system, secondary care and those who provide temporary accommodation for homeless people The Action Plan will set targets based on local needs and must be subject to regular monitoring and review to ensure that these targets are being met Within each Board an individual will be identified who is able to take responsibility for the health and homelessness agenda and report on this through the Performance Assessment Framework. The officer nominated will be in a key position to enable the delivery of action and co-ordinate the partnership approach. The details of the nominated officer should be made available to the Health and Homelessness Co-ordinator The Health and Homelessness Co-ordinator is required to report to the Minister for Health and Community Care and to the Health and Homelessness Steering Group on the progress made on the above areas of work by Boards NHS Boards are therefore required to include the Health and Homelessness Action Plan as an integral part of their Local Health Plan. These will be assessed by the Health and Homelessness Co-ordinator. Following Scottish Executive agreement, Action Plans should be implemented from April 2002 as part of the Local Health Plan. 4. BACKGROUND INFORMATION ON HEALTH AND HOMELESSNESS 4.1 The remainder of this Guidance is designed to give advice to local health care systems as they tackle this task. Section 5 gives some summary information on the specific health needs of homeless people within the wider social inclusion context. Section 6 highlights some of the key issues identified in access to health 5

11 care for homeless people, and Section 7 seeks to map out the partnership context for work with homeless people. Annex A Annex B Annex C Annex D provides the Homelessness Task Force s working definition of homelessness. provides a short summary of the key changes in homelessness legislation in Scotland. provides details of the membership of the Health and Homelessness Steering Group. provides a list of NHS Scotland s health and homelessness contacts. 5. THE HEALTH OF HOMELESS PEOPLE 5.1 Every area of Scotland faces the blight of homelessness. Across Scotland, 45,731 homelessness applications were made to local authorities in Of those some 18,600 were considered to be in priority need (e.g. families with children, elderly, etc.). However, those who are not recorded as a priority in legislative terms, and who may not even apply to the local authority as homeless such as young single people, can also have significant health needs. 5.2 Addressing homelessness has to be a critical aspect of the social justice agenda, given that homeless people are among the most disadvantaged of our society. The 1999 Office for National Statistics survey (ONS) of a sample of homeless people in Glasgow found that 96% of those surveyed were not in work; 63% had no educational qualifications and only 18% were educated to SCE O-grade or above. Similar rates have been recorded in other surveys across the UK. 5.3 Of course, it will be the health of homeless people that particularly concerns NHS Scotland and it is clear that there is a greater risk of mortality and morbidity amongst homeless people than in the wider population. Health problems more prevalent in homeless people include: Mental Health. The Royal College of Physicians (RCP) of London 1994 report Homelessness and Ill Health reported that 57% of homeless people surveyed reported depression and 48% anxiety. Self-harm is also common. Misuse of alcohol and drugs and the consequent associated physical problems e.g. abscesses from injecting sites; Hepatitis B and C. The ONS survey mentioned above found that 41% of under 25s and 70% of year olds had drug problems and 61% of homeless people aged 35 and over drank at hazardous levels. 6

12 Foot and skin care, head lice and scabies. The RCP Report found that 24% of their sample had skin problems and 19% had persistent foot trouble. Poor dental health. Leg ulcers. Respiratory infections. 5.4 Health problems are not confined to people sleeping rough. The charity Health and Housing 1999 report Homelessness: Making the Case found that people living in temporary accommodation, whether with friends or in hostels, have little privacy or security, share facilities such as kitchens and bathrooms, and experience some of the typical problems of poor quality housing such as overcrowding, damp and cold. These kinds of housing conditions are associated with a number of health problems including an increased risk of dermatological problems, musculoskeletal problems, poorer obstetric outcomes and mental health problems. 5.5 Of particular concern is the health of children of homeless families. Health and Housing s report states these children are prone to behavioural disturbance, have higher levels of illness and infection and are more prone to accidental injury, suffer delayed development and have poor sleep. 5.6 Finally, the Saffron project in Glasgow identified in its work with young single minority ethnic homeless people, Mental health problems including stress, depression, lack of confidence, anxiety/panic, addictions; Physical health problems including dental problems, weight loss, gynaecological problems, scars, hair loss; and Emotional health problems including low self-esteem, guilt, anger, unable to create/maintain relationships and fear. 5.7 This small sample of the evidence available underlines the need for NHS Boards to review how they can help improve the health of all homeless people. 6. ACCESS TO HEALTH CARE FOR HOMELESS PEOPLE 6.1 NHS Boards will need to review their health care services and the extent to which they are available and accessible to homeless people. 6.2 The Glasgow Review Team s Report on Street Homelessness in Glasgow identified the following problems that create barriers for homeless people seeking appropriate health care: 7

