(42) A high priority should be placed upon monitoring of quality and delivery of Health and Homelessness Action Plans. The Health Department's Primary Care Modernisation Group should set out how primary care needs of homeless people would best be met. |
(48) In the case of primary care services, specialist provision should be seen as transitional for all but a small number of homeless people. It should provide planned support over a reasonable period of time until individuals are re-housed and settled with access to their local GP practice and primary health care team. The general approach should be to support homeless people to maintain their current health networks or to establish new regular contact with mainstream health services. |
RAG status: Amber | Delivery contact: Scottish Executive - Health Department |
Progress to date: - Health and Homelessness Action Plans were developed in the period to March 2005 and all NHS Boards are now implementing them. The Health Department's Primary Care Modernisation Group was dissolved in 2002. NHS Boards have responsibility for ensuring that the primary care needs of homeless people are met and are in line with the Health and Homelessness Standards.
- In March 2005 the Scottish Executive published its Health & Homelessness Standards for NHS Boards. The standards are at the centre of the Scottish Executive's commitment to improve the health of homeless people. The Health & Homelessness Standards require NHS Boards to re-state and further refine their commitment to meeting the health needs of all homeless people. The standards are not clinical standards, but are strategic and aimed at the corporate level of NHS Boards in recognition of the critical importance of strong leadership in tackling health inequalities.
- NHS Boards are implementing the standards from April 2005 onwards and actions are being incorporated into the wider plans of the Board. Whilst NHS Boards hold the strategic responsibility for the standards, it is expected that delivery will in the main be through Community Health Partnerships ( CHPs). CHPs need to consider and plan for the needs of homeless people and NHS Boards must ensure that there is appropriate accountability in place to ensure continuous improvement. The health improvement and health inequalities guidance for CHPs assists in meeting these requirements.
- At the time of their publication in 2005, meeting the Health and Homelessness Standards was expected to form part of the NHS Scotland Performance Assessment Framework ( PAF). Ministers have now introduced new delivery and performance management arrangements for NHS Scotland: " Ministers' Key Objectives, Targets and Performance Measures for the NHS and Local Delivery Plans: Guidance 2006/07". These new arrangements replace the previous system of Local Health Plans and the PAF. The Local Delivery Plan approach introduces the first steps towards a greater alignment between financial and operational planning, focused on achieving the key targets which support the "core set" of Ministerial objectives (Health, Efficiency, Access and Treatment - or HEAT).
- Although monitoring the implementation of the Health and Homelessness Standards is not a component of the HEAT core objectives, performance targets or the supporting measures, Boards are expected to operate the Standards - as above. In the recent Ministerial Statement on Abolition of Priority Need a commitment was given to undertake a survey of NHS Boards by the end of March 2006 on progress against implementation of the standards 'one year on'. The survey will help to (i) establish a baseline of information as to how well NHS Boards are responding to the implementation of the standards, and (ii) identify areas against the standards where Boards may need further assistance and support in implementation. We will review the results of the survey with key stakeholders.
- With regard to specialist services, the Health and Homelessness Standards recognise that these services may be appropriate for homeless people for a short period of time, but that the existence of such services should not mean that everyone who is homeless is automatically channelled through this route. The aim is to incorporate homeless people within mainstream services and ensure that these services are designed in ways that meet their needs (standards 5.3 and 5.4 refer).
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Action required & by whom: - Scottish Executive Health Department to undertake a survey of NHS Boards on progress against implementation of the Health and Homelessness Standards 'one year on' - March 2006
- Members of the Health and Homelessness Steering Group will be involved in reviewing the findings of the survey.
- The findings will also be reported to the Homelessness Monitoring Group to consider and, where appropriate agree, follow-up work with NHS Boards.
- The findings will also inform what further monitoring is required and the frequency of that monitoring by the Scottish Executive Health Department.
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Key milestones: - Health and Homelessness Standards published March 2005.
