Brighton and Hove Common Ambition: Coproducing the Homeless Health Care System

Brighton and Hove Common Ambition aims to improve health services for homeless and vulnerably housed people in Brighton and Hove. Led by people experiencing homelessness, the project will conduct a health needs audit and a review of current services for homeless people, feeding the findings into service improvements that better meet patient needs.

The need for improved homeless health services is significant: homelessness has a huge impact on the physical health of the individual. According to the Faculty for Homeless Health, people experiencing homelessness are 34 times more likely to have tuberculosis, 50 times more likely to have Hepatitis C, 12 times more likely to have epilepsy, 6 times more likely to have heart disease, and 5 times more likely to have a stroke. Recent research by Homeless Link (reference here maybe?) showed that in addition to physical health issues, 86% of individuals experiencing homelessness have mental health problems, 39% take drugs or are recovering from a drug problem and 27% have, or are recovering from, an alcohol problem.

The combination of physical and mental ill-health, drug/alcohol misuse and the lack of secure accommodation creates a level