Gatekeepers
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Contents • Partnership • Tips for health • Health of homeless people • Gatekeepers report and findings • Lived experience testimony • Impact • Acknowledgements voicesofstoke.org.uk expertcitizens.org.uk
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 voicesofstoke.org.uk expertcitizens.org.uk
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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voicesofstoke.org.uk expertcitizens.org.uk
Top tips for health 1. 2. 3. 4.
Don’t be poor Don’t live in a deprived area Don’t be disabled 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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Top tips for health 6. 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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HEALTH OF THE HOMELESS
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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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Homeless people aged 16 to 24 are twice as likely to die as their housed peers. Crisis & University of Sheffield (2012), “Homelessness Kills�
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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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Cause of death GENERAL POPULATION
HOMELESS PEOPLE
Source: Crisis and University of Sheffield (2012), “Homelessness Kills”, page 7.
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Hospital interactions
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NHS England guidance A 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/wpcontent/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf Gateway Reference 04448, November 2015.
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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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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 voicesofstoke.org.uk expertcitizens.org.uk
The results 48% 26%
26%
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TESTIMONY voicesofstoke.org.uk expertcitizens.org.uk
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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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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Hard Edges in Stoke Impact on use of services for 22 customers 12-month prior vs. 12-months since
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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 voicesofstoke.org.uk expertcitizens.org.uk