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Supporting People In Wales

Supporting People In Wales. 6 th October 2010. Presenter: Dr Kerry Bailey MBBS MSc BSc MRCGP FFPH. Independent Review of Supporting People Programme for Deputy Minister for Housing. By Professor Sir Mansel Aylward CB With Special Thanks to Sian Price Ciaran Humphreys Lorna Bennett

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Supporting People In Wales

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  1. Supporting People In Wales 6th October 2010 Insert name of presentation on Master Slide Presenter: Dr Kerry Bailey MBBS MSc BSc MRCGP FFPH

  2. Independent Review of Supporting People Programme for Deputy Minister for Housing By Professor Sir Mansel Aylward CB With Special Thanks to • Sian Price • Ciaran Humphreys • Lorna Bennett • Keith Cox • Sion Lingard • Tracey Price • Annie Delahunty

  3. ‘Supporting People’ Housing Related Support: • £142 million programme • Enables vulnerable people to gain and retain independence by remaining in their own homes. • Any support required to prevent Homelessness • Confused, inequitable and inefficient funding. Lacking governance Insert name of presentation on Master Slide

  4. The association between housing and ill health has long been recognised’ ( NICE, 2005) • Well documented research has conclusively demonstrated a close association between social disadvantage [such as homelessness] and health impairment … high levels of mental health problems and physical health disorders have been found’ (Wrate and Blair, 1999: 93-94).

  5. Supporting People - Relevance to Public Health Wales ‘Our purpose is to give people power to protect and improve health and wellbeing and reduce inequities by informing, advising and speaking up for them’ • Improve health and reduce health inequities by addressing the social and economic factors which determine people’s health • Prevent disease and ill health by reducing the risks in people’s behaviour Supporting People is delivering Public Health - Public Health is everybody's business But we are the specialists – to advise, inform and advocate

  6. People who are homeless More likely to report health problems and > 1 health problem • Depression, psychoses; Mental Health issues 10 -11 times as prevalent as general population • Chronic chest and vascular problems, diabetes and tooth decay • musculoskeletal problems, wounds, skin ulcers • difficulties with seeing or hearing • tuberculosis, BBV ( Bines, 1994) ‘There is a relatively high prevalence of sexual risk behaviour among the young homeless population [unprotected sex, sex under the influence of substances and circumstances where sex is used in exchange for money or drugs’ (Wrate and Blair, 1999)] [The risks associated with such behaviour include sexually transmitted infections, unplanned pregnancy and potential for abuse or exploitation.] The link between homelessness and poor health is not direct but mediated, through family relationships (e.g. divorce, family breakup, unemployment, substance misuse, etc.

  7. Supporting Which People? • People fleeing domestic violence • People with learning difficulties • People with mental health problems • People suffering from alcohol dependency • People suffering from drug dependency • Refugees • People with physical disabilities who require support • Young single homeless who require support and young people leaving care • Ex-offenders • People who are homeless or potentially homeless and in need of support • People with chronic illness including AIDS, AIDS-related conditions or who are HIV positive. • Vulnerable single parents who require support. • Elderly

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  9. How? • Individual Support Plans • Whatever is needed to enable them to lead independent lives Fred, 58 • Chef, drinks too much, getting into debt, fridge broke down, couldn’t get a loan, drank more lost job, drank more about to lose tenancy – Supporting People referral • Checks what benefits can get, apply for a loan for fridge • Financial planning, budgeting • Shopping, Healthy eating • Keep busy, get on some courses • Ready for detox - sustained

  10. Mark, age 21 • Mother died when young, in care, back to father but he died, on streets, mental health issues, moved around the country several years, became a Heroin addict in one hostel • Various stand alone detoxes • But then, Supporting People hostel, indentifies needs, financial training, kept busy, certificates for first time in life – cooking, sexual health • led to tenancy with support • detox, helped to apply for grant to go to Machynlleth(CAT), growing own veg, built a greenhouse out of plastic bottles talking about the pleasures of cooking food you have grown • Certificates, Training for work and recently a job • Within a year has turned life around

  11. Enid, 76 A lady who had 22 admissions for COPD the year before and none since in Supporting People ( extra care scheme) – no change in health community package • Husband recently died • Help with Financial planning, budgeting • Shopping, Healthy eating, Social gatherings • Living independently and avoided residential or nursing home Ethos is of progression support to develop independence What ever is needed – but not repeatedly

  12. Huggard Hostel funded by Supporting People – ‘Society’s last safety net’ • Engage chaotic people who would otherwise be rough sleeping – often substance misuse, previously looked after, mental health issues • ‘There are many schemes to help people living on the pavement our aim is to take people living in the gutter and get them onto the pavement – and that is the hardest and most important 4 inches anyone will make’.

