Faculty of Homeless and Inclusion Health
London Regional Meeting Minutes, 9 July 2016
UCLH Education Centre
Attendees
Stephanie Barker, University of
Southampton
Poppy Freeman, CHIP
Alex Bax, Pathway
Khalil Hassanally, The Greenhouse /
Health E1
Angela Burnett, Freedom from Torture
Nigel Hewett, Pathway
Helen Burnett
Frances Klemperer, Joint Homelessness
Team Westminster CNWL
Stan Burridge, Pathway
Pam Campbell, Homeless Healthcare
Team Southampton
Andrew Casey, St Mungo’s
Kathy Mohan, St Mungo’s
Garry Money, London Homeless Health
Programme
Peter Chambers, Pathway volunteer
Steph Ratcliffe, Providence Row
Elizabeth Clowes, Pathway volunteer
Tristy Robinson, JHT and London
Homeless Health Programme
Dennis Curran, St Thomas’ Hospital
Steve Davily, St Mungo’s
Jenny Drife, Psychiatrist
Tim Robson, Pathway UCLH
Al Storey, TB Find and Treat team
Cat Whitehouse, Pathway
Joseph Ellis, Pathway volunteer
1.
Welcome and introductions
Nigel Hewett welcomed attendees and each participant introduced themselves.
2.
London Homeless Health Programme
Garry Money introduced the London Homeless Health Programme which began a
year ago, following a recommendation in the London Health Commission’s Better
Health for London Report. It is working towards pan-London commissioning for
homeless health services, and has the potential to top slice the budgets from London
CCGs, by their agreement.
Gary joined the Programme in January 2016. He is an NHS operational manager who
specialises in bridging the gap between frontline services and CCGs. He is working
alongside Tristy Robinson, Joint Homelessness Team Manager. The first six months
of his tenure were spent networking within the NHS and exploring the sector. He now
hopes to deliver 5 key outcomes by September, to secure the future of the project.
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Key outcome 1 – Reviewing Homelessness Primary Care Services
Garry has been reviewing the demand and need for primary care services for
homeless patients and problems with mainstream registration. In particular homeless
healthcare professionals felt that little action is taken when services wrongly refuse
patient registrations.
Across London there are 5 specialist homelessness GP practices in 4 boroughs,
operating on piecemeal and sometimes insecure funding. Garry hopes to bring in a
new system, to support these services or developing a new core specification that
reflects what is proportionate and needed. Faculty members asked for data around
the number and proportion of homeless people who currently access primary care.
This is unknown.
Key outcome 2 – Increase CCG Awareness of Homelessness
Garry and Tristy found that many CCGs did not know the extent of homelessness in
their area. They lacked knowledge of the types and locations of local provision.
Homelesslink are preparing a toolkit and leaflet on these issues for CCGs.
Key outcome 3 – Best Practice Guide for CCGs
The team are working on a themed best practice commissioning guide for CCGs. This
draws upon the Faculty standards and aims to dovetail with Sustainability and
Transformation Plans. It should raise the quality of local commissioning decisions.
LHHP will hold workshops on each theme in the coming months.
Key outcome 4 – Non Recurrent Improvement Budget
This aims to create small interventions with a wider impact. Work includes:
● The production of cards for homeless patients explaining healthcare rights, with
a contact number for complaints and breaches.
● Training for GP reception staff on eligibility for registration and healthcare.
● Scoping work for intermediate care.
Key outcome 5 – Patient Inclusion
The programme has been working with Groundswell to explore the health issues that
are important to homeless people. Groundswell have convened 13 focus groups,
around 100 people in total. There are also two EbEs on the programme board.
Garry opened the floor for questions and observations.
Observation
Faculty members raised concerns about key outcome 1, and the practicality of
providing good quality primary care for complex needs homeless patients in
mainstream practices. GPs in specialist services are given additional time to work with
patients, reflecting the complexity of need. Mainstream provision limits time and
resources.
Homeless health services across the country are constantly under threat, some have
been closed or intentionally been allowed to decay to become mainstream services.
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Specialist services support patients turned away from mainstream practice and need
to be retained.
Answer
Garry explained that London specialist services are working to decades old
specifications and face a number of problems. Despite this homelessness specialist
services consistently have outstanding CQC ratings; and he wishes to ensure they are
supported.
He is in discussion with Yvonne Doyle, Regional Director of Public Health, who also
advises the Mayor. Garry feels there is a need to focus on outcomes, rather than
paying for time spent, and apply lessons from other client groups to homelessness.
Observation
A Faculty member said that homelessness services struggle to fit within narrow CCG
frameworks, but otherwise operate well. They feel a new specification is not required,
and advocate for networking existing provision and plugging gaps as needed.