13 Homeless people felt they were not well received when they tried to use health services. The team had received reports of inadequate treatment or poor reception at accident and emergency departments. Homeless people did not find it easy to register with a GP or to continue to access GP services if they moved on. Negative self-image, lack of self-esteem and feelings of worthlessness meant that many homeless people lack the ability and confidence to seek out appropriate health care. It is difficult to tackle health problems effectively when people are living in poor accommodation and lack social support. There are also gaps in the provision of some vital services and, even where they are available, their success can be undermined if people are then discharged back into hostels or inadequate accommodation. There is a balance to be struck between providing specific services directly to homeless people and ensuring that homeless people can access mainstream services. 6.3 In keeping with these findings, Health and Housing s Homelessness Report showed that homeless people experienced greater difficulty in accessing health services, whether because of difficulty registering with a GP or having been removed from a GP s list. A report undertaken by North et al (1996) found a higher than average inappropriate use of A&E Departments by homeless people and that savings to the NHS could be made if appropriate visits to primary care services could be substituted. 6.4 Some of the potential barriers to access mainstream services NHS Boards will wish to consider involve: The criteria for accessing services, for example, a demand that a person be drug- or alcohol-free before accessing mental health services. The content of services: There may be services for people with severe and enduring mental illness but few services for people with mental health problems. GPs may be unwilling to prescribe substitute medication for homeless drug misusers, where they do there are concerns about risk of overdose and safe storage of substitute medication. 8

14 The way in which the service is delivered: The GP service and prescribing is linked to the area within which a person lives. Some homeless people may move around constantly between rough sleeping and hostels, others, including families, may lose their local connections during a spell in temporary accommodation. The GP service is provided through an appointment system, which some homeless people may not be able to negotiate. Waiting times may create difficulties for homeless people with mental health problems. Limited consultation times do not allow time for a full assessment to determine how best to respond to a person with multiple and complex needs. Accident and Emergency Departments are often the first point of contact for homeless people. Staff may not have received training on homelessness issues and may not be in a position to respond appropriately to homeless people. 6.5 NHS Boards will recognise parallels with the experience of people with mental health problems or who have a severe and enduring mental illness and other groups whose lifestyles or circumstances make accessing health care problematic. This experience and expertise will facilitate the work of NHS Boards in addressing the health care needs of homeless people. It is also an opportunity for NHS Boards to identify whether their current strategies, for example Children s Services, alcohol and drug misuse, require modification to ensure that the needs of homeless people are being addressed. 6.6 The Scottish Executive s Effective Interventions Unit has identified accessibility to services as one of the key elements of its work on the development of integrated care provision to people who misuse drugs. 6.7 A key outcome of this work will be to identify how services can best meet the needs of a number of disenfranchised or socially excluded groups in our society including homeless people. To this end a fixed-term working group has been convened of key professionals from drug misuse services around Scotland and others such as the Health and Homelessness Co-ordinator to assist in this work. 6.8 The group will consider existing research and current practice from within and outwith the drugs field, and make recommendations to the Effective Interventions Unit which will inform the guidance which the Unit gives out to DATs and to drug services. 9

