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
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Welcome 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
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
Contents• Partnership• Tips for health• Health of homeless people• Gatekeepers report and findings• Lived experience testimony• Impact• Acknowledgements
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This 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
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
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
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
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
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Hand over to Andy
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
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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
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
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
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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
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
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Impossible right? It is no wonder that homeless people experience very poor health outcomes
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HEALTH OF THE HOMELESS
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So, 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
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“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.
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The average age of death for homeless men is 47 It is 43 for women
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
Homeless people aged 16 to 24 are twiceas likely to die as their housed peers.
Crisis & University of Sheffield (2012), “Homelessness Kills”
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Homeless 16 - 24 year olds are twice as likely to die Compared to their housed peers
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
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”
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Homeless 35 – 44 year olds are Between five and six times More likely to die Than their housed peers
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
GENERAL POPULATION HOMELESS PEOPLE
Cause of death
Source: Crisis and University of Sheffield (2012), “Homelessness Kills”, page 7.
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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…
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Hospital interactions
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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
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
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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
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
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
The 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
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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
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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
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
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
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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
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
The results
48%
26% 26%
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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
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TESTIMONY
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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?
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IMPACT
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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
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CCG and Public Health have responded positively and are taking action Group met twice so far Director of Public Health Clinical Director of the CCG Portfolio Holder CCG Commissioning
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
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
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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
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
Hard Edges in StokeImpact on use of services for 22 customers 12-month prior vs. 12-months since
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Evidence that getting the right help works
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
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
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Finally, thanks to everyone that was involved. Especially, Expert Citizens, Paul and Ben as the driving forces behind this
