Glasgow City CHP Item No. 9

EMBARGOED UNTIL DATE OF MEETING Glasgow City CHP Item No. 9 CHP Committee Meeting Date: Tuesday, 17 th February 2015 Paper No 2015/004 Subject: Presented by: Recommendation(s) Summary/ Background Policy/ Legislative Context Homelessness and Asylum Health Services (HAHS) Ann Forsyth, Homeless & Asylum Service Manager The committee are asked to note the content of report and agree the future direction of HAHS i.e. to maintain dedicated service for homeless people and those within the asylum process. Provide an update to the CHP committee on HAHS following Glasgow City Councils (GCC) review of homelessness services and the increase in number of asylum seekers to the city. Provision of HAHS ensures Glasgow City contributes to improving health outcomes of these vulnerable groups. Financial Implications Human Resources Implications HAHS has an annual budget of 2.8m and requests to utilise existing budget to meet increased demands in asylum. Nil Service User/Carer Engagement Equalities Implications Partnership Implications Sample of service user feedback on use of HAHS and mainstream services during 2014 highlights benefits of targeted services. Transfer of resource within HAHS from homeless to asylum will ensure capacity to meet increasing demands in asylum while providing targeted services to homeless people. As part of GCC homeless review HAHS will continue to be responsive to needs of those homeless or seeking asylum in the city during GCC homeless implementation programme. FoI/EIR Status Public tick If not to be made public, exemption (Section/Regulation) to be relied on under FoI/EIR legislation must be inserted below. Not Public Contains Personal Data DPA applies S.38 9 th February 2015

Glasgow City Community Health Partnership Report To: Report By: Glasgow City CHP Committee Ann Forsyth, Homeless and Asylum Services Manager Date: 17 th February 2015 Subject: Homelessness and Asylum Health Services (HAHS) 1. 1.1 2. 2.1 Purpose of the Report This report seeks approval from Glasgow City CHP Committee to the future direction for the delivery of specialist health services for homeless people and those people seeking asylum. Background Following the Glasgow City Council (GCC) Strategic review of Homelessness in September 2014 it was agreed that Glasgow City CHP would consider the HAHS in the context of Changes to how Glasgow City Council will deliver its homeless casework services over the next 3 years and possible impact on health services. The roll out of the Housing Options model which is a preventative approach to tackling homelessness The continuing presentation of homeless people who have complex needs, which cannot be accommodated effectively within mainstream health services. The need for a city wide, centralised, safety net for people who become homeless and who may experience difficulties accessing services in local areas. The increasing numbers of asylum cases being accommodated in Glasgow. The unknown impact of welfare benefit and asylum decisions on homelessness trends. The need for joint management and financial arrangements for health and social care services within HAHS to ensure the most appropriate and efficient delivery of health care services to these vulnerable groups. 3. 3.1 3.2 Homelessness Context Over the past 10 years Homeless Health Services (HHS) has had a continuous review process to ensure health services respond flexibly to the changing landscape and management of homelessness in the city. This has resulted in the HHS multi agency response shifting from meeting the needs of all homeless people to promoting a local mainstream response. This has resulted in the health provision which is delivered through HHS focusing on meeting the needs of the most excluded rough sleepers and those living in emergency accommodation, by linking them with appropriate services and to support their transition into mainstream services. This has been achieved through capacity building within mainstream health services. Homelessness presentations to Glasgow City Council have reduced by 36.2% in the past 4

years from 10,402 in 2010/1 to 6,652 in 2013/14. However, HHS has not seen a proportionate reduction in those presenting with complex needs as our presentations have only reduced by 16.75% (Table 1). 3.3 Despite a relatively smaller reduction in presentations to HHS we have focused on new ways of working, which have enabled the Service to make a significant contribution to the NHSGGC efficiency savings, whilst ensuring that the needs of most complex homeless people in Glasgow continue to be met through a good quality, centralised resource within HHS. Table 1: Homeless presentations & HAHS Data Year GCC Homeless HHS Referrals HAHS Budget Staffing WTE Applications 2010 11 10,402 3207 3,344.8 63 2011 12 9,214 3065 2,891.1 59 2012 13 8,240 2797 2852.2 46 2013 14 6,652 2702 2,615.9 45 Total reduction 36.2% 16.75% 728.9 (21.8%) 28.6% 4. 4.1 4.2 Asylum and Refugee Context Over the past 18 years Glasgow has supported asylum seekers in the city and provided more permanent accommodation for those refugees who choose to settle in Glasgow. During this time NHSGGC has been committed to meeting the needs of asylum seekers and refugees in the city, through provision of both targeted and mainstream service provision. In 2011 the development of the Asylum and Health Bridging Team (AHBT) ensured equitable provision for all newly-arrived asylum seekers. The establishment of the AHBT has resulted in a clear pathway from health screening for newly arrived asylum seekers through to allocation and registration with a GP. In contrast to the reducing number of homeless presentations, the A&R service has seen an increase in the demand in recent years. Table 1 below shows that from 2011/12 to end of quarter 3 of 2014 15 there has been an 118% increase in asylum seekers requiring health screening and 176% increase in GP allocations. Table 2: Asylum Notification and AHBT Data Year AHBT Notifications GP Allocations (included IA & other ) AHBT Staffing Budget 2012 13 876 930 104.1k* 7 (resources HHS) 2013 14 887 1582 248.3k 8 2014 15 1033 (End Dec 14) 1634 (End Dec 14) 253.6 8 Total increase 118% 176% Not comparable 1 Staffing WTE 4.3 4.4 During quarter 3 of 2014/15 the AHBT was unable to support all newly- arrived asylum seekers, which resulted in 111 asylum seekers being dispersed to temporary accommodation and allocated to GP practices without an initial health assessment. As with homeless services consideration needs to be give to the following factors to meet the 2

