PowerPoint Presentation · • Rachele Hine • Karen McCall • Susan Perry • Contributors • Jane Morton, Staffordshire University • Responders • Cllr Ann James • Dr Lesley

v o i c e s o f s t o k e . o r g . u ke x p e r t c i t i z e n s . o r g . u k

Gatekeepers

PresenterPresentation NotesWelcome

Andy Meakin, Director of VOICES

Jo Cutts, Expert Citizens

Paul Astley, Healthwatch Stoke-on-Trent

We’re going to talk about a report called Gatekeepers

Looked at access to GP services for homeless people presenting for registration at practices with no ID


Contents• Partnership• Tips for health• Health of homeless people• Gatekeepers report and findings• Lived experience testimony• Impact• Acknowledgements

PresenterPresentation NotesThis is what we intend to cover

Hopefully by the end, you’ll be able to answer

Why we did this

Who it was about and who was involved

What we did and are doing

How we did it

What the impact has been

Of course, there will be the opportunity to ask questions at the end

Hand over to Paul Astley – report author and analyst from Healthwatch Stoke-on-Trent


Working in partnership• All organisations involved have similar

aims & philosophies• Have a remit/commissioned to

influence service change/design• Tradition of bottom up design,

ensuring the input of service users• Service Design built around

experiences


Developing outcomes• More than a research project in

that this requires outputs to be applied

• Publication of paper is merely part of the journey

• Expertise in the field – “lived experience”

• Staff Experiences

• Knowledge of the broader sector

• Project Management with clear goals from outset

• Ability to access and negotiate with health and care leadership

PresenterPresentation NotesHand over to Andy


PresenterPresentation Notes

Thanks Paul

I’m going to begin with top ten tips for health

Source: Quoted in “The Health Gap” by Professor Sir Michael Marmot (page 50)

From: University of Bristol

As I go through these quickly, imagine trying to achieve these if you’re homeless, particularly street homeless


Top tips for health1. Don’t be poor

2. Don’t live in a deprived area

3. Don’t be disabled

4. Don’t work in a stressful, low paid, manual job

5. Don’t live in damp, low quality housing or be homeless



Top tips for health6. Be able to afford social activities

and holidays

7. Don’t be a lone parent

8. Claim all the benefits to which you are entitled

9. Be able to afford and own a car

10. Use education to improve your socio economic position

PresenterPresentation NotesImpossible right?

It is no wonder that homeless people experience very poor health outcomes


HEALTH OF THE HOMELESS

PresenterPresentation NotesSo, I’m going to spend a little time illustrating just how poor

Using research from Crisis and the University of Sheffield

Stick with me, I promise there’s cheerier stuff later on


“Homeless people are more likely to die young, with an average age of death of 47 years old and even lower for homeless women at 43.”

Crisis & University of Sheffield (2012), “Homelessness Kills”, page 4.

PresenterPresentation NotesThe average age of death for homeless men is 47

It is 43 for women


Homeless people aged 16 to 24 are twiceas likely to die as their housed peers.

Crisis & University of Sheffield (2012), “Homelessness Kills”

PresenterPresentation NotesHomeless 16 - 24 year olds are twice as likely to die

Compared to their housed peers


Homeless people aged 35 to 44 are between five and six times more likely

to die as their housed peers.

Crisis & University of Sheffield (2012), “Homelessness Kills”

PresenterPresentation NotesHomeless 35 – 44 year olds are

Between five and six times

More likely to die

Than their housed peers


GENERAL POPULATION HOMELESS PEOPLE

Cause of death

Source: Crisis and University of Sheffield (2012), “Homelessness Kills”, page 7.


Compare the reasons for death between the general population and the homeless

This chart indicates that the causes of these deaths are largely preventable

IF, as Professor Marmot suggests, we can tackle the Social as well as the Clinical determinants

This is not a bolt from the blue, there are indications that people are in trouble…


Hospital interactions


Here we’re looking at 8 VOICES customers

8 people presented at A&E 262 times in 12-months, they spent 110 nights in hospital

The same 8 people got more of the help they needed in the following 12-months

Their usage fell to 181 presentations at A&E, and just 21 nights in hospital



So, access to primary care is really important for homeless people

GPs often do outstanding work with the homeless

It is often the involvement of a GP that is the difference between access to

drug and alcohol treatment, mental ill-health treatment, etc.

and crucially, even

welfare benefits and housing

That’s why we needed to look at the anecdotal reports of barriers


NHS England guidanceA patient residing in the practice area does not need identification• Specific examples cited in the

guidance include• People that are street homeless or

in unstable accommodation• People fleeing domestic violence

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf

Gateway Reference 04448, November 2015.

