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This article describes the development of the Supported to Independent Living project (SIL), which is for the support and care for people with mental health needs in…
This article describes the development of the Supported to Independent Living project (SIL), which is for the support and care for people with mental health needs in Oxfordshire to live as independently as possible in ordinary housing in the community. The project is a partnership between NHS Oxfordshire (Primary Care Trust), the Oxfordshire Supporting People programme and Oxfordshire County Council Social and Community Services.Although there was a very vigorous development of community living for people with longstanding mental health needs through the provision of group homes, particularly in Oxford City that started in 1963, there has not been an overall strategy for the development of mental health services for the County as a whole. The needs of a diverse, younger, often more mobile and potentially more challenging group of service users for housing with appropriate care and support have not been met.A joint strategy between the County Council and the Primary Care Trust (PCT) to meet these needs has therefore been developed that introduces a pathway of linked accommodation and support arrangements. These range from intensive support through to floating support in the community, and are intended to offer individuals a guided pathway away from specialist services to more mainstream provision. The services are based on the principles of recovery, personalisation and ordinary housing.As well as achieving significantly reconfigured services the strategy has to deliver savings to meet the cuts imposed on the Supporting People programme grant by Central Government.The project has involved the PCT and the County Council in close partnership working, and important and significant involvement of and engagement with service users and carers. A framework agreement has been agreed by all of the organisations involved. It sets out the roles and responsibilities of each and covers local government, the NHS, housing and support.
The purpose of this paper is to describe the delivery of the first clinically led, inter-professional Pathway Homeless team in a mental health trust, within the King’s…
The purpose of this paper is to describe the delivery of the first clinically led, inter-professional Pathway Homeless team in a mental health trust, within the King’s Health Partners hospitals in South London. The Kings Health Partners Pathway Homeless teams have been operating since January 2014 at Guy’s and St Thomas’ (GStT) and Kings College Hospital and expanded to the South London and Maudsley in 2015 as a charitable pilot, now continuing with short-term funding.
This paper outlines how the team delivered its key aim of improving health and housing outcomes for inpatients. It details the service development and integration within a mental health trust incorporating the experience of its sister teams at Kings and GStT. It goes on to show how the service works across multiple hospital sites and is embedded within the Trust’s management structures.
Innovations including the transitional arrangements for patients’ post-discharge are described. In the first three years of operation the team saw 237 patients. Improved housing status was achieved in 74 per cent of patients with reduced use of unscheduled care after discharge. Early analysis suggests a statistically significant reduction in bed days and reduced use of unscheduled care.
The paper suggests that this model serves as an example of person centred, value-based health that is focused on improving care and outcomes for homeless inpatients in mental health settings, with the potential to be rolled-out nationally to other mental health Trusts.
Finding a suitable home can be difficult in a constrained housing market such as small rural village. Within Ambridge, only a small proportion of the homes in the village…
Finding a suitable home can be difficult in a constrained housing market such as small rural village. Within Ambridge, only a small proportion of the homes in the village is known about, and it is rare for additional homes to be added to those where named characters live. This chapter takes a generational view of housing pathways and options, showing how Generation X, Millennial and Generation Z populations in Ambridge are housed. The chapter examines the extent to which characters rely on friends or family for solving their housing problems and considers the role of family wealth and wider dependence in determining housing pathways. The research shows that dependence on others' access to property is by far the most pronounced feature of housing options for these households. These pathways and housing choices are compared to the wider context in rural England, to consider the extent to which luck, in the form of the mythical ‘Ambridge Fairy’, plays a role in helping people to find housing. The ways in which the Ambridge Fairy manifests are also considered – showing that financial windfalls, unexpectedly available properties and convenient patrons are more likely to be available to people with social capital and established (and wealthy) family networks. The specific housing pathway of Emma Grundy is reviewed to reflect on the way in which her housing journey is typical of the rural working-class experience of her generation, within the wider housing policy context.
The Papworth Trust and Habinteg Housing Association have just launched the findings of a two‐year research programme into the need for better housing and support for…
The Papworth Trust and Habinteg Housing Association have just launched the findings of a two‐year research programme into the need for better housing and support for disabled people. A planning model or ‘toolkit’ has been produced based on the approach developed by the researchers (Pathways Research), which can be used by any local authority to evaluate the housing needs of wheelchair users.
The purpose of this paper is to review the history and current state of provision of homeless medical respite services in the UK, drawing first on the international…
The purpose of this paper is to review the history and current state of provision of homeless medical respite services in the UK, drawing first on the international context. The paper then articulates the need for medical respite services in the UK, and profiles some success stories. The paper then outlines the considerable challenges that currently exist in the UK, considers why some other services have failed and proffers some solutions.