  13. Why should these people get the money? • Pressures in a recession/political climate • Local Authority Statutory groups (different) • Evidence form England that money inside RSG spent elsewhere

  14. Costs and estimated net benefits per annum per 1000 units of supported people services by client group - Capgemini 2008, Research into the Costs and Benefits of Supporting People, England

  15. Literature Review by Vulnerable Adults team (Sian Price) • Support related to housing results in stability Direct benefits to Healthcare • San Francisco – ‘use of acute care by homeless people with mental illness, substance misuse problems and other disabilities – 236 people • Compared to year before - placement significantly reduced • percentage of residents with an ER visit (53% to 37%) • mean number of visits per person (1.94 to 0.86) • total number of emergency department visits (56% decrease from 457 to 202) • significantly reduced the likelihood of being hospitalised (19% to 11%) & mean number of admissions per person (0.34 to 0.19) Martinez T E, Burt M R (2006). Impact of permanent supportive housing on the use of acute care health services by homeless adults, Psychiatric Services 57(7); 992-999.

  16. Cost Savings to Health - Brent • ‘Frees up expensive hospital beds by facilitating the timely discharge of older people from hospital and reduces readmissions i.e. the revolving door is partially closed’ • Diverts people away from residential and nursing care. ‘ We estimate this saves Brent around £388k each year’ low running costs (£40,600 in 2007-8) • 80% of people who it supports remain in a community based placement for at least 2½ or more years after their support ceases or until they die.

  17. Effective and Cost Effective • Evidence suggests schemes are effective and cost effective • Reduces pressures on other services • More research needed to evaluate ‘good work’ especially in Wales • £2 for every £1 in Carmarthenshire

  18. Neath Port Talbot (Annie Delahunty) • 1 years baseline data - 693 returns • 1/3 chronic health conditions • 9% used A/E in year before • Mental Health problems, arthritis, respiratory, diabetes

  19. Personal Responsibility 1.4.26 Spider Graph Monthly Soft Outcomes SU Name: Signature: ___________________ KW Name: Signature: __________________ 10 9 8 Accommodation 10 Living Skills 9 7 Date: 8 6 7 10 6 5 5 9 4 8 4 3 6 7 3 2 2 5 1 4 1 3 2 10 9 8 7 6 5 4 3 2 1 1 Meaningful use of time Social Networks 1 1 2 3 4 5 6 7 8 9 10 2 3 4 1 1 5 6 2 2 1 3 7 3 2 8 4 3 9 4 5 6 4 10 5 7 5 6 8 Independence 9 6 Relapse prevention 7 10 7 8 8 9 9 10 10 Mental Health Physical Health

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  21. Public Health - Operational • Most vulnerable/deprived • ‘Difficult to reach’ - they are already engaged with • Delivering Health Promotion interventions • Accessing People who are more likely to have BBV, TB, mental health issues

  22. Public Health- Strategic • Stakeholder in programme - outcomes directly impact on health services as well as on health • Advocacy • Co-production • Influence planning and commissioning • Joint Strategic Needs Assessments– unmet needs • Evidence of programmes/evaluation

  23. Public Health Wales • Take up or make up opportunities to get involved with ‘Supporting People’ Because there are ample opportunities to achieve our aims ‘Our purpose is to give people power to protect and improve health and wellbeing and reduce inequities by informing, advising and speaking up for them’ • Improve health and reduce health inequities by addressing the social and economic factors which determine people’s health • Prevent disease and ill health by reducing the risks in people’s behaviour

  24. Independent Review of Supporting People Programme for Deputy Minister for Housing Thank you Questions? kerry.bailey@wales.nhs.uk

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