Answer
Garry is believes that greater GLA/Mayoral involvement might help here. There will be
an event at the end of July for the third sector, which specialist NHS services can
attend. Tristy has become part of the Mayor’s Health Inequality Strategy Team, and is
working to link in Healthwatch organisations.
Observation
A Faculty member asked how vulnerable migrants and people with no recourse fit into
the programme, especially those in outer London boroughs where there are even
fewer resources than available in inner London boroughs.
Answer
Some vulnerable migrants may not be included because the programme’s definition of
homelessness excludes people in temporary accommodation, gypsies and travellers.
Garry summarised current recourse to public funds entitlements. He acknowledged
that some services wrongly refuse treatment because of immigration status. Some of
the funding will support training to change this. He also noted that some hostels do not
have GP coverage within them.
Observation
A Faculty member asked whether addictions work would be included in the
programme, as the recovery agenda is having a significant and negative impact on
homeless people with addictions.
Answer
This is not commissioned by the NHS and will not be directly in scope, however
Lambeth Council are keen to work on this area.
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3.
Research into Peer Support in Homelessness Services
Stephanie Barker from the University of Southampton presented research into peer
support in homelessness services, investigating the experience for both supporters
and clients. The full presentation is enclosed.
4.
Education Committee Update
The Faculty Education Committee was established to develop training and education
on inclusion health. They have held two well received CPD days and a third is planned
for 30 September in Leicester. The programme will include a presentation from a
Pathway EbE who recently wrote an article in the BMJ on Novel Psychoactive
Substances.
The Committee has been working with UCL to plan a short summer 2017 course
introducing inclusion health concepts, with a view to founding an inter-professional
Post Graduate Diploma in inclusion health.
The course must be commercially viable, however cost may be a barrier for some
attendees. Pathway will be seeking funding to offer bursaries to people with lived
experience of homelessness who wish to undertake the course.
5.
Experts By Experience Update
Stan, who leads EbE involvement for Pathway and The Faculty announced that Alister
Fergusson, who worked with the service for a number of the years, has passed away.
He paid tribute to Alister’s life and work and dedicated Pathway’s forthcoming EbE
handbook to his memory. Alister’s daughter would appreciate donations towards
funeral costs.
6a.
Faculty Update – Hostel Medicine Management
In November Faculty members discussed medicine management in hostels. Most
support workers are not qualified to store and dispense controlled substances for
clients who require additional support. The group gathered protocols and guidance
from across the sector with the aim of mapping and reaching a consensus on good
practice.
Westminster CCG have now taken on developing this area, is also working in this
area and have now agreed to lead the work. The Faculty will share the protocols
developed and help to circulate their findings once available.
6b.
Faculty Update – National Standards for Homeless and Inclusion Health
The Faculty’s Standards for Homeless and Inclusion Health are being used to support
commissioning in many areas of the country, and are influencing the London-wide
commissioning programme. Work on version three will begin shortly, with invitations to
collaborate issued through the Faculty mailing list. This will be a complete revision of
all sections of the Standards.
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6c.
Faculty Update – News and Events
The Faculty Mental Health subgroup met recently. Anyone with an interest in this area
is invited to join the group. The group discussed alcohol and mental health issues.
The East of England Subgroup met in Great Yarmouth. 30 people from across the all
disciplines attended. Pathway is working with Primary Care organisations in the area
after the CCG requested inclusion health input.
The Faculty has established a subgroup to create care record templates for EMIS.
These will be used in conjunction with data sharing protocols for key homelessness
services across London, allowing patients to access seamless care. The work may
also allow us to begin to develop a shared view of ‘Key Performance Indicators’ for
homelessness services.
The Faculty has been coordinating national public health roundtable meetings with
Public Health England. The next meeting is in late July and will include discussion of a
possible 18 month action learning set for directors of public health. A Faculty member
suggested that public health colleagues should play a key role in joining up the
commissioning of addictions services with mainstream NHS provision in local areas.
The Faculty has been working with the Academy of Medical Royal Colleges to create
a national statement on inclusion health across all Royal Colleges.
The CQC has informed the London Network of Nurses and Midwives that bad practice
and refusal of homeless registration should be reported to the CQC. The Faculty is
considering setting up a special email address to which concerns could be sent, to be
forwarded on to the CQC.
7.
Pathway/Faculty Update – Fifth International Symposium
Planning for the fifth International Symposium on Homeless and Inclusion Health in
March 2017 is underway, although funding has yet to be confirmed. Potential themes
include addictions, mental health and the impact of Brexit. Pathway is seeking
volunteers to join the conference committee, to help shape the overall conference
programme. For 2017 we propose to issue a formal call for presentations. Volunteers
willing to help review these submissions would be extremely welcome to join the
group. Contact the Pathway office if you are interested.
8.
Pathway Update
Bristol has commissioned a Pathway service. The group will begin training in the
autumn, operating alongside the Compass Healthcare specialist primary care service.
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