- Commence survey of NHS Boards' implementation of Health and Homelessness Standards - March 2006
- Collate findings of survey by end of April 2006; produce summary of key findings by May 2006; produce report and follow-on actions by June 2006.
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(43) All local authorities should record information about the GP registration of all those who register as homeless, and should offer information about local health services to homeless people rehoused outwith their existing GP area. |
RAG status: Amber | Delivery contact: Scottish Executive, Communities Scotland |
Progress to date: - Agreement reached that reporting against recommendation to be reflected in annual progress reports.
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Action required & by whom: - See recommendations 18-21.
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Key milestones: - See recommendations 18-21.
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(44) NHS Boards should ensure their strategic planning embraces the current and future service needs of homeless people. Drug and Alcohol Teams should include, in their planning priorities, the service requirements of homeless people relating to substance misuse. Monitoring of the effectiveness of such processes should be undertaken through the Scottish Executive's assessment of Local Health Plans and Corporate Action Plans on Substance Misuse. |
(47) Actions within the national drugs and alcohol plans which will prevent addictions contributing to homelessness and which will tackle substance misuse amongst homeless people should be given high priority. The recommendations of the Glasgow Street Homelessness Team in relation to the development and provision of drug and alcohol services to hostel dwellers should be more widely applied. Local action to tackle substance misuse and homelessness in parallel should be developed through homelessness strategies and Drug and Alcohol Action Team plans. The results of Scottish Executive work on effective interventions in tackling substance misuse should be disseminated to support commissioners and purchasers of services and service providers in both homelessness and drugs and alcohol agencies. |
RAG status: Amber | Delivery contact: Scottish Executive - Health Department |
Progress to date: - Strategic links are developing well in most areas ensuring that the needs of homeless people are reflected in a wide range of appropriate strategies. Strategic links are seen as vitally important and where such links have been established there is evidence of the complex needs of homeless people being mainstreamed through the wider planning process. Standard 1 of the Health and Homelessness Standards reinforces the need for NHS Boards to incorporate the health needs of homeless people into the Board's Health Inequalities Strategy and all other relevant strategic planning frameworks. Resources will be subject to each Board's prioritisation processes.
- Standard 4 of the Health and Homelessness Standards focuses on the important area of access to health services. Homeless people need to know how, where and when they can access health services. The Single Shared Assessment is highlighted as an appropriate way of working to deliver the complex needs of homeless people.
- Community Health Partnerships ( CHPs) are a mechanism to deliver and support change. Delivering for Health (published in October 2005) set out 9 key priorities for CHPs. These included providing 'anticipatory care' (with the intention that CHPs target resources at disadvantaged groups and deprived households with better access to and use of services) as well as improving health and tackling inequalities and specific health outcomes.
- Homeless and Substance Misuse Advisory Group established in November 2005. The group are aiming to develop an integrated set of approaches for homeless substance misusers, and those at risk of homelessness, that creates joint-working and integrated services, and ensures that those services are working together locally to deliver appropriate accommodation and levels of support. The group will also consider, disseminate and encourage implementation of examples of best practice.
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Action required & by whom: - Scottish Executive Health Department to work with CHPs to incorporate substance misuse links in the implementation of the Health and Homelessness Standards.
- The survey of NHS Boards on implementation of the Health and Homelessness Standards ('One Year On') will help identify what progress is being made in these areas and identify what further work is required.
- Corporate Action Plans to be submitted by NHS Boards (10 April 2006) outlining what activities are to be taken at local level to address issues of homelessness and substance misuse.
- Homelessness and Substance Misuse Advisory Group undertaking a mapping exercise to identify gaps in service provision for substance misusers.
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Key milestones: - Health and Homelessness Standards published March 2005; implementation ongoing.
- Homelessness and Substance Misuse Advisory Group established October 2005.