15 7. DEVELOPING IMPROVED HEALTH CARE SERVICES FOR HOMELESS PEOPLE IN PARTNERSHIP 7.1 Our National Health has stated categorically that the role of NHS Scotland in Improving Health is to work in partnership with others. There are numerous examples of partnerships of which the NHS is a leading member. 7.2 The Rough Sleepers Initiative is one example of such a partnership that has drawn together statutory and voluntary organisations to plan and develop services in a co-ordinated way. In 2000/01, an additional 4 million was made available to NHS Boards for spend on RSI projects; the support was directed at existing rough sleeping initiatives with the intention of pump-priming and evaluating services with long term potential. 7.3 Examples of the use to which the 4 million has been put include: Argyll and Clyde: working towards the production of a standard checklist for RSI projects of: the health needs of rough sleepers; the health problems which increase the risk of becoming a rough sleeper; the health and healthrelated services for those who sleep rough, and those at risk of sleeping rough and the competencies required for health workers working with RSIs. Ayrshire and Arran: Outreach Health, Housing and Advice Project to assist primary care to target homeless people. Dumfries and Galloway: hand-held records for travelling families and young homeless people; examining health and health-service needs of prisoners coming up to release, and targeting housing needs where there are drugrelated issues. Fife: Research project to gather evidence of need, education and training for voluntary and housing staff. Glasgow: capital costs relating to the provision of short- and long-term stay places, first year of the establishment of the Homeless Addictions Team. Grampian: improved treatment room facilities. Highland: pilot provision of outreach Community Psychiatric Nurse, designated health visitor and designated chiropody service. Lanarkshire: Specialist nursing provision. Lothian: emphasis on integration in primary care, especially with drugs and alcohol services. Tayside: targeting health care and improving facilities for rough sleepers and those at risk of sleeping rough. 10

16 7.4 In considering effective working with homeless people, The Report of a Review of the Rough Sleepers Initiative in Glasgow (June 2001) by the Social Work Services Inspectorate comments on good practice in integrated care planning. The use of different methods of working with homeless people at different stages in their homelessness is highlighted, in particular the use of common assessments, care planning and the care programme approach are outlined as effective means of engaging with homeless people. Those working with this vulnerable group, including those in NHS settings, may find value in considering the findings of the report when developing and evaluating interventions. A Strategic Response 7.5 One of the aims of this Guidance is to encourage NHS Boards to develop a more strategic response across their area and contribute more fully to other partnerships in their areas that are also addressing the needs of homeless people. This strategic response should be reflected in the following documents and actions. 7.6 Within each Local Authority s boundary, the Homelessness Strategy for each local authority will be the key strategic document for tackling homelessness. While the Local Authority will be responsible for co-ordinating this, every partner working with homeless people will be required to contribute fully. Clearly NHS Boards will be key players in the development and implementation of this strategy. Other partnership arrangements such as DATs and AMCCs, Social Inclusion Partnerships and Supporting People will also provide vehicles for agreements on joint collaborative action. 7.7 Within the NHS, the three-year Action Plan outlined under 3.11 will form the NHS Board s contribution to the local authority s Homelessness Strategy. A significant aspect of this Action Plan will be the review of existing policies, for example, Children s Services and the Framework for Mental Health. NHS Boards shall also be expected to have considered and improved the way they consult with homeless people and ensure their views are reflected in the development and evaluation of services. Health s Action Plan, and its contribution to the homelessness strategy, should also reflect initiatives such as joint assessments of homeless people, care planning and joint arrangements for continuity of support which should become the standard approach to supporting homeless people. 7.8 One of the Health and Homelessness Co-ordinator s key tasks will be to consider each NHS Board s contribution to the Homelessness Strategy for each area. Progress will be reviewed, gaps identified and support provided wherever this is needed. The Boards contribution to an area s Homelessness Strategy will also be monitored through the NHS Performance Assessment Framework. 11

17 7.9 In addition, the provision of services for young homeless drug users is currently monitored through Drug Action Team Corporate Action Plans. There is increased provision outlined in these plans for 2000/01. Future planning arrangements will seek to ensure a joined-up approach with the new homelessness planning requirements. 8. CONCLUSIONS 8.1 Section 3 of this Guidance summarises the requirements of NHS Boards in relation to health and homelessness. This Guidance provides NHS Boards with information on why the Scottish Executive has made addressing the health needs of homeless people a key priority, and provides a background on the health and health care needs of homeless people, together with suggestions on how partnership working on this issue could be addressed. 8.2 The challenge to all who work with homeless people is to take this Guidance and ensure it delivers to improve the health of homeless people. 12

