Beyond The Ward – Exploring the Duty to Refer in Hospital Settings: New Report Investigates the Effectiveness of Key Aspect of the Homelessness Reduction Act 2017

  • New report by inclusion health charity Pathway and national homelessness charity Crisis finds the opportunity to prevent homelessness in hospital settings is frequently missed.  
  • Severe strain on the NHS, coupled with a deepening housing crisis, means people are often discharged either straight back onto the streets or into unsuitable temporary accommodation without any support. 
  • As we head into winter, vulnerable people with nowhere safe to stay will face disastrous worsening of ill health, adding an avoidable pressure on overburdened NHS services, as patients return again and again seeking help. 
  • Health services can play a crucial role in preventing homelessness. Crisis and Pathway are calling for better integration between health and housing services to ensure needless deaths can be prevented.  

 

People experiencing homelessness face shocking health inequalities and poor outcomes in comparison with the general population, with an average age of death of 45 for men and 43 for women. One third of deaths among people experiencing homelessness are caused by treatable illnesses.  

Produced by inclusion health charity Pathway and national homelessness charity Crisis, in collaboration with lived experience partners from both Pathway and Groundswell, this new report examines how the duty to refer is currently working in practice, drawing on evidence gathered from surveys and workshop discussions with hospital and local authority staff, in addition to analysis of existing Homelessness Case Level Collection data.   

Introduced in 2017 as part of the Homelessness Reduction Act, the Duty to Refer creates an obligation for various public bodies to refer service users who they identify as at risk of or experiencing homelessness to the relevant local authority. For patients, this means an opportunity to recover in appropriate accommodation and access the health and social care services which can help them onto a more positive life path. For hospitals, it is the chance to break the cycle of costly repeat admissions.  

The findings suggest that, while good practice exists among hard-working NHS and local authority housing staff, the effectiveness of the duty is significantly undermined by wider system pressures being felt across both the NHS and local authorities. Crucially, poor levels of integration between overstretched health provision and under-resourced housing services see people experiencing homelessness all too often falling between the cracks. At the same time, a frequent lack of the accountabilities necessary to ensure consistent adherence to the duty means that basic implementation of the referrals process is uneven; a postcode lottery with regards to access to services.  

To address this unacceptable situation, the report calls for change at both system and local level, including: 

  • Dedicated step-down and intermediate care facilities to help support people experiencing homelessness with complex needs, along with embedded housing officers in all hospitals to ensure effective integration between health and housing services.  
  • The establishment of integrated homelessness forums so health, housing, and social care work together to adopt best practice and co-ordinate services at the local level. 
  • To increase the impact of the duty to refer, Integrated Care Systems should be given responsibility and held to account for overseeing the operation of the duty in their areas, co-ordinating with local government housing services to drive compliance. 

 A referral mechanism can only be as good as the systems into which someone is referred, and until these wider systemic pressures are addressed the duty will fail to make the impact it was designed to. Moreover, the difficulties encountered by the duty in implementation also serve as an important indicator of the effectiveness of integration between health, care and support services more broadly, and thus the health of the system at large. As such, these findings and recommendations should be of huge interest to both national and local government, healthcare leaders and local authority partners. 

 You can download the full report here. Furthermore, you can reach out to Pathway at info@pathway.org.uk if you would like to discuss the report and any of its findings and recommendations further. 

 

Alex Bax, CEO of Pathway, said:  

“The advent of the Duty to Refer was a significant step towards ensuring that health services play their part in preventing and responding to homelessness, however this report highlights an implementation gap between the clear aims of the Homelessness Reduction Act and the realities of implementing the duty to refer in busy hospital settings. People facing homelessness need more specialist support in hospital, and safe places to recover, including intermediate care for those who need it.”    

 

Matt Downie, CEO of Crisis, said: 

“We know from our frontline services that preventing homelessness is more effective than allowing people to get to a point where they need emergency help. The Duty to Refer, where public services including hospitals are legally required to intervene to help prevent homelessness, could be a perfect example of that.  

Not only would a fully functional Duty to Refer system save people from the hardship of homelessness, it would also ease the burden on the NHS and public services. It’s vital – and good sense – that the system is given the resources it needs to work properly.  

But ultimately, without more genuinely affordable housing, the Duty to Refer system will be operating with its hands tied behind its back. It’s therefore vital that the Westminster government acts swiftly and provides the long-overdue investment to deliver the 90,000 social homes a year that we need.”  

 

Elizabeth Keat, Integration Lead, Homeless and Health Inclusion, Leeds Community Healthcare NHS Trust, said: 

“We welcome the recommendations for improvements in this area to ensure that homelessness is identified on assessment, not on discharge. Although large turnovers of staff in hospitals can be problematic when implementing processes, the duty to refer for homelessness should have the same systemic monitoring as safeguarding referrals; recorded, monitored, audited, reported on and viewed with importance on an individual and systemic level. Specialist hospital in-reach teams can not only help to embed this practice, but also maximise the opportunity presented by an admission to advocate for vulnerable people, enabling them to feel cared for and be connected with wider services upon a planned discharge.”  

 

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Notes to editors  

The Homelessness Reduction Act 2017 places a statutory duty on Hospital Trusts, NHS walk-in centres and Accident and Emergency departments to refer (with consent) any patient who is homeless, or at risk of homelessness in the next 56 days. Homelessness may include patients residing in hostels or unsuitable accommodation, people in insecure accommodation or people sleeping rough. 