PresenterPresentation NotesThe guidance for GPs is clear from NHS England

People living in their catchment should be registered

Even if they have no ID

It specifically includes homeless people and those fleeing domestic abuse

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf


Situation we tested• Anecdotal information that

registration was a problem• Support workers and others in the

sector• Signposting was directed at a

specialist practice or walk-in centres

• Limited choice for homeless people


Anecdotally, for as long as I can remember, people have fed back that registering homeless people could be difficult

The word was that people were often signposted to walk-in centres or telephone helplines or specialist practices

This wasn’t always necessary or didn’t meet the person’s needs, e.g. travel cost and distance could be a problem

The potential was that people wouldn’t seek early help, perhaps leading to crisis, or simply use A&E as a proxy for the GP

As Paul mentioned earlier

We wanted to test the extent to which the anecdotes of people and professionals were reflected in practice


What we did• Expert Citizens conducted a mystery

shop

• 47 practices across Stoke-on-Trent contacted

• Scenario presented was registration of a homeless person with no ID

• No other details were given

• Also considered case studies and testimony from stakeholders


Expert Citizens, VOICES, and Healthwatch Stoke

Consulted with stakeholders

Compiled some case studies

Conducted a mystery shop of 47 practices

The only details passed in the mystery shop were that the person was homeless and had no ID

This is typical for a homeless registration


The results

48%

26% 26%


This is the results of the mystery shop

Nearly half refused, around ¼ couldn’t give a clear answer

Only around ¼ said yes

People refused were indeed signposted to a specialist practice, walk-in, or telephone helplines

Some of the telephone numbers given were no longer in use

The case studies and testimony of stakeholders also confirmed the anecdotal evidence

You’ll see in the report, even the Community Matron for the Homeless, Jane Morton

Found difficulty in accessing and maintaining GP registration for her patients


TESTIMONY


Introduce - Jo Cutts, Expert Citizen and one of the researchers on this project

Jo is going to talk us through her experiences of trying to register with a GP

Jo, can you describe to us what happened to you?

What reasons did they give you? Was there an opportunity to appeal?

How would you describe the attitude of the staff?

What advice was offered about how your health needs could be met?

How did the experience with the practice make you feel?

How did it feel to be involved in this project?


IMPACT


What£s happening• CCG and Public Health have

responded positively and are taking action

• Group met twice• Director of Public Health• Clinical Director of the CCG • Portfolio Holder• CCG Commissioning

PresenterPresentation NotesCCG and Public Health have responded positively and are taking action

Group met twice so far

Director of Public HealthClinical Director of the CCG Portfolio HolderCCG Commissioning


Key actions• CCG written to all GPs reminding

them of the NHS England guidance

• Assurances • Key staff will receive training• Involvement of people with lived

experience• Incorporation of this customer

group in to equality delivery system

• Action on hospital discharge


A communication from the Clinical Director has gone to all GPs

We have received assurances of action around the report’s recommendations

There is work on-going to better coordinate hospital discharge for homeless people

The report gained momentum and led to

Articles on BBC Radio Stoke and Radio 5 Live

Questions to a Health Minister (David Mowat) in the Houses of Parliament


Hard Edges in StokeImpact on use of services for 22 customers 12-month prior vs. 12-months since


Evidence that getting the right help works


Acknowledgments• Authors

• Paul Astley, Healthwatch Stoke• Ben Wilson, VOICES

• Expert Citizen researchers• Joanne Cutts• Rachele Hine• Karen McCall• Susan Perry

• Contributors• Jane Morton, Staffordshire University

• Responders• Cllr Ann James• Dr Lesley Mountford• Dr John Gilby• CCG Commissioning• Ruth Smeeth MP• BBC Radio Stoke• BBC Radio 5 Live


Finally, thanks to everyone that was involved.

Especially, Expert Citizens, Paul and Ben as the driving forces behind this

Slide Number 1ContentsWorking in partnershipDeveloping outcomesSlide Number 5Top tips for healthTop tips for healthSlide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14NHS England guidanceSituation we testedWhat we didThe resultsSlide Number 19Slide Number 20What£s happeningKey actionsHard Edges in StokeAcknowledgments

Documents

PowerPoint Presentation · • Rachele Hine • Karen McCall • Susan Perry • Contributors • Jane Morton, Staffordshire University • Responders • Cllr Ann James • Dr Lesley