- Commence survey of NHS Boards' implementation of Health and Homelessness Standards - March 2006
- Collate findings of survey by end of April 2006; produce summary of key findings by May 2006; produce report and follow-on actions by June 2006.
- Findings from Homelessness and Substance Misuse Advisory Group mapping exercise will be disseminated locally to assist with service provision. Mapping will commence in June 2006.
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(45) NHS Boards should ensure that all children in homeless families are able to access the full range of universal health services for children; and the health and homelessness co-ordinator should monitor this action. |
(46) NHS Boards should assess the provision of mental health services to homeless people to minimise the barriers to access. Being free from substance-misuse should not be an automatic pre-condition for access to services. |
RAG status: Amber | Delivery contact: Scottish Executive - Health Department |
Progress to date: - The Health and Homelessness Standards published in March 2005 represent a major step forward towards the delivery of recommendations 45 and 46. The standards apply to all groups of homeless people. As well as addressing issues for single people, the standards highlight for NHS Boards the significant issues for children and families who are homeless, their vulnerability and specific health needs. NHS Boards in addressing the performance requirements will need to ensure such differing needs are taken into account. They will require excellent strategic linkages, for example including homeless issues in Children's Services Plans, which in turn will ensure appropriate responses from maternity services, screening, surveillance and immunisation for homeless children.
- The Standards also emphasise that NHS Boards ensure that being alcohol or drug free is not a pre-requisite for access to services. NHS Boards have a responsibility to take action to ensure homeless people have equitable access to the full range of health services (Standard 4.3 refers).
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Action required & by whom: - The survey of NHS Boards on implementation of the Health and Homelessness Standards ('One Year On') will help identify what progress is being made in these areas and identify what further work is required.
- The findings will also be reported to the Homelessness Monitoring Group to consider and where appropriate agree follow-up work with NHS Boards.
- The findings will also inform what further monitoring is required and the frequency of that monitoring by the Scottish Executive Health Department.
- Corporate Action Plans to be submitted by NHS Boards (10 April 2006) outlining the activities being taken at local level to address issues of homelessness, mental health and substance misuse.
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Key milestones: - Publication of research carried out for HEBS on Delivering Health Care to Homeless People - 2004.
- Health and Homelessness Standards published March 2005; implementation ongoing
- Publication of research into support needs of homeless families - Spring 2006.
- Commence survey of NHS Boards' implementation of Health and Homelessness Standards - March 2006
- Collate findings of survey by end of April 2006; produce summary of key findings by May 2006; produce report and follow-on actions by June 2006.
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(49) The Health and Homelessness Co-ordinator, whose remit includes setting standards for homelessness training programmes, should support training on homelessness for health professionals and ancillary staff. |
RAG status: Green | Delivery contact: Scottish Executive - Health Department |
Progress to date: - The Health and Homelessness Coordinator post was established within SEHD to assist Boards in the development of Health and Homelessness Action Plans and to mainstream Health and Homelessness activity into the NHS. The publication of the Health and Homelessness Standards in March 2005 marked the end of that transition period of mainstreaming and integration within Board and CHP planning activities, at which point the Health and Homelessness Coordinator post was discontinued.
- A key component of Health and Homelessness Standard 5 is that NHS Boards need to demonstrate that all front line staff have the skills and knowledge to assist homeless people and are trained accordingly. The underpinning principle of this standard is that the Board's services respond positively to the health needs of homeless people.
- Staff training is critical to ensuring appropriate service responses, though the content and level of training and awareness raising should be determined by local circumstances. Such training should include all relevant staff, including reception and administrative personnel.
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Action required & by whom: - Delivery of the Health and Homelessness Standards to be monitored by the Scottish Executive Health Department and CHPs.
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Key milestones: - Health and Homelessness Standards published March 2005.
- Commence survey of NHS Boards' implementation of Health and Homelessness Standards - March 2006
- Collate findings of survey by end of April 2006; produce summary of key findings by May 2006; produce report and follow-on actions by June 2006.
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