18 REFERENCES Homelessness and Ill Health, Royal College of Physicians, 1994 Homelessness: Making the Case, Health and Housing, 1999 Kershaw A. Singleton N. and Meltzer H., Survey of the health and well-being of homeless people in Glasgow, Office for National Statistics, 1999 National Monitoring and Interim Evaluation of the Rough Sleepers Initiative in Scotland, Scottish Executive, Central Research Unit, June 1999 North C., Moore H. and Owens C., Go home and rest: the use of an Accident and Emergency Department by homeless people, Shelter, 1996 Our National Health, a plan for action, a plan for change, Scottish Executive, 2000 ( The Report of a Review of the Rough Sleepers Initiative in Glasgow, Social Work Services Inspectorate, Scottish Executive, June 2001 ( Report on Street Homelessness in Glasgow, Glasgow Street Homelessness Review Team, 2000 Supporting People, Decision-Making Processes and Working Arrangements: Implementation Interim Guidance, Scottish Executive, 2001 ( Further reference material can be found by searching the University of Glasgow s web site, which contains an extensive bibliography of relevant research. The site can be accessed at using health as the key word to search the bibliography. 13

19 ANNEX A HOMELESSNESS TASK FORCE Working Draft Description of Homelessness The Task Force has identified a range of housing situations which describes the meaning of homelessness for the purposes of its work. This description embraces the following categories. It is acknowledged that the various categories are not mutually exclusive, but in the interests of clarity, all have been specified. 1. Those persons defined in current legislation as homeless persons and persons threatened with homelessness i.e. those: Without any accommodation in which they can live with their families; Who cannot gain access to their accommodation or would risk domestic violence by living there; Whose accommodation is unreasonable ; or is overcrowded and a danger to health; Whose accommodation is a caravan or boat and they have nowhere to park it. 2. Those persons experiencing one or more of the following situations, even if these situations are not covered by the legislation: Roofless: Those persons without shelter. This includes people who are sleeping rough, victims of fire and flood, and newly-arrived immigrants (see footnote). Houseless: Those persons living in emergency and temporary accommodation provided for homeless people. Examples of such accommodation are night shelters, hostels and refuges; Households residing in accommodation, such as Bed and Breakfast premises, which is unsuitable as long-stay accommodation because they have no where else to stay; Those persons staying in institutions only because they have nowhere else to stay. 14

20 Insecure accommodation: Those persons in accommodation that is insecure in reality rather than simply, or necessarily, held on an impermanent tenure. This group includes: tenants or owner-occupiers likely to be evicted (whether lawfully or unlawfully); persons with no legal rights or permission to remain in accommodation, such as squatters or young people asked to leave the family home; persons with only a short-term permission to stay, such as those moving around friends and relatives houses with no stable base. Involuntary Sharing of Housing in Unreasonable Circumstances Those persons who are involuntarily sharing accommodation with another household on a long-term basis in housing circumstances deemed to be unreasonable. Footnotes 1. Beyond the above specific categories of persons in situations of homelessness or near homelessness, the Homelessness Task Force recognises a range of other vulnerable persons (to be described in the HTF report) at particular risk of homelessness, who are also the subject of proposed preventative action. 2. The responses to newly-arrived immigrants are governed by separate UK legislation and rules administered by the Immigration Service and are not a focus for the Homelessness Task Force. 15

21 ANNEX B CHANGES TO THE HOMELESSNESS LEGISLATION LEGISLATION The Homelessness Task Force produced an interim report in April 2000 with recommendations for legislative amendments to be included in the Housing (Scotland) Act. These were endorsed by the Executive and included in the Act, which received royal assent in July WHAT DOES THE NEW LEGISLATION DO? Additional duties placed on Local Authorities: Duty on local authorities to carry out assessments of homelessness in their areas and, based on these assessments to produce strategies for preventing and alleviating homelessness; Duty to ensure that advice about homelessness and the prevention of homelessness is available free of charge. Increased Rights for Homeless People: Homeless people who are assessed as being in priority need and have not become homeless intentionally will be entitled to permanent accommodation; The right to request a review of a homelessness decision by the local authority; A basic package of rights, including enhanced advice and assistance and access to temporary accommodation for homeless people who are assessed as not being in priority need; Introducing a right to register on a housing list; Enabling minimum rights for people living in hostels; Extension of the period during which local authorities have a duty towards people threatened with homelessness from 28 days to 2 months. Other Measures: Legislative changes to ensure that homeless people are not disadvantaged if a local authority has transferred its housing stock into community ownership; New arrangements for monitoring and regulation of local authorities homelessness functions. 16