Pathway is the UK’s leading Homelessness and Inclusion Health charity. We work with the NHS and other partners to create improved models of care for people experiencing homelessness and excluded groups. In the last 3 years, the Pathway Partnership Programme has helped 9 NHS Trusts in England to create in-reach Pathway teams of doctors, nurses, social care professionals and peer supporters who support over 4000 homeless patients every year. Founded in 2009, Pathway works to improve the quality of healthcare people experiencing homelessness and excluded groups receive by: 

  •  developing and sharing best models of care like our hospital teams;
  • increasing specialist skills of workers in healthcare;
  • influencing policy; and
  • reducing stigma in healthcare against people experiencing multiple exclusion.

The Faculty for Homeless and Inclusion Health is an inclusive membership organisation for people involved in healthcare for excluded groups. Membership is open to nurses, doctors, allied medical professionals, social workers, public health experts, health advocates and support workers, commissioners, researchers and people with a lived experience of exclusion. Our aim is to improve the quality of healthcare for people experiencing homelessness and other excluded groups. The Faculty is hosted by Pathway. 

For more information, email info@pathway.org.uk 

 

Medics join with homelessness charities in open letter to the Home Secretary, urging reversal of asylum practice. They warn of homelessness and health risks amid pressures on the NHS.

  • Changes to Home Office practice are giving refugees as little as seven days to leave their temporary accommodation, pushing many onto the streets.
  • Refugees who become homeless as a result will face significant risks to health, especially in colder weather, when pressures on the NHS are already at their greatest.
  • Signatories, including leading medical Royal Colleges and homeless charities, call on Government to restore the previous standard of 28 days notice to quit accommodation, and to stop all evictions during very low temperatures to avoid loss of life.

A coalition of leading organisations in health and homelessness has issued an urgent open letter to the Home Secretary, expressing deep concerns over changes to Home Office practice affecting refugees granted asylum decisions. Signatories, including the Royal College of GPs, the Royal College of Emergency Medicine, the Royal College of Physicians, the Royal College of Nursing, and prominent homelessness charities including Crisis, Shelter and St. Mungo’s, are speaking out against a practice that compels individuals to leave National Asylum Support Service (NASS)-funded accommodation within seven days of receiving a decision on their asylum application.

The signatories underline that these changes will likely result in dire consequences for the health of those affected and will place additional, avoidable burdens on an already stretched NHS. The open letter highlights that such a practice means that many refugees will immediately become homeless, exposing them to serious health harms of homelessness, particularly during the coldest time of the year, leading to spirals of poor health and potential loss of life.

The letter says, “Practice that forces new refugees onto the street runs contrary to the founding principles of the NHS and are a waste of human life and potential. Reversing this would be an excellent start to your tenure as Home Secretary and we look forward to working with you to achieve this.”

People without an address struggle to access primary care so this new Home Office behaviour will also force refugees to rely on emergency health services, at the very time of year when those parts of the NHS are under the most pressure.

The signatory organisations and individuals urgently call on the Home Secretary to:

  • Restore the minimum 28-day period before refugees are required to leave their Home Office accommodation. This will allow for more time for homelessness prevention assistance and transition planning for primary care and housing.
  • Ensure that refugees receive all their new documentation at one time. People should receive their refugee grant letter, their Biometric Residence Permit, the letter containing the date when their asylum support will end, and the notice to quit their accommodation on the same day. The 28-day notice period should not begin before this point.
  • Stop all evictions during very low temperatures, at the very least when homelessness Severe Weather Emergency Protocol arrangements are activated.
  • Work urgently with NHS England, primary care providers and refugee support organisations to maintain access to primary care for evicted refugees.

The full letter can be read here.

 

ENDS

____________________

Notes to editors

For more information contact: Dee O’Connell, Pathway Head of Policy and Programmes, dee.oconnell@pathway.org.uk / 07989 396 320

  • The acceleration of asylum decisions as the Government seeks to clear the backlog is a key driver of this issue. 5000 decisions are expected in London alone between now and Christmas, with 2500 decisions a month taking place nationwide.
  • This is against a backdrop of record levels of rough sleeping and the likely failure of Government to hit is rough sleeping target.
  • This letter underlines recent concerns expressed by The Refugee Council and others.
  • 4,068 people were counted sleeping rough in London between July and September 2023, according to the latest CHAIN figures. This represents a 12% increase on the same period in 2022 and is London’s highest quarterly rough sleeping count since records began.
  • Local authority leaders are extremely concerned by the impact on rough sleeping Boroughs warn of ‘spiralling’ homelessness crisis as London rough sleeping hits record high | London Councils
  • Pathway is the UK’s leading homeless and inclusion health charity. We work with the NHS and other partners to create improved models of care for people experiencing homelessness.
  • The Faculty for Homeless and Inclusion Health is an inclusive membership organisation for people involved in healthcare for excluded groups. Membership is open to nurses, doctors, allied medical professionals, social workers, public health experts, health advocates and support workers, commissioners, researchers and people with a lived experience of exclusion. Our aim is to improve the quality of healthcare for people experiencing homelessness and other excluded groups. The Faculty is hosted by Pathway.

