To inform the board of the results of Herefordshire’s Homeless Link Health Needs Audit and to consider the recommendations arising from the audit.

The consultant in public health presented the results of Herefordshire’s Homeless Link Health Needs Audit, with attention drawn to the following:

a.         The audit was identified as an action in Herefordshire’s Homelessness Prevention Strategy 2016-20.

b.         The health inequalities faced by people who were homeless were considerable, with greatly reduced average life expectancy compared with the general population; over 30 years lower for men and 40 years lower for women.

c.         The audit was undertaken between December 2016 and February 2018, with 102 audits completed through face-to-face interviews by undertaken by Home Group, Supported Housing for Young People Project (SHYPP) and the council’s outreach service.

d.         The key findings were summarised, including background information, physical and mental health conditions, drug and alcohol use, and access to services.

e.         The rough sleeper outreach worker outlined two case studies which highlighted the complexities: the first demonstrated that access to mental health services were often vital for people who were homeless; and the second demonstrated that the provision of accommodation had to be complemented by a willingness to engage and support to address mental health and addiction issues.

f.          The recommendations were outlined, and it was suggested that a workshop be held to examine care pathways.  The audit would be published on the JSNA website, with the intention of repeating it again in three years.

Duncan Sutherland welcomed the audit and commented on the importance of breaking down silos and taking a pro-active approach.  An overview was provided of an integrated initiative in Bristol that was achieving impressive results and it was recommended that consideration be given to the submission of a bid to the Homes England ‘Move On Fund’ to increase the availability of move-on accommodation.

The chief executive emphasised that expressions of commitment had to be backed up by actions to support vulnerable people.  Noting that 25% of respondents had spent time in prison, it was suggested that the Ministry of Justice could be involved in the development of creative initiatives and solutions.  It was acknowledged that the issues were profoundly challenging for any community, especially where people rejected help, and some practical shape was needed to take this work forward.

The director of public health said that the audit was a good piece work, it reinforced the need to focus on community resilience, the workshop should result in an action plan, and the board had an important role to play in holding lead agencies to account.

The cabinet member children and families suggested that opportunities for community work could be explored to help homeless people reengage with the wider community.

Jo-anne Alner supported a workshop to identify and overcome barriers to healthcare and other services, noted that a new mental health crisis line was being developed, and re-iterated a commitment to consider representation on the Herefordshire Homelessness Forum.

Dr Hearne said that the workshop should explore care pathways from the perspectives of homeless people and then make recommendations at network and strategic levels to deliver the changes needed.

Resolved: That the health and wellbeing board:

(a)      sign up to the ‘Charter for Homeless Health’ and implement its commitments, including identifying need, providing leadership and commissioning for inclusion;

(b)      requests board members to review within their organisations access to services, including mental health services, primary and secondary health care and preventative services for homeless people with the aim to improve health and reduce first-line use of A&E and ambulance services;

(c)      seeks assurance from lead agencies (including Herefordshire Council, NHS Herefordshire Clinical Commissioning Group, Wye Valley NHS Trust and 2gether NHS Foundation Trust) on the actions they are taking to address this inequality and considers these in a future session together with local consideration / adoption of the national memorandum of understanding on health and housing “Improving health and care through the home: A National Memorandum of Understanding”; and

(d)      endorses the Homeless Health Needs Audit being undertaken again in three years’ time (2022; completing the audit cycle) and being reported to the board.