Download Health care for single homeless people in South Yorkshire

Health care for single homeless people in South Yorkshire
A study of health care provision for single homeless people in South Yorkshire was conducted in
2010. It was commissioned and funded by the NIHR Collaboration for Leadership in Applied
Health Research and Care, South Yorkshire (CLAHRC SY). The study had three objectives:
•
To identify current arrangements for delivering primary-care, mental health and substance
misuse services to single homeless people in South Yorkshire.
•
To assess which arrangements are working well and which not so well, and the reasons for
the variations.
•
To identify gaps in health-care service-provision for single homeless people.
Information was collected by: (i) compiling an inventory of hostels and day centres for single
homeless people in Barnsley, Doncaster, Rotherham and Sheffield; (ii) surveying the managers of
the services identified (29 hostels and 7 day centres); and (iii) interviewing 61 homeless people.
Arrangements for accessing health care
Three-quarters of hostel and day centre managers believed that the current arrangements for
accessing medical care were working well, although some believed that there is a lack of
understanding among some GP and practice staff about the needs of the client group. By contrast,
only 26% reported that the current arrangements for accessing mental health services, and 56%
substance misuse services, worked well, with delays in assessments and treatment commonlyreported. They also reported difficulties in getting clients to engage with these services. The staff
believed that they needed more help and advice from health professionals to manage clients with
mental health issues and to carry out health promotion work, and more training in recognising
physical health problems, mental health issues, and motivating clients with complex needs.
The experiences of single homeless people
Among 61 homeless people interviewed, 77% reported physical health problems, including many
with serious and long-standing conditions. The majority relied on a Homeless Health Care team
or a walk-in health centre for medical care; only 38% were registered with a local GP. Four-fifths
reported mental health problems, but only 37% with the problems were receiving treatment.
Alcohol and drug problems were also common, but less than one-half were under the care of
specialist substance misuse services. Nearly one-half reported dental problems, but only 16%
were registered with a local dentist. Those in contact with Homeless Health Care teams were
more likely to be aware of physical illnesses, to have had health screening and vaccinations, and
to be linked into mental health and substance misuse services.
Recommendations
• NHS Trusts should examine ways in which homeless people’s access to primary care and
mental health, substance misuse and dental services can be improved.
• There should be increased collaboration between NHS agencies and staff and the specialist
homelessness services.
• There should be improved health screening for homeless people that targets those most at
risk, e.g. with long histories of homelessness and substance misuse problems.
• More health-care professionals should be given the role of proactively engaging with
homeless people’s projects, including carrying out health promotion work and providing
training to their staff on helping clients with health problems.
Knowledge into Action
The CLAHRC Partnership, which includes representatives from all South Yorkshire PCTs, has
been instrumental in ensuring the recommendations of the study are brought to the attention of
senior commissioners in the NHS. NHS Barnsley is working with the Metropolitan Borough
Council and the Barnsley Drug and Alcohol Action Team to consider the implications of the
findings for health-care services, and how to join up pre-existing developments and future
commissioning needs.
In Barnsley, the research has already led to: (i) Dual Diagnosis training in early 2011 for 92 multiagency staff working with single homeless people, and the refurbishment of a 60 bed hostel with
improved access to health care: (ii) work being underway to increase registration with local GPs,
and to improve access to substance misuse services; (iii) the inclusion of dental health needs
highlighted by the research in the 2011 Barnsley Oral Health Needs Assessment; and (iv)
consideration of widening vulnerable people’s access to the Health Integration Team, which
currently provides primary care services for asylum seekers, migrant workers and immigrants.
Full Report: Maureen Crane and Tony Warnes, Single Homeless People’s Access to Health Care
Services in South Yorkshire. University of Sheffield, April 2011.