The paper is primarily a literature review, but also offers original analysis of data and interviews, and presents new ideas from the authors. All authors have considerable experience of assessing the need for and delivering homeless medical respite services.
The paper builds on previous published information regarding need, and articulates the human rights argument for commissioning care. The paper also discusses the current complex commissioning arena, and suggests solutions.
The literature review was not a systematic review, but was conducted by authors with considerable experience in the field. Patient data quoted are on two limited cohorts of patients, but broadly relevant. Interviews with stakeholders regarding medical respite challenges have been fairly extensive, but may not be comprehensive.
This paper will support those who are thinking of undertaking a needs assessment for medical respite, or commissioning a new medical respite service, to understand the key issues involved.
This paper challenges the existing status quo regarding the need for a “cost-saving” rationale to set up these services.
This paper aims to be the definitive paper for anyone wishing to get an overview of this topic.
This article highlights the links between housing and health and suggests that the health sector has much to benefit from joined‐up working with the housing and support…
This article highlights the links between housing and health and suggests that the health sector has much to benefit from joined‐up working with the housing and support sector. There are advantages to both sectors of working in this way, particularly in the area of commissioning services. By working creatively together at key points along the care pathway, local partners can support each other in the delivery of services. Many housing associations are uniquely placed to deliver services that offer key solutions to person‐centred working and can help to build healthier communities.
Homeless people experience extreme health inequalities and high rates of morbidity and mortality (Aldridge et al., 2017). Use of primary care services are low, while…
Homeless people experience extreme health inequalities and high rates of morbidity and mortality (Aldridge et al., 2017). Use of primary care services are low, while emergency healthcare use is high (Mathie, 2012; Homeless Link, 2014). Duration of admission has been estimated to be three times longer for homeless patients who often experience poor hospital discharge arrangements (Mathie, 2012; Homeless Link, 2014). This reflects ongoing and unaddressed care and housing needs (Blackburn et al., 2017). The paper aims to discuss these issues.
This paper reveals how GPs employed in secondary care, as part of Pathway teams, support improved health and housing outcomes and safe transfer of care into community services. It draws on published literature on role of GPs in working with excluded groups, personal experience of working as a GP in secondary care, structured interviews with Pathway GPs and routine data collected by the team to highlight key outcomes.
The expertise of GPs is highlighted and includes holistic assessment, management of multimorbidity or “tri-morbidity” – the combination of addictions problems, mental illness and physical health (Homeless Link, 2014; Stringfellow et al., 2015) and research and teaching.
The role of the GP in the care of patients with complex needs is more visible in primary care. This paper demonstrates some of the ways in which in-reach GPs play an important role in the care of multiply excluded groups attending and admitted to secondary care settings.
This review for the Joseph Rowntree Foundation has been carried out while government departments, local statutory authorities, provider organisations and voluntary and…
This review for the Joseph Rowntree Foundation has been carried out while government departments, local statutory authorities, provider organisations and voluntary and service user groups are still working up to the introduction of Supporting People in 2003. There is concern that the involvement of social services and health agencies in planning and service commissioning could lead to resources going into mainstream community care and health programmes, leaving less available to support those who come into Supporting People by a homelessness, housing or probation/prison route.
Four routes or pathways have now been identified by which individuals may come within the scope of PSA 16 National Indicator 149, which is concerned with monitoring…
Four routes or pathways have now been identified by which individuals may come within the scope of PSA 16 National Indicator 149, which is concerned with monitoring efforts to achieve settled accommodation for individuals with significant mental health problems. This article focuses on their needs and the identification of those with mental health needs as seen through these four principal routes. An understanding of these four possible pathways can help to identify areas for priority action, local delivery chains and partnerships, and also highlight some of the challenges and risks in and for delivery.
A partnership of agencies in South West England commissioned a review of supported housing, with the primary aim of linking supported housing (and the Supporting People…
A partnership of agencies in South West England commissioned a review of supported housing, with the primary aim of linking supported housing (and the Supporting People programme) with other regional strategies and initiatives such as housing, health, crime reduction and community safety. The review produced a new conceptual framework for the planning and management of housing and support services, with a strong emphasis on aims and outcomes. It also brought together data on current services across the region and identified key trends and issues to be addressed. Many of the recommendations and proposals have been incorporated into the draft Regional Housing Strategy, due to be finalised in May 2005.