Agenda item

Homelessness is a serious societal and complex public health issue that is an indicator of fundamental breakdown in a person’s life with wide-ranging causes and consequences including ill-health. Rough sleeping is the most visible and extreme end of homelessness.

There is a strong link between health and homelessness with poor health a major cause of homelessness, and homelessness/rough sleeping increasing the risk of additional health needs developing and/or exacerbation of existing ones. It is now well recognised that those experiencing homelessness often suffer multiple disadvantage, experiencing a combination of problems including substance misuse, contact with the criminal justice system and mental ill health. They often fall through the gaps between services and systems, making it harder to address their problems and lead fulfilling lives. Solutions to improve the health and wellbeing of the homeless population require both a systemwide commitment and well-coordinated local services.

A range of services (both commissioned and those provided by the charitable sector) are available across the BCP conurbation to support the health needs of the homeless population. Dedicated provision to address the needs of rough sleepers is commissioned by NHS Dorset. A multi-disciplinary team approach has been maturing and brings together a range of partners to manage a personalised approach to individuals with complex presenting needs.

Despite positive developments in recent years, a recent Healthwatch report allied to local data and intelligence indicate ongoing challenges associated with the current configuration of service provision.

Working in partnership, BCP Council and NHS Dorset will undertake a Homeless Health Needs Assessment to better understand any unmet need within the population cohort alongside the effectiveness of existing pathways of care in meeting identified needs.

The health needs assessment will incorporate:

·       Scale and size of population (using an agreed definition)

·       Impact and outcomes associated with all current commissioned local homeless health provision including primary care

·       Impact and outcomes associated with local non-statutory provision

·       Areas of strength / weakness / gaps in the current model of care

·       Quantitative & qualitative intelligence associated with population cohort including lived experience

The needs assessment will then be used to inform future strategic commissioning intentions where indicated, including the potential for a co-produced redesign of existing models of care.

The Deputy Director of Place, NHS Dorset, Head of Housing Options and Partnerships and Service Manager – Housing, Health & Social Care and chair of the Homeless MDT presented a report, a copy of which had been circulated to each Member and a copy of which appears as Appendix 'A' to these Minutes in the Minute Book.

Homelessness was a serious societal and complex public health issue that was an indicator of fundamental breakdown in a person’s life with wide-ranging causes and consequences including ill-health. Rough sleeping was the most visible and extreme end of homelessness.

There was a strong link between health and homelessness with poor health a major cause of homelessness, and homelessness/rough sleeping increasing the risk of additional health needs developing and/or exacerbation of existing ones. It was now well recognised that those experiencing homelessness often suffered multiple disadvantage, experiencing a combination of problems including substance misuse, contact with the criminal justice system and mental ill health. They often fell through the gaps between services and systems, making it harder to address their problems and lead fulfilling lives. Solutions to improve the health and wellbeing of the homeless population required both a systemwide commitment and well-coordinated local services.

A range of services (both commissioned and those provided by the charitable sector) were available across the BCP conurbation to support the health needs of the homeless population. Dedicated provision to address the needs of rough sleepers was commissioned by NHS Dorset. A multi-disciplinary team approach had been maturing and brought together a range of partners to manage a personalised approach to individuals with complex presenting needs.

Despite positive developments in recent years, a recent Healthwatch report allied to local data and intelligence indicate ongoing challenges associated with the current configuration of service provision.

Working in partnership, BCP Council and NHS Dorset would undertake a Homeless Health Needs Assessment to better understand any unmet need within the population cohort alongside the effectiveness of existing pathways of care in meeting identified needs.

The health needs assessment would incorporate:

•         Scale and size of population (using an agreed definition)

•         Impact and outcomes associated with all current commissioned local homeless health provision including primary care

•         Impact and outcomes associated with local non-statutory provision

•         Areas of strength / weakness / gaps in the current model of care

•         Quantitative & qualitative intelligence associated with population cohort including lived experience

The needs assessment would then be used to inform future strategic commissioning intentions where indicated, including the potential for a co-produced redesign of existing models of care.

The Committee discussed the report and presentation, including:

•          In response to a query, clarification was provided on the Homelessness Multi-Disciplinary Team (MDT) eligibility criteria. Referrals may be declined where individuals were not homeless or at immediate risk of homelessness, where agencies were already effectively coordinating support without MDT involvement, or where individuals were outside the BCP area. 

•          There was some discussion on data collection and recognition that improved data gathering was required to support service development and evaluation. 

•          It was highlighted that women tend to remain involved with the MDT for longer periods, partly because they were more likely to move between unsafe forms of accommodation and can be harder to identify through traditional rough sleeper outreach approaches. 

•          The Committee was advised that targeted work was undertaken to identify homeless women, including participation in the annual Women's Census, engagement through food providers, healthcare settings and voluntary sector services, and partnership working with Dorset Working Women's Project. 

•          Members noted that information gathered through this work informed the commissioning of a specialist supported housing service for women with multiple disadvantage. The service was reported to be providing successful off-street accommodation and longer-term housing options. 

•          The Healthwatch Representative offered support to contribute case studies and lived experience evidence to the Homeless Health Needs Assessment. 

•          In response to a query, it was noted that referrals to the MDT can be made by any partner agency, with the majority currently coming from the outreach service. Other referral partners included housing, adult social care, healthcare services, the homeless intervention team and specialist support organisations. 

•          The Committee noted progress to date and the planned Homeless Health Needs Assessment, which would inform future service redesign and commissioning intentions. 

•          In response to a query, the Committee was advised that completion of the full needs assessment was anticipated by the end of March 2027, subject to wider organisational changes within the Integrated Care Board (ICB). 

•          The Chair requested that a future update be brought to the Committee at the beginning of the next financial year setting out the assessment findings, proposed actions and any implications for future commissioning and service provision.  ADD TO THE WORK PLAN. 

RECOMMENDED that the Committee NOTE current progress to date and planned work to undertake a Homeless Health Needs Assessment as a means of informing future service redesign where indicated.

Voting: Nem. Con.