The Health Needs Audit Toolkit ’s end homelessness together Francesca Albanese, Research Manager Homeless Link.

The Health Needs Audit Toolkit

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Francesca Albanese, Research Manager Homeless Link

How it works

What is a Health Needs Audit?

• A free tool to assess the health needs of people who are homeless in a local area

• A means to use this evidence to inform strategic and practical change to improve health outcomes and reduce health inequalities

• Developed in 2011: • To date, 31 audits undertaken by 27 areas with

3,355 respondents

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The aims of the audit

What is a Health Needs Audit?

• Provide an evidence base on the health needs of homeless people

• Improve service access and delivery by bringing statutory and voluntary services together

• To increase the involvement and voice of homeless people

• Ultimate aim – to improve the health of homeless people

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What can it help achieve?

Why do a Health Needs Audit?

It will help you assess local need and redesign services to meet need • Local areas have increased responsibility for assessing and improving the health of

their local population (e.g. JSNA) and to ensure needs and voice of whole population included in the process: the audit gives you the tools to do this.

It will help identify and address health inequalities• Homeless people experience poor health outcomes and face inequalities in accessing

services. The audit helps understand and evidence levels of need and service usage.

It will help you reduce financial & personal cost• DH report: homeless people use x4 acute health services and x8 inpatient services

than general population (totalling £85m p.a.)• Current financial pressures make addressing health needs appropriately and avoiding

wider impacts of poor health even more important: the audit can help identify how resources can be more effectively spent.

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How does the process work?

Carrying out a Health Needs Audit

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Partnership of representatives from health, housing and voluntary sector come together to plan an audit

Agencies recruited to take part – e.g. day centres, hostels, supported accommodation projects, outreach services

Audit conducted with clients

Analysis and action planning Data directly inputted onto online tool and analysis generated at local level for you and your local partners

How does the process work?

Carrying out a Health Needs Audit

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PLAN:

Set up group of partners

COLLECT DATA:

Client surveys by agencies

over agreed time period

INTERPRET DATA:

Use LimeSurvey

Collect further

evidence

USE THE DATA:

Disseminate findings

Agree action in

partnership

IMPLEMENT & REVIEW:

Review & map trendsWork with

clients

What does the survey cover?

What can a Health Needs Audit tell you?

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Client background

Physical health needs

Mental health needs

Levels of substance use, including dual diagnosis

Access to services

Vaccinations and Screening

45% prevented from training, volunteering or working due to ill-

health

Profile of 3,355 respondents

Homeless health in England

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71% male

9% rough sleepers

17% training / education

6% in employment

32% <25

69% in supported/hostel accommodation

Physical health problems >12 months

Identify and address health inequalities

Joint and muscular

Chest and breathing

Stomach

Eyes

Skin

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22 %

15%

11%

14%

8%

14%

7%

4%

2%

2%

Reported health problems

Mental health issues

Identify and address health inequalities

Depression

Schizophrenia

Personality disorder

Bipolar disorder

PTSD

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34%

6%

7%

5%

7%

3%

1 – 3%

3 – 5%

1 – 3%

3%

Reported health problems

High use of secondary healthcare services among homeless people

Reduce financial and personal cost

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27% visited A&E 1- 2 times in past 6 months

Rough sleepers use GPs the least 24% in the last 6 months (71% total population)

21% admitted to hospital in past 6 months

Contextualizing the data

Additional types of evidence

Qualitative techniques • Focus groups or follow up in-depth interviews clients who have completed the survey explore a specific topic in depth

Things to consider: size of group, ethics, topic area and sensitivity i.e. mixed gender may not be appropriate

Additional quantitative data• Mapping health needs audit data against other sources of information

• Opinions & Lifestyle survey and Health Survey for England • Are health agencies aware of homelessness and housing data?

• Statutory homelessness stats• Prevention and relief stats• Housing stock condition survey • Local health needs assessment

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Making changes based on the audit

How can the data be used?

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• Improvements to services:• Help develop services in line with what works and where unmet need

exists• Encourage agencies to take practical action at local level in partnership• Improve dialogue with clients about health and understanding of their

needs

• Strategy and planning:• Feed clients’ experiences and needs directly to commissioners • Inform JSNA development to include homeless people’s needs• Inform wider agenda around health of homeless people

What changes have been made?

How has the data been used by local areas?

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• Improved access to services:• Clients and workers trained to become Health Champions• A new service specification for TB screening services at NFA practice• Training sessions for GPs to raise awareness

• Service improvement:• Hostel staff trained on mental health issues

• Improving clients’ understanding about health:• Film to highlight available services and how to access them• Section on health added to pre-tenancy training

• Informing the wider agenda:• Launch event for findings • Findings fed back to key stakeholders (HWB, CCG, etc.)• Findings incorporated into JSNA portfolio

Over to you

Further information and advice

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Further resources:

• Toolkit and guidance• http://www.homeless.org.uk/health-needs-audit-toolkit

• Interactive web tool for national data• http://

www.homeless.org.uk/facts/homelessness-in-numbers/health-needs-audit-explore-data

• The unhealthy state of homelessness • http://

www.homeless.org.uk/sites/default/files/site-attachments/The%20unhealthy%20state%20of%20homelessness%20FINAL.pdf

• JSNA guidance• http://

www.homeless.org.uk/sites/default/files/site-attachments/20141009%20JSNA%20Briefing.pdf

We’re here to help

Contact us if you are thinking about doing an audit:

Email:[email protected]

Francesca Albanese:[email protected] 7840 4411

Rachel Hurcombe:[email protected] 020 7840 4418

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What we doHomeless Link is the national membership charity for organisations working directly with people who become homeless in England. We work to make services better and campaign for policy change that will help end homelessness.

© Homeless Link 2014. All rights reserved. Homeless Link is a charity no. 1089173 and a company no. 04313826.

Homeless LinkGateway House, Milverton Street, London SE11 4AP 020 7840 4430 Twitter: @HomelesslinkFacebook: www.facebook.com/homelesslink

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