Why public health interest?

1. Homelessness is health inequalitySussex rough sleeping, single homelessness & street community event, 18 July 2016Gill Leng @gill_lengNational lead: housing & health

2. Why public health interest? • “The science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society” • Public health is ‘everyone’s business’ • Public health outcomes focus on • increased healthy life expectancy • reduced differences in life expectancy • healthy life expectancy between communities • As professions • Share the same origins • Same desire but better quality of life

3. Why PHE interest? • PHE mission: toprotect 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

4. Partnership interest “The right home environment is essential to health and wellbeing, throughout life” • Describes • Key features of the home • Evidence of the difference it can make • Contribution to health and social care • Context for change • Commits national partners to joint action • Leadership • Evidence • Solutions

5. Good health is not just the NHSA home is not just a house Health Behaviours 30% Socioeconomic Factors 40% Clinical Care 20% Built Environment 10% Smoking 10% Education 10% Access to care 10% Environmental Quality 5% Diet/Exercise10% Employment 10% Quality of care 10% Built Environment 5% Income 10% Alcohol use 5% Poor sexual health 5% Family/Social Support 5% Community Safety 5% Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute

6. The house Good health: work of a life time 05-15 00-04 66-85 16-30 31-45 46-65 Cold & disrepair Cold & disrepair On own & Isolated Paying the mortgage Overcrowded Living in TA 86+ Sharing poor PRS Can’t get upstairs The home Family experience Individual experience Abuse and neglect Drug or alcohol use Mental ill-health Criminal justice Poverty

7. Beyond integrated care Source: King’s Fund: Population Health; going beyond integrated care, 2015

8. People Interventions Good health through the home Health, care & other institutional settings End of life care People leaving a health, care or other institutional setting move on to a healthy home environment Hospital discharge, prison resettlement etc, People who become ill, face crisis or other life change manage their health & wellbeing at home Step down, specialist & supported housing Healthy homes and neighbourhoods Integrated ‘health and wealth’ services Information, advice, support in PIE Homeless response Support from people with lived experience People with long term conditions are able to manage their health at home Housing support/tenancy sustainment Homeless prevention Everyone’s home promotes good health & prevents ill-health Making every contact count Healthy communities and health equity

9. Action? Systems leadership • Outcome: There isnational and local systems leadership and accountability for homelessness and inclusion health • PHE: • ‘Improving health through the home’ Memorandum • Public Health Minister on cross-government group • Leadership meetings – first in Feb 2016, next in July • Embedded homelessness in related priority areas • Drug and alcohol commissioning prompts and data • Enabling right home environment for TB treatment (2016) • Population health framework for single homeless (2016) • Regional support programme in 2016/17 • Support small number of areas to lead by example • Support other PHE priorities eg, mental health & suicide prevent

10. Action: intelligent commissioning • Outcome: Local commissioning is informed by • Full understanding of homeless & inclusion health needs • Evidence of effective prevention & response measures • Involvement of people with lived experience & agencies which support them • PHE: • Revised homeless health needs audit (Homeless Link) • Rapid review of homeless prevention interventions in health and other community settings • Standards of evidence in housing (HACT) • Contributing to relevant research eg, KCL health care • 16/17 reviewed health data to understand what tells us

11. Action: homes and services • Outcome: High quality services across the system, and homes, are commissioned to enable prevention and support recovery and rehabilitation for men and women, supporting people to improve their own health and wellbeing • PHE: we know enough about what works: why not adopted? • 2016/17 programme • Action to translate models that work eg, hospital discharge • Joint work with NHSE to engage CCGs • Workforce development with partners eg, HEE, RSPH • Supportive of partners approaches • Crisis – access to the private rented sector • Homeless Link - Housing First model • Engaged in future of supported housing review

12. Local examples of public health engagement • DsPH may be responsible for local homelessness & housing related support budgets • Specific examples (not exhaustive!) • Bradford (BRICCs): Supporting homeless health pathway • West Midlands • Homelessness Network • Regional Offender Housing Protocol • Blackburn with Darwen: MEAM approach • Brighton and Hove: Systems-based approach to single homelessness • LB Richmond: Robust homelessness JSNA • London homeless health: Informed response to Health Commission healthcare recommendation

13. Contact • Gill Leng • Tel: 07766 660799 • @gill_leng • Email: gill.leng@phe.gov.uk