4.1.5 Use of services - summary

Notwithstanding the limitations of the small sample, the above data highlight several points.

• Housing First customers who are housed have lower use of the criminal justice system and might manage their health better than those who do not start a tenancy following referral to

Housing First. • Comparisons between those referred to Housing First/recorded as customer who were housed vs. not housed (but would have been supported in other ways through VOICES) indicate that housing in its own right can be an effective an intervention to reduce criminal behaviour and health-related crises that warrant unplanned emergency care. • The generally old age of Housing First customers (relative to life expectancy for homeless populations) is likely to have a major effect on the outcomes. For example, those approaching older age (and often with chronic health issues) may have a reduced propensity and capacity for criminal behaviour [15]; better management of health in those with chronic conditions could reduce the need to emergency hospital visits, perhaps through improved access to primary care (which was not measured here). There may be value in exploring whether this pattern is common across Housing First programmes, whereby a readiness and ability to sustain a tenancy is more likely with increasing age and frailty, which might underlie transitions from being a perpetrator to a victim of crime. • Patterns for health service use were less clear and harder to interpret (compared with those for criminal justice system use). - Reduction in A&E episodes during Housing First tenancies were evident, but this followed an apparent increase from pre-support levels. This increase could reflect the ongoing consequences of chronically poor health; although the stability of Housing

6b. Hospital in-patient episodes

Similar to patterns for the overall sample, quarterly fluctuations were observed for in-patient episodes in those housed vs. not housed.

Figure 6. Health Service use per customer, by quarter, in housed vs. not housed Housing First customers

First tenancy helped to reduce A&E demands over time, a sharp reduction within 12 months after many years (even decades) of poor health and living is not realistic - For hospital in-patient episodes, the effect of Housing First appeared to be inverse to that expected. Being housed increase the hospital admission in much higher rate than the preceding 12 months with VOICES support. - Outpatient hospital episodes care followed a similar pattern to in-patients, reducing during Housing First but with overall increases from pre-support levels. This could be interpreted as evidence of benefit: that receiving support led to increases in planned hospital stays, and over the first 12 months of Housing First, the need for planned hospital care reduced as issues became more manageable. However, this requires verification.