22 WHAT ISSUES ARE BEING COVERED IN THE HOMELESSNESS TASK FORCE TIMETABLE? The Task Force is now considering further policies for homelessness prevention and strategies to alleviate existing homelessness. Amongst the issues being examined are: Underlying causes of homelessness and preventative measures. The benefits system and employment issues. The needs of specific groups: young people including care-leavers, families, exoffenders, ex-servicemen, elderly, disabled, ethnic minorities. Accommodation strategies. Resettlement approaches. The connection and integration of services. Life-skills and education. Consideration of these various issues is being informed by the findings of a range of major research projects and lessons from international experiences. The Group s views on these and other issues will be provided in its final report, expected towards the end of

23 ANNEX C HEALTH AND HOMELESSNESS STEERING GROUP Chairperson Ms Catriona Renfrew Tel: Director of Commissioning Fax: NHS Greater Glasgow Dalian House catriona.renfrew@gghb.scot.nhs.uk 350 St Vincent Street GLASGOW G3 8YZ Dr John Wrench Tel: Director of Public Health Fax: NHS Highland Assynt House john.wrench@hhb.scot.nhs.uk Beechwood Park INVERNESS IV2 3HG Mr David Fraser Tel: Chief Executive Fax: Dumfries and Galloway Primary Care NHS Trust Crichton Hall dfraser@dg-primarycare.scot.nhs.uk Crichton Royal Hospital Bankend Road DUMFRIES DG1 4TG Mr Robert Aldridge Tel: Director Fax: Scottish Council for the Single Homeless Wellgate House robert@scsh.demon.co.uk 200 Cowgate EDINBURGH EH1 1NQ Ms Wendy Hayhurst Tel: Head of Housing and Social Work Fax: East Lothian Council 6-8 Lodge Street whayhurst@eastlothian.gov.uk HADDINGTON EH41 3DX 18

24 Mr Bill Robertson Tel: Director Social Work Service Fax: Angus Council County Buildings Market Street FORFAR Angus DD8 3WS Ms Alice Docherty Tel: PCT Homeless Co-ordinator Fax: The Caretaker s House 260 Broad Street alice.docherty@glacomen.scot.nhs.uk GLASGOW G40 8YU Ms Sue Irving Tel: Health and Homelessness Co-ordinator Fax: for Scotland Aberdeen Office Tel: Scottish Executive Health Department Sue.Irving@scotland.gsi.gov.uk St Andrew s House EDINBURGH EH1 3DG Ms Lindsay Manson Tel: The Homelessness Team Fax: Development Department Room 2F Lindsay.Manson@scotland.gsi.gov.uk Scottish Executive Victoria Quay EDINBURGH EH6 6QQ Colin Brown Tel: Primary Care Unit Fax: Room 1W.09 Scottish Executive Colin.Brown@scotland.gsi.gov.uk St Andrew s House Regent Road EDINBURGH EH1 3DG 19

25 ANNEX D NHS SCOTLAND HEALTH AND HOMELESSNESS CONTACTS SEPTEMBER 2001 Argyll and Clyde: Dr David Bell Tel: Consultant in Public Health Medicine Fax: NHS Argyll and Clyde Ross House david.bell@achb.scot.nhs.uk Hawkhead Road PAISLEY PA2 7BN Margaret Tannahill Tel: Senior Public Health Nurse Fax: NHS Argyll and Clyde Ross House Margaret.Tannahill@achb.scot.nhs.uk Hawkhead Road PAISLEY PA2 7BN Ayrshire and Arran: Director of Health Policy Tel: Board HQ Fax: Boswell House 10 Arthur Street AYR Pat Lerpiniere Tel: Patient Service Manager Fax Addiction Service Benedick Centre Pat.Lerpiniere@aapct.scot.nhs.uk East Netherton Street KILMARNOCK KA1 4AX Dr Jeremy Stirling Tel: Consultant Psychiatrist Fax c/o Clinic K Psychiatric Office jeremy.stirling@aapct.scot.nhs.uk Crosshouse Hospital KILMARNOCK KA2 0BE 20