Beyond Pockets of Excellence: Integrated Care Systems for Inclusion Health – A New Report and Network for Local and National Policymakers and Commissioners

  • This new report shares lessons learned from a six-month collaboration between seven Integrated Care Systems. The programme encouraged ICSs to explore how they could improve health and care outcomes for the most excluded: people in ‘inclusion health’ groups. Pathway led the programme with support from our partners at Groundswell and The King’s Fund.  
  • People in inclusion health groups experience extremely poor health outcomes, with studies showing dramatically higher morbidity, comorbidity and mortality rates and shockingly low average ages of death compared to the general population. This programme explored what ICSs could do to make a difference, given their legal duties in relation both to integration and to addressing health inequalities. 
  • The collaboration looked at different ways ICSs could lead: to improve services, to include populations routinely excluded or invisible to the system, and to provide good quality integrated care beyond the ‘pockets’ of good practice we found in every geography.  
  • The findings were in line with the Hewitt Review’s recommendation that tackling inequalities should be core business.  
  • As one of our programme leaders, an NHS Trust Chief Executive, said at the outset of the collaboration: “if integrated care cannot tackle Inclusion Health, we should all be worried.” This project showed that ICSs have real opportunities to use their system overview, their convening powers and leadership roles, and their budget setting, to improve services for the most excluded and rapidly reduce the stark health inequalities they face. 

 

Inclusion health groups include people experiencing homelessness, vulnerable migrants, people engaged in sex work and Gypsy, Roma and Traveller Communities. When it comes to health they face a double whammy, suffering some of the worst health outcomes and experiencing poor access to the health and care services that would help them. The most recent ONS statistics showed the average age of death in 2021 for people identified as homeless was just 45 for men and 43 for women; 42% of English Gypsies have a long-term condition, as opposed to 18% of the general population. Just getting registered with primary care without an address remains a major challenge in many places. 

The establishment of Integrated Care Systems, with clear duties to address health inequalities and the theoretical power to really join up health and care services around people’s needs, represent a huge opportunity to reverse this situation.  

Last Autumn Pathway, the inclusion health charity, formed a partnership with Groundswell and The King’s Fund, and created a ground-breaking collaborative programme for seven ICSs from across England to explore the potential of these new systems for inclusion health groups. Through six learning and developmental sessions, we worked together to explore how ICSs could make change happen and improve outcomes for people in the most vulnerable and excluded communities. Expert contributors from the NHS, housing and social care shared multiple examples of evidence-based good practice, as well as their reflections on how to achieve the system change needed to make that progress a reality.  

The programme identified two commonly occurring patterns: firstly, the excellence of particular places or specific services in providing good quality care to a specific Inclusion Health population, while sitting alongside poorly developed services for other vulnerable populations; and secondly, the success of certain places in providing access and care to a high standard in one neighbourhood, without that leading to better quality on a bigger footprint. 

This report, presenting the lessons learned from the collaboration, suggests a number of steps that will help local systems build an evidence-based Inclusion Health route-map, in addition to presenting case studies of good practice and other learning from the programme. It can be downloaded here or by emailing us at info@pathway.org.uk.  

Our ICS partners all acknowledged that the new system is still in a formative stage, so the publication of this report is just the beginning. Pathway is now exploring the possibility of convening a second programme for a new cohort of ICS partners who want to go further in meeting the needs of their most poorly served populations.  

Additionally, we will be launching a specialist inclusion health network for system leaders and managers working within ICS leads to share knowledge and good practice on how to improve services for inclusion health populations. This new network will be hosted by the Faculty for Homeless and Inclusion Health, the multi-disciplinary national professional network hosted by Pathway and focused on health care for people experiencing homelessness and other excluded groups.  

The first online meeting is set for 11am on Friday 6 October, so if you work in Integrated Care and are interested in joining the network, please sign-up here or email us at faculty@pathway.org.uk 

You can download the full report here.

 

Alex Bax, CEO of Pathway, said:

Integrated Care Systems are the opportunity we have long been waiting for to tackle the unacceptable health inequalities faced by some of our most vulnerable and excluded populations. For a long time, we have been aware of the excellent care offered in isolation to particular groups in particular localities. This report asks the questions of what makes good inclusion health, and how can leaders seek to replicate those successes across current universalist services? 

 

Rachel Brennan, Participation and Progression Director for Groundswell, said:

Our work over the course of the programme with participants from seven regional ICSs provided us with critical insights into the challenges facing different inclusion health communities, inspirational examples of great practice, and a clear vision of the practical steps required and leadership necessary to fulfil the promise of integrated services.” 

 

Toby Lewis, Chief Executive of Rotherham, Doncaster and South Humber NHS Trust and former King’s Fund Senior Fellow, said:

We do not need to create the evidence on how to tackle Inclusion Health, nor to remake the case for why. Between last year’s NICE guidance on homelessness, and this new collaboration from leaders across seven Integrated Care Partnerships, brought to life in this report, we have the raw material to do. The ask of ICB top teams is to get stuck in in making sure that place partnerships are fully focused in 2024 on this opportunity to address longstanding inequalities. 

 

Homelessness and Inclusion Health charity Pathway hosts its Annual Conference

15.03.2023

· Homelessness and Inclusion Health charity Pathway hosts its Annual Conference with a call on Government and NHS leaders to protect funding for specialist homeless health services as rising rates of homelessness further increase pressures on the NHS.

· The conference opens as recent data shows a 26% rise in rough sleeping, with the Government set to miss its own target to end it for good by 2024.