needs of those in the Asylum process and those refugees settling in local communities: Increasing numbers of asylum seekers with possible 50% increase requiring health screening. Rising numbers of asylum seekers in dispersed accommodation i.e. 3,400 asylum seekers living in dispersed accommodation across the city. Increasing numbers of refugees asylum seekers receiving refugee status and who may approach GCC for accommodation by making a homeless application. Impact on population, with approx 68% of those who are refugees choosing to settle within the city. 4.5 5. 5.1 5.2 5.3 5.4 In the past the joint management of both the homeless and asylum seeker health services has enabled resources to be managed flexibly to ensure the services can cope with fluctuations in demand. Over the past year, however, there have been a number of unplanned spikes in the number of asylum seekers accommodated in Glasgow and the Home Office predict this will continue for Glasgow. The current arrangements within HAHS are, therefore, no longer sustainable as A&R services require an increase in resources to meet this increasing demand. Health Care provision The health care needs of homeless people are well documented, with the use of services by homeless people tending to be sporadic with higher presentations to A&E and admissions to hospital. The evidence for those within the A&R process is less developed but, our experience is that that they suffer from the same health inequalities as many other vulnerable groups. The recognition by the NHS of the difficulties experienced by vulnerable people has resulted in the development of targeted, multi agency services, such as Homeless Health Services, Women s Justice service, Asylum Health and Bridging Team and A&R service, which are based on the key principle of supporting service users to engage with community services. Much of the recent evidence on how best to meet the needs of those experiencing homelessness debates the efficacy of taking a targeted or mainstream approach to service provision. Recent studies recommend that for metropolitan areas the most effective approach is to focus on opportunistic intervention and transitional input, to support an individual s engagement with mainstream services. Many of the recommendations are based on the service user experience and on the social and economic benefits, including health care costs, in providing specialist services over crisis emergency care. As well as targeted provision of health service from HHS, NHSGGC continues to support additional health resource for homeless people through acute and mental health services. In recent years, however, changes in organisational structures has resulted in the strategic, operational and governance aspects becoming fragmented within the CHP, such as. Homeless Trauma and Personality Disorder Team sitting within South Sector resulting in variations in pathways and a more disjointed planning framework. 3

6. 6.1 Resource & Finance Despite the savings exercise over the past few years, HAHS is in a relatively stable position. However, there are a number of risks which need to be taken into account: For both Homelessness and Asylum, Glasgow City has a higher percentage of presentations that any other local authority in Scotland, but little consideration has been given by the Government to matching the allocation of health resources to meet the needs of these vulnerable groups. The service is based in a leased property at Hunter Street. The land was originally owned by Glasgow City Council and was provided rent free as HAHS has been a joint health and social work service. However, the ten year lease has expired and City Property is now seeking a market rent of 75,000 per year for the site. Negotiations are ongoing to reduce the rent and to attract new services to the building. If we have to fund the rent this will limit our capacity to support the additional asylum seekers and refugees coming into Glasgow. The complex funding arrangement between Health and Social Work. 7. 7.1 Service Model In NHSGGC the services developed to meet the need of vulnerable group have remained consistent with best practice and are built on multi agency services provided in a flexible and responsive way. They provide opportunistic interventions for those who may not choose to engage with health services. The current model of delivery is demonstrated in Diagram 1, which shows how targeted interventions are used to promote engagement with mainstream services and aim to reduce health inequalities through being responsive to the needs of the most excluded groups. Diagram 1 R E S P O N S I V E Acute Liaison services Prison Targeted Services: Homelessness Newly Arrived Asylum seekers Emergency accommodation: Homeless Initial Asylum M A I N S T R E A M Mainstream: GP CMHT CAT C&F Prevention: GCC Community teams Housing Options 4

8. 8.1 8.2 8.3 8.4 8.5 8.6 Future direction It is positive to note that homelessness in the city is on a downward trend. However, of concern, is the increase in the number of people who have been displaced from their country of origin and are seeking asylum. NHSGGC is committed to the early intervention and prevention model of Housing Options, which is being implemented on a phased basis across the City. The impact of Housing Options has been encouraging so far but longer term analysis is required to determine if this approach sustains a reduction in homelessness applications. Furthermore, whilst the overall number of homelessness presentations is decreasing, there has not been a proportionate reduction in those presenting with complex needs. NHSGGC has shown its ongoing commitments to meeting the complex needs of homeless people, through the multi agency provision of targeted homelessness services, while working proactively with local services to meet the needs of homeless people in their community. Given this context it is proposed that the current model of service provision (i.e. a central resource which is accessible to those experiencing multiple exclusion and those living in emergency accommodation) continues to be our preferred model (as outlined in Diagram 1) While homelessness is reducing the number of asylum seekers needing support is on the increase and in recent years the ability to move resources within the Service has enabled us to meet the rising demands. The future direction of HAHS needs to consider the two separate elements of the service to ensure that future planning and provision of services to both homeless and A&R populations is sustainable and effectively co-ordinated. We need to consider how we can improve our planning and co-ordination of homelessness and asylum health services with other specialist services, such as those in mental health services. 9. 9.1 Recommendations 1. Note the contents of report. 2. Agree to the strategic direction in section 8.. 5