26 Borders: Dr Alan Mordue Tel: Consultant in Public Health Medicine Fax NHS Borders Newstead MELROSE TD6 9DB Kenny Richardson Tel Borders PCT Fax Unit 3 Tweed Horizons kenny.richardson@borders.scot.nhs.uk NEWTON ST BOSWELLS TD6 0SG Dumfries and Galloway: David Fraser Tel; Chief Executive Fax: Dumfries and Galloway Primary Care NHS Trust Crichton Hall dfraser@dg-primarycare.scot.nhs.uk Crichton Royal Hospital Bankend Road DUMFRIES DG1 4TG Dr Derek Cox Tel: Director of Public Health Fax: NHS Dumfries and Galloway Grierson House DCox@dghb.scot.nhs.uk Crichton Royal Hospital Bankend Road DUMFRIES DG1 4ZG Fife: Morna McKiernan Tel: ext. 287 Asst. Health Promotion Manager Fax: Health Promotion Department Haig House morna.mckiernan@fife-pct.scot.nhs.uk Cameron House LEVEN KY8 5RA 21

27 Dr Tim Dyke Tel: Consultant in Public Health Medicine Fax: NHS Fife Springfield House CUPAR Fife KY15 5UP Grampian: Ms Jane Williams Tel: General Manager Fax: Aberdeen West LHCC Foresterhill Health Centre Westburn Road ABERDEEN AB25 2AY Sarah Gray Tel: NHS Grampian Fax: Summerfield House 2 Eday Road sarah.gray@ghb.grampian.scot.nhs.uk ABERDEEN AB15 6RE Greater Glasgow: Jane Arroll Tel: Director Professions Allied to Medicine Fax: Greater Glasgow PCT Gartnavel Royal Hospital jane.arroll@gartnavel.glacomen.scot.nhs.uk Trust HQ 1055 Great Western Road GLASGOW G12 0XH Catriona Renfrew Tel: NHS Greater Glasgow Fax: Dalian House P.O. Box catriona.renfrew@gghb.scot.nhs.uk 350 St Vincent Street Charring Cross GLASGOW G3 8YZ 22

28 Highland: Lynda Thomson Tel: NHS Highland Fax Assynt House Beechwood Park INVERNESS IV2 3HG Jan Baird Tel: Local Service Manager Fax: Royal Northern Infirmary Ness Walk INVERNESS IV3 5SF Lanarkshire: Dr Kathleen Long Tel: Lanarkshire Primary Care Trust Fax: Trust HQ Strathclyde Hospital Airbles Road MOTHERWELL ML1 3BW Consultant in Public Health Medicine Tel: NHS Lanarkshire Fax: Beckford Street HAMILTON ML3 0TA Lothian: Dr Mike Winter Tel: Medical Director Fax: Lothian Primary Care NHS Trust St Roque Astley Ainslie Hospital EDINBURGH EH9 2HL Phil Mackie Tel: Senior Specialist in Public Health Fax: Dept. of Public Health and Health Policy Lothian Health Deaconess House 148 Pleasance EDINBURGH EH8 9RS 23

29 Dr Cindy Brook Tel: ext West Lothian Healthcare NHS Trust Fax: St John s Hospital Howden Road West cindy.brook@wlt.scot.nhs.uk LIVINGSTON EH54 6PP Shetland: Shirley M Windsor Tel: Planning Officer Fax: NHS Shetland Brevik House Shirley.Windsor@shetland-hb.scot.nhs.uk South Road LERWICK ZE1 0TG Tayside: Julia Egan Tel: Directorate of Public Health Fax: NHS Tayside Kings Cross Hospital julia.egan@thb.scot.nhs.uk Clepington Road DUNDEE DD3 8EA Dr Bill Mutch Tel: Medical Director Fax: Tayside Primary Care NHS Trust Ashludie Hospital bill.mutch@tpct.scot.nhs.uk MONIFIETH DD2 5NF Western Isles: Dr Maggie Watts Tel: ext. 152 Director of Health Gain Fax: NHS Western Isles 37 South Beach Street Maggie.Watts@wihb.scot.nhs.uk STORNOWAY Isle of Lewis HS1 2BB 24

30 Crown copyright 2001 ISBN X Further copies are available from The Scottish Executive Primary Care Unit, St Andrew s House, Regent Road, Edinburgh EH1 3DG Tel: Produced and designed on behalf of the Scottish Executive by Astron. B /01 w w w. s c o t l a n d. g o v. u k