· Key speakers include Dr Shubulade (Lade) Smith CBE, President Elect of the Royal College of Psychiatrists, Professor Sir Stephen Powis, Medical Director of NHS England, and Matt Downie MBE, CEO of Crisis.

Click here for full details of the conference programme.

 

Pathway, the UK’s leading homelessness and Inclusion Health charity, will host the 12th International Conference of the Faculty for Homeless and Inclusion Health, taking place on 15 and 16 March in London, with additional options to attend online or at regional hubs in Leeds, Manchester and Birmingham.

The conference follows recent data which shows that rough sleeping has risen by 26% across England, with the Westminster Government now all but confirmed to miss its commitment to end rough sleeping by 2024.

With severe threats to the funding of vital services, the link between homelessness and poor health is more apparent and urgent than ever, warns Pathway. Figures show that people who are homeless have death rates ten times higher than people who are securely housed. The longer people are stuck in homelessness the more extreme are the health consequences and greater the cost to the NHS. Analysis by Crisis, the national homelessness charity, shows that the cost of leaving a person homeless is £10,000 more per year than if the same person had a home of their own.

The lack of a stable home also has heartbreaking consequences when it comes to people’s wellbeing and life expectancy. The most recent ONS statistics revealed that the average age of death in 2021 for people identified as homeless was just 45 for men and 43 for women, highlighting the urgent need for Government action to tackle homelessness in all its forms for good.

Pathway’s two-day symposium will see an international gathering of healthcare professionals, academics and NHS leaders to discuss the role that healthcare can play in helping people with the most complex needs, and to share best practice and examples of how joined-up service can help improve health outcomes. With the most recent NHS reforms establishing Integrated Care Systems, Pathway’s focus will be on how more integrated care should help the most vulnerable people in our society.

Key speakers at the conference include Dr Shubulade (Lade) Smith CBE, President Elect of the Royal College of Psychiatrists, Professor Sir Stephen Powis, Medical Director of NHS England, and Matt Downie MBE, CEO of Crisis. There will also be a selection of specialist mobile vehicle-based services from around the country, who take health care out of buildings and onto the streets to better reach people who need help and support. These include the HealthBus Trust, Dogs on the Streets, and Dentaid.

The workshop programme will include presentations on aspects of clinical practice and research, sessions for frontline staff on maintaining wellbeing in an overloaded system, as well as sessions looking at the need to tackle stigma, discrimination and other barriers to accessing care.

 

Alex Bax, CEO of Pathway, said:

With no end in sight to the cost-of-living crisis, Pathway’s frontline hospital teams are seeing rising numbers of new patients experiencing homelessness presenting with increasingly complex needs.”

We cannot afford to let this vulnerable group down. Along with funding to protect specialist services , we need mainstream health, housing and social care to work together to respond to this health emergency. The new Integrated Care Systems represent a real opportunity for the NHS and local government to work together to achieve this.”

 

Matt Downie, Crisis Chief Executive, said:

Health and homes are deeply intertwined, and often inseparable. When one is good it naturally benefits the other. But we know that poor health can be both a cause and a consequence of homelessness.”

Without the protection and foundation of a stable home, your health – both physical and mental – is left to suffer. Day in, day out we see the barriers to accessing healthcare that arise when you lose your home or have to sleep on the streets.”

With many services close to breaking point and the housing and cost of living crises doing untold damage to people’s wellbeing, this conference from Pathway is more important than ever in bringing together the key voices in health and homelessness.”

 

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Notes to editors

 

For more information, contact Jonathan Lucas, Pathway Communications Officer, at jonathan.lucas@pathway.org.uk

For free press passes, contact Neil Stewart Associates at karen.stewart@neilstewartassociates.co.uk

 

Inclusion Health is a service, research, and policy agenda that aims to address health inequities among the most vulnerable and excluded populations.

Pathway is the UK’s leading Homelessness and Inclusion Health charity. We work with the NHS and other partners to create improved models of care for people experiencing homelessness and excluded groups. In the last 3 years, the Pathway Partnership Programme has helped 10 NHS Trusts in England to create in-reach Pathway teams of doctors, nurses, social care professionals and peer supporters who support over 4000 homeless patients every year, across 13 different sites.

Founded in 2009, Pathway works to improve the quality of healthcare people experiencing homelessness and excluded groups receive by:

 

· developing and sharing best models of care like our hospital teams;

· increasing specialist skills of workers in healthcare;

· influencing policy; and

· reducing stigma in healthcare against people experiencing multiple exclusion.

For more information, email info@pathway.org.uk

 

The Faculty for Homeless and Inclusion Health is an inclusive membership organisation for people involved in healthcare for excluded groups. Membership is open to nurses, doctors, allied medical professionals, social workers, public health experts, health advocates and support workers, commissioners, researchers and people with a lived experience of exclusion. Our aim is to improve the quality of healthcare for people experiencing homelessness and other excluded groups. The Faculty is hosted by Pathway.

For more information, email faculty@pathway.org.uk

New Short Film Aims to Support NHS Staff Caring for People Facing Homelessness

A powerful new film is being shared with NHS teams across the country to prompt reflection and conversations about the challenges faced by people living with homelessness. This is part of an ongoing commitment to provide compassionate and inclusive care for all.

Commissioned by NHS England, ‘Less?’ movingly documents the personal stories from Jamesy, Jeff, Julian and Mandy who have faced and overcome homelessness. In this film, they share their experiences and interactions with health services in the UK.

