Should hospitals be doing more to help homeless men and women before discharge?

I recently quoted some research from Leicester that homeless men and women are six times more likely to attend at A&E than the ‘housed’ population, four times more likely that they will be admitted, and are likely to stay twice as long.

Today on the radio I heard that the cost to the NHS of treating a homeless person is five times that of the housed population.

In a previous post I reflected on the medical interventions at First Base Day Centre, and how they prevented the need for A&E presentations and hospital admissions.  The savings to the NHS must be far greater than the cost of running the whole of the service at First Base which has a deficit each year of between £50,000 and £100,000.

Today Homeless Link published an excellent guide for hospital staff and managers “From Hospital to Home: Steps for hospital staff – identify need and take action”.

Homeless Link says “When someone who is homeless is admitted to hospital, their stay will often last longer, and become more complex and costly for the NHS, than your other patients.

“When they leave, more than 70% will be discharged straight back onto the streets, further damaging their health and all but guaranteeing their readmission.

“Housing is key to a ‘safe discharge’ from hospital, as well as to reducing the ongoing burden on your service. There are steps you can take to help.”

Here is the Homeless Link guidance:

On admission, identify homeless patients and those living in homelessness services:

• Ask if people have accommodation, whether they can return and if they risk losing it
• Contact the patient’s support services – this can prevent them losing their accommodation

If a housing need is identified, know how to respond and who to refer them to

• Find out who to notify within the hospital and externally – is there a named contact?
• Know how to make a referral to the local Housing Options team
• Ask for training on the assessment and referral of homeless people
• Keep an up-to-date contact list of local agencies such as hostels, outreach and drug and alcohol services on each ward.

If homeless people discharge themselves:

• Alert local services
• Record the self-discharge and the reason

Ensure patients can access ongoing care

• Complete a social needs assessment
• Notify the GP and relevant agencies about follow up treatment
• Provide a copy of the discharge plan and medication

Help people return to their accommodation

• Let the housing agency know when the patient is returning to ensure they can get in
• Avoid out of hours discharge
• Help the patient get home – they may need travel expenses

I wonder if there is a champion in local hospitals ensuring that these good practice guidelines are being implemented?

Taking tough decisions

(This is the text of my ‘Bottom Line’ column that appeared in the Brighton Argus on 16th August 2011).

In my working life I am involved in two very different organisations which share a common objective: the provision of specialist services for those in the greatest need. But in spite of the common objective, there are fundamental differences in expectations of my role in the two organisations

One is the charity, Brighton Housing Trust (BHT). The name itself is misleading. We don’t just operate in Brighton (and Hove), but also in Eastbourne, Hastings, St. Leonards and other districts in East Sussex. We do a lot more than housing, including legal advice and representation, mental health services, services for those with alcohol and other drug addiction, work and learning activities, etc.

The other organisation is BHT Enterprises Ltd., a profit making company, operated on a commercial basis. BHT IT Solutions and BHT Design are just two of the businesses within the company. The profits generated by BHT Enterprises are gift aided to the charity, BHT, to support its charitable work, for example, at First Base Day Centre.

First Base provides services to some of the most vulnerable men and women in Brighton and Hove. For example, we provide early morning sessions for those who have slept out. We ensure that the causes of their homelessness are addressed, and help them to secure and maintain accommodation.

The Centre operates at a loss of about £100,000 per annum, but because of the high “Mission-fit”, the charity chooses to support the work of First Base from our own funds and donations we receive from many very generous supporters.

Being a charity doesn’t stop us making difficult decisions, such as changing terms and conditions of employment for staff three or so years ago. And we have recently had to make a very difficult decision in BHT Enterprises.

It is not a charity and takes a commercial view on its activities. One of its business streams, the highly respected Blue Rocket PR, staffed by four very talented PR specialists, has in recent times struggled in the challenging economic environment in which it operates.

BHT Enterprises Ltd. has no room for sentiment, for considerations such as “Mission-fit”. With my fellow Directors we felt that the outlook for Blue Rocket PR was not positive, in spite of the expertise of its staff, and we have made the decision to shut the business.

Of course on a personal level I am sad to lose Blue Rocket PR from our wider ‘family’, but as a commercial enterprise we could not wait to see if its prospects would improve nor could we subsidise its business activities from charitable funds.

It takes different mindsets to run charitable and commercial organisations. But in each, tough decisions have to be made if we are to remain true to our purpose.

The successes of the year past and a major challenge ahead

As we reach the midway point of the year, I have been reflecting on how BHT is doing in what are very testing times. My conclusion is that, overall, BHT is doing well, with excellent services continuing to be provided to clients. We have achieved financial stability, and BHT’s reputation continues to be very positive. There is just one area of serious concern, the future funding of our Legal Services.

A year ago I had ten areas of concern yet, one by one, the challenges facing us have been addressed. The highlights of the year so far include:

our supported housing services, particularly in Brighton and Hove, where the scale of the funding cuts have been limited to just 4.5% over 4 years;

• The women’s counselling service, Threshold, whose future looked bleak until we secured £393,000 from the Big Lottery Fund through its Reaching Communities programme;
• Finding Futures, based in Hastings, has secured £497,000 from the Reaching Communities Programme of the Big Lottery Fund and a new contract with East Sussex County Council;
• First Base Day Centre has undergone a major refurbishment. After twelve months, restoration work to the building, St Stephen’s Hall has been completed and the centre is due to be formally re-opened at an event on Thursday 7 July 2011;
• The Accommodation for Work Project was in the running for the 2011 National Lottery Awards’ “Best Voluntary/Charity Project”. While the project did not make it through to the final round, it was nevertheless well-deserved recognition for this service.

At the beginning of April, BHT left the Affinity Sutton Group The move, which was supported by Affinity Sutton, is designed to allow BHT to thrive as an independent organisation by being ‘fleet of foot’ in responding to new opportunities presenting themselves to us.

One of the most exciting plans we have is to take client involvement to a new level, building on the co-design and co-production of services to spread co-delivery across the organisation. This will include the BHT Intern Programme which is attracting much interest and media coverage.

The main challenge facing BHT is the future of our Legal Services. The Justice Secretary, Ken Clarke MP, recently published the Sentencing and Legal Aid Bill that contains proposals to reduce the legal aid budget by £350 million. Much of the work that our three advice centres undertake (in Brighton, Eastbourne and Hastings) will no longer attract legal aid funding. In Brighton alone, we are currently funded to take on around 1,400 housing cases. This is expected to drop by more than 500 cases each year. There will no longer be legal aid funding for any welfare benefits work and face to face debt advice will by telephone only, and as with housing, only be available for those at imminent risk of losing their home.

The impact on these cuts will see an increase in homelessness, family breakdown, and general hardship. With the loss of around £0.5 million funding, our advice services will see considerable contraction and, nationwide, there will be a de-skilling of the sector as advisers, with many years experience, will move elsewhere.

BHT has been campaigning hard to oppose the cuts to legal aid and will continue to do so. I would encourage you to write to the five Members of Parliament in the areas where we have advice centres urging them to support funding for independent advice services. The MPs are Simon Kirby (Brighton Kemp Town), Caroline Lucas (Brighton Pavilion), Mike Weatherley (Hove), Stephen Lloyd (Eastbourne) and Amber Rudd (Hastings and Rye).

If you would like to support the campaign to save Legal Aid, please view the short film on the Justice For All website and sign the online petition. The government has listened on a number of issues; there is no reason why they should not listen on this occasion and reverse these measures which will lead to an increase in homelessness along the coastal south east.