“A warm smile, a friendly word can make a massive impact on a person to relax, to begin to trust, to begin again to believe that a person wants to help,” says Mandy in ‘Less?’.

Last month, NHS England Chief Nursing Officer, Dame Ruth May and NHS Confederation Chair, Lord Victor Adebowale took part in a panel discussion in London alongside the four film participants to launch the film.

 

Lord Victor Adebowale, Chair of the NHS Confederation, said:

“This film reminds us what’s important. The NHS and social care system was set up to provide care for people at the end of the inverse care law. Homelessness is a litmus test of our ability to treat and help those people and this film is telling us that we need to do better.”

Among the core values enshrined in the NHS Constitution are delivering compassionate care to all and recognising that everyone counts. With rising homelessness adding to growing demand for services, those supporting the new film say it can play an important role in ensuring these values are maintained.

Following its launch, ‘Less?’ is being shared with NHS integrated care boards across the country to prompt conversations and reflection with staff as part of the drive to foster a compassionate and inclusive health service.

 

Prof Bola Owolabi, Director – Health Inequalities, NHS England, said:

“Members of inclusion health groups, such as those facing, or at risk of, homelessness, are most at risk of experiencing health inequalities. As a result, accessing care may be more challenging, sometimes due to negative past experiences, as shown in this film. This film is a way we can share the lived experience of those facing homelessness so that we can raise awareness of the challenges they face and drive change towards an inclusive health service for all.”

“In addition, our Core20PLUS5 approach provides a framework to drive progress on healthcare inequalities among people experiencing homelessness and other inclusion health groups.”

“We have recently developed a suite of resources to ensure consistent high-quality care in our urgent and emergency care settings for people experiencing homelessness. Over the next year, we will be providing further tools and support to help integrated care boards and partnerships to better serve people experiencing homelessness and other groups that face social exclusion, building on good practice that is already evident.”

‘Less?’ was directed by CJ Barton and produced by Dr Caroline Shulman. The film was created in partnership with the homelessness charities Pathway and Groundswell. For more information about the film and to view it, please visit the film’s website: https://journeystohealth.co.uk/.

 

Further Information

About Pathway

Pathway is the UK’s leading homeless healthcare charity. We work with the NHS and other partners to create improved models of care for people experiencing homelessness along with  other excluded groups. So far, the Pathway Partnership Programme has helped 11 hospitals in England to create teams of doctors, nurses, social care professionals and peer supporters who support some 3,500 homeless patients every year.

Pathway Experts by Experience

We believe that lived experience should be at the heart of what we do. Our Experts by Experience colleagues, who have had lived experience of homelessness, advise across all our work and can educate healthcare professionals about the care of people experiencing homelessness. Through Pathway, our colleagues receive support and training to carry out the role and opportunities to influence across a range of areas. These recently include the impact of universal credit reform in partnership with the Institute of for Public Policy Research (IPPR), the development of our Mental Capacity Act assessment e-learning and editorial decisions on the Faculty for Homeless and Inclusion Health International Symposium.

Groundswell

Groundswell works with people with experience of homelessness, offering opportunities to contribute to society and create solutions to homelessness. Participation is at our core because the experience of homelessness is crucial in making decisions that affect lives and ultimately help people to move out of homelessness. We aim to address four key issues: homelessness; health inequalities; lack of participation in service delivery and policy; and a society that does not work for everyone. We achieve this by ensuring people can access health care; offering progression opportunities for people with experience of homelessness; and by creating change in policy and practice.

New Report Shows How Project Supported 10 People Experiencing Homelessness Into Sustained Healthcare Employment

14 February 2023

Today sees the launch of an evaluation report** from the NIHR Policy Research Unit at Kings College London on Access to Employment in NHS Health Care Support Worker Roles for People with Lived Experience of Homelessness Programme.

The report highlights the success of the Access to Employment programme, a joint project designed and delivered by the Royal Society for Public Health (RSPH), Groundswell, NHS England and Pathway that supports individuals with lived experience of homelessness to successfully apply for roles as healthcare support workers.

The programme was piloted in five NHS Trusts* between 2021- 2022 and on each occasion was tailored to meet local needs of the Trust. The main programme elements included engaging with and preparing Trusts to recruit, linking Trusts with local Voluntary & Community Sector organisations (VCS) to identify potential recruits and running a bespoke pre-employment training programme. New recruits and Trusts also received specialist support with applications, recruitment and during induction.

The successful programme has resulted in:

  • Ten participants with experience of homelessness successfully being employed as Healthcare Support Workers and many others now engaged with positive outcomes such as volunteering within their host Trusts
  • Following the participation of trusts in their regions NHS England (North East and Yorkshire) are working to establish a trauma-informed Asset Based Community Development sharing hub to support hyperlocal recruitment methods for those with lived experience of homelessness, which can be scaled and spread across the two regions
  • The possibility of further roll out of the programme in other regions.
  • Best Diversity & Inclusion Employer Award for Pennine Healthcare at 2022 Nursing Times Awards

The evaluation findings are being used to develop a toolkit for Trusts who are looking to diversify their workforce to include people with lived experience of homelessness. The toolkit is expected to be launched in the spring.

 

Kiran Kenth, Director of Programmes at RSPH said:

“This was a rewarding project for our team to be involved with and we welcome the evaluation report released today, especially the call for NHSE to work with partners and establish a working group that will build on the experience and learning that we had.

“The work here is one step towards challenging the inequalities in our society and supporting people who have been homeless into employment in health and social care, where we know there are large numbers of vacancies.

“The RSPH looks forward to working with partners to roll out the programme further with even more success.”

 

Alex Bax, Chief Executive of Pathway said:

“We’re delighted with the success of the Health Care Support Worker programme. For recruits, getting a job as an NHS Health Care Support Worker has the potential to be life changing and we’ll continue to do all we can to support them.

“The findings of the report illustrate what can be achieved when NHS employers take a more flexible approach, and some tailored support is put in place for people with lived experience of homelessness. It also hints at how Care Workers own life experiences can themselves contribute to better care quality in the NHS.

“We’re proud to have been part of this ground-breaking project. I look forward to seeing the continued impact it will have on the lives of those experiencing homelessness.”

 

Further Information

About RSPH: Royal Society for Public Health is an independent health education and campaigning charity, committed to improving and protecting the public’s health and wellbeing. We are the world’s longest-established public health body with over 5000 members who are committed to supporting the public’s health. Our activities include providing qualifications, e-learning, accreditation and programmes. We also campaign on a wide range of issues to support better health and wellbeing for the public.

About Pathway: Pathway is the UK’s leading homeless healthcare charity. We work with the NHS and other partners to create improved models of care for homeless people and excluded groups. So far, the Pathway Partnership Programme has helped 11 hospitals in England to create teams of doctors, nurses, social care professionals and peer supporters who support some 3,500 homeless patients every year.

 

*Pennine Care (PC) NHS Foundation Trust (Northwest); Cumbria, Northumberland, Tyne and Wear (CNTW) NHS Foundation Trust (Northeast); Black Country Healthcare (BCH) NHS Foundation Trust (Midlands); East and North Hertfordshire (ENH) NHS Trust (East of England); and Portsmouth Hospitals University (PHU) NHS Trust (Southeast).

**https://kclpure.kcl.ac.uk/portal/files/196022093/Kessler_2023_Health_Care_Support_Worker_Roles_for_People_with_Lived_Experience_of_Homelessness.pdf

Pathway Announces Appointment of Four New Trustees To Board

Pathway is pleased to announce the appointment of four new Trustees to its Board: Professor Yvonne Doyle, Professor Sultan Mahmud, Jo Land and Anthony Omo.

Professor Yvonne Doyle is Medical Director of Public Health at NHS England as well as a fellow of the UK Academy of Medical Science. Professor Sultan Mahmud is currently Director of Healthcare for BT Enterprise. Jo Land is the CEO of Avenues Group, a specialist provider of support services to people with learning disabilities, autism and acquired brain injury. Anthony Omo is General Counsel and Director of Fitness to Practise at the General Medical Council (GMC), the UK’s national regulator for doctors.

Each brings a wealth of experience and expertise, and we look forward to working with them to further our goals of improving health outcomes for people in inclusion health groups and reducing health inequalities.

The new Trustees will help the Board set Pathway’s strategic direction, as we continue to drive forward national action on inclusion health. We would like to offer our sincere thanks to our outgoing trustees, Sir Ian Kennedy, and Professors Steve Field and Andrew Hayward for their extensive contributions and dedication during their time as Trustees.

Pathway’s CEO Alex Bax said:

“We’re delighted to welcome Professor Yvonne Doyle, Professor Sultan Mahmud, Jo Land and Anthony Omo to the our Board. They each bring Pathway a wealth of knowledge and experience, and a wide range of different perspectives. I also know they are all dedicated to our cause: to improve health outcomes for the most excluded, and to change the system.”

“I’d also like to use this opportunity to pass on my sincere thanks to Sir Ian Kennedy, and Professors Steve Field and Andrew Hayward for all they’ve done to support Pathway over our first decade and more. They’ve each made huge contributions during their time on the Pathway Board. The whole organisation is grateful for their contribution to Pathway’s work and to inclusion health.”

 

Further information

Pathway

Pathway is the UK’s leading inclusion health charity. We work with the NHS and other partners to create improved models of care for people experiencing homelessness and other excluded groups and use insights from the frontline to bring about system change. So far, the Pathway Partnership Programme has helped 10 hospitals in England create specialist teams of doctors, nurses, housing, social care professionals and peer supporters who support some 3,500 patients experiencing homelessness every year.

Faculty of Homeless and Inclusion Health

The Faculty for Homeless and Inclusion Health is a growing network of health professionals and people with lived experience working with inclusion health populations, including people experiencing homelessness, Gypsy, Roma and Traveller communities, vulnerable migrants and sex workers. The Faculty has published national standards for health services (endorsed by the Royal College of Physicians), offers multi-disciplinary CPD, runs an annual international symposium, and supports a network of regional Primary Care Inclusion Health and national special interest groups. It is hosted by Pathway.

 

Trustee Biographies

Prof Yvonne Doyle CB

Professor Doyle qualified as a doctor and has worked in senior roles in the NHS and Department of Health and Social Care (DHSC), and in the academic and independent sectors. Between 2013 and 2019 she provided leadership for health and reduction of inequalities at city-wide level to the population of London and was Statutory Adviser to the Mayor of London.

In 2019 Professor Doyle was appointed Medical Director and Director of Health Protection for Public Health England where part of her job was medical leadership for the national inputs to the COVID-19 pandemic. She was designated the first Medical Director for Public Health at NHSE in October 2021 to develop and rebuild the public health service in that organisation.

Prof. Sultan Mahmud

Professor Mahmud is Director of Healthcare for BT Enterprise and is the leader of the company’s healthcare business. Prior to this he has had a distinguished career in the NHS spanning two decades, including the position of Chief of Innovation, Integration and Research at the Royal Wolverhampton NHS Trust (RWT). An experienced executive with a passion for innovation, he is a respected figure in health technology circles in the UK and internationally.

Anthony Omo

Anthony Omo is General Counsel and Director of Fitness to Practise at the General Medical Council (GMC), the UK’s national regulator for doctors. He leads the GMC’s work delivering the statutory function of ensuring doctors are fit to practise. This includes an extensive reform programme, in-house legal services and acting as senior adviser to the Chief Executive, Chair and Council. Anthony is also the Scottish Government senior sponsor and Senior Management Team champion for the GMC’s BME Network.

Jo Land

Jo Land is the CEO of Avenues Group, a specialist provider of support services to people with learning disabilities, autism and acquired brain injury, as well as being a Non-Legal Member of the Employment Tribunal service. An experienced senior leader in social care, she has over twenty years of experience in the not-for-profit sector following a career as a HR professional in the private and commercial world.

New Pathway Medical Director confirmed

Dr Chris Sargeant appointed as Medical Director and Secretary of the Faculty for Homeless and Inclusion Health 

Pathway is delighted to announce the appointment of Dr Chris Sargeant as the charity’s new Medical Director and Secretary to the Faculty for Homeless and Inclusion Health.   

Chris is a highly experienced inclusion health professional who will bring a wealth of expertise and insight to the role. He has led the Pathway Team in Brighton for 10 years, is a founding director of ARCH (Brighton’s specialist homeless and inclusion health service), and a long-standing colleague and advocate for better care for the most excluded. He has been the clinical lead of the Pathway Partnership Programme for the last two years. 

Pathway’s CEO Alex Bax said 

“I am so pleased that Chris has agreed to take on this important role. He brings extensive front-line clinical experience across a wide variety of services and settings and huge commitment to the cause of inclusion health.  Colleagues across the Faculty will enjoy working with him to help us develop the Faculty into its second decade.” 

Dr Chris Sargeant said 

“It is a great privilege to be asked to take on these roles and to build on the great work of Dr. Nigel Hewett who has set high standards to meet.  

“One of my first priorities will be to get out to meet Faculty members and visit as many services as I can to ensure I’m fully aware of what’s happening in Inclusion Health services across the country.  

“I also hope to build on the Faculty’s first successful ten years, consolidating Inclusion Health as being central to national actions to tackle health inequality. As part of this, I aim to represent and include all those working in this field, and most importantly, those who use our services.  

“I know that colleagues across the Faculty want to do more to help us address the social injustices that lead to the health inequalities that have such on impact of our patients and service users. I look forward to working together to deliver on this aim.” 

Further information 

When he is not working for Pathway Chris will continue to see patients Brighton and lead the Pathway Team at the Royal Sussex County Hospital. 

Dr Chris Sargeant biography: 

Chris trained at the Royal Free Hospital in London where he qualified in medicine in 1989. He has been a GP for 30 years and has worked in Inclusion Health since 1998. 

He was the first GP at the Primary Care Service for people experiencing homelessness in Brighton, which developed into ARCH Healthcare of which he was the founding Chair and is now a director. 

He has worked in the Pathway team at the Royal Sussex County Hospital in Brighton for 10 years, and has also worked as a GP with Special Interest in Substance Misuse in London, and as a Senior Clinical Lecturer at Brighton and Sussex Medical School (BSMS). 

Chris lives near Brighton and in his spare time enjoys running (increasingly shorter distances), playing 5-a-side football badly, swimming in the sea and trying to grow food on his allotment. 

Pathway 

Pathway is the UK’s leading homeless healthcare charity. We work with the NHS and other partners to create improved models of care for homeless people and excluded groups. So far, the Pathway Partnership Programme has helped 11 hospitals in England to create teams of doctors, nurses, social care professionals and peer supporters who support some 3,500 homeless patients every year. 

Faculty of Homeless and Inclusion Health 

The Faculty for Homeless and Inclusion Health is a growing network of health professionals working with: 

  • Homeless people 
  • Vulnerable migrants 
  • People selling sex 
  • Gypsy and traveller communities 

The Faculty has published national standards for health services (endorsed by the Royal College of Physicians), offers multi-disciplinary CPD, runs an annual international symposium, and supports a network of regional homeless healthcare hubs and special interest groups.

Pathway and Crisis launch Invitation to Tender for Homeless & Inclusion Health Monitor scoping report

Invitation to tender – Scoping research to test the gaps and feasibility of new evidence on inclusion health and homelessness

18.07.2022

Pathway and Crisis invitation to tender on scoping research to test the gaps and feasibility of new evidence on inclusion health and homelessness.

As part of Pathway’s and Crisis’ future research priorities we want to develop new evidence in the area of inclusion health and homelessness. This a vast area and the Office for Health Inequalities and Disparities are also looking at developing a central repository bringing together secondary data on health and homelessness.

We want to add value and not duplicate work, whilst at the same time developing  and synthesising research and evidence that highlights the health and social care challenges faced by many people experiencing homelessness.

We are looking for a contractor to help us scope the feasibility and focus of the work.

Read the full Invitation to Tender document here.

The deadline for submission proposals is 12pm Monday 15th August

Proposals and questions should be submitted to: Dee O’Connell dee.oconnell@pathway.org.uk (Pathway) or Francesca Albanese Francesca.Albanese@crisis.org.uk (Crisis)

No-one left behind: Supporting people with complex needs on universal credit

Immediate release
5th April 2022

 

Pathway supports today’s report from IPPR on the cost of living crisis, by urging the DWP to end the ‘punitive sanctions regime’ that’s pushing people into hardship.

IPPR’s analysis of DWP data shows sanctions on benefit claimants have almost returned to pre-pandemic levels. As the cost of living hits people relying on social security hardest, we agree that benefits need a rethink to ensure a more ‘humane’ system.

Social security payments are now lagging far behind inflation, which will push many vulnerable benefit claimants into hardship and destitution. The IPPR’s analysis of the latest DWP figures show that sanctions on benefit claimants are almost back to pre-pandemic levels, despite the cost of living crisis now increasing the risk of people falling into destitution. In November 2021, when the latest data is available, 46,000 claimants were sanctioned, but the number of people being sanctioned has likely risen since then.

Today’s report warns that people on Universal Credit are not being treated as individuals, with their own circumstances and needs – leading to impossible conditions being imposed on claimants to receive their benefits. These inappropriate conditions set claimants up to fail and lead to sanctions, according to researchers.

This means many people mistakenly find themselves ‘at the sharp end of an often-punitive system’ and that for those vulnerable people with complex needs, this can be potentially lethal.

IPPR says that ‘punitive sanctions’ remain a core part of the Job Centre regime, despite limited evidence on their effectiveness and extensive evidence of the hardship they can cause – particularly for those with complex needs.

Interviews with those adversely affected revealed that many claimants felt pressured by the power-dynamic to agree to unsuitable conditions without raising concerns, and that open-plan Job Centres made them reluctant to raise important personal information. Others reported being put ‘on edge’ by the presence of security guards.

One Universal Credit claimant told researchers:

“I feel like I was in that situation where I haven’t got a penny to my name, I would have agreed to anything. If I challenge it they are gonna question it and it could delay everything.”

IPPR argues that the entire Universal Credit system needs to be reformed to increase levels of support and to achieve a higher basic minimum standard of living. In response to the Chancellor’s ‘shockingly inadequate’ Spring Statement, IPPR called for a policy combining an increase in Universal Credit and legacy benefits of 8.1 per cent and a rise in child benefit by £10 per child per week.

To ensure the benefits system works better overall and to ensure claimants, particularly those with complex needs, do not face inappropriate conditions or punitive sanctions, IPPR’s report calls for:

·    A humane approach – Claimants should be given a ‘second chance’ and not sanctioned immediately if they don’t appear meet the conditions of their benefits. They should get an opportunity to explain the situation, clear up any confusion and discuss potential changes to conditions.

·    Improved information – Claimants should have all the information they need about their claim and the conditions relating to it. They should automatically be informed of and offered the opportunity to change how and when their benefits are paid and given the chance to ask for an advance to avoid the five-week wait before receiving benefit payments.

·    Greater sensitivity – Claimants should be given the option to discuss their personal circumstances in a private room or over the phone or video call.

·    Better conversations – Job Centre work coaches should be better trained to spot warning signs of someone with complex needs. For example, researchers found that claimants who said they had ‘no housing costs’ on their applications were not being systematically asked why this was – meaning many who required homelessness support were not being offered it and were being expected to do entirely inappropriate job searches.

·    Preventing serious harm – Decision-makers should have the power to cancel a sanction if there is a risk of harm for the claimant. A range of public servants, from doctors to social workers, should also have the ability to raise ‘complex-needs flags’ with DWP so they are fully aware of the challenges people face and ensure they are not set up to fail.

Henry Parkes, IPPR senior economist, said:

“As the cost of living crisis deepens, the UK government must do more to support people living on low incomes – whatever their circumstances. It absolutely shouldn’t be making people’s lives any harder by imposing inappropriate conditions and punitive sanctions on them in a time of need.

“Alongside desperately needed action to increase the value of Universal Credit to keep up with the rising cost of living, we also need urgent action to ensure our social security system offers genuine security where people fall back on it. This should include urgent reform of the punitive sanctions regime, and a wholesale review of how the system can treat every claimant with dignity and respect.”

Julian Dalley, a support worker with lived experience of homelessness and rough sleeping, said:  

“Too often universal credit treats you like you must be lying and like what you have said isn’t true. The staff have no idea what it’s like to be on the street or moving from one friend’s sofa to the next. People who hit rock bottom need time and support to get themselves sorted out, but instead of support, DWP staff often feel like they are judging you, that you have failed and need to be taught a lesson.”

Alex Bax, CEO of Pathway, a homeless healthcare charity, said:

“Our specialist teams working in hospitals with homeless patients hear too many stories of sanctions, exclusions or inappropriate barriers being enforced by the benefits system. It often seems that the system withdraws support from people precisely when they need it most, when someone’s circumstances suddenly fall apart, when a relationship has broken down or when bad luck strikes.

“The benefits system defaults to assume wrong-doing and deceit. For people who’ve been made homeless, perhaps in the context of a mental illness or battling an addiction, Universal Credit is too often another source of stress and difficulty, rather than a basic building block of their recovery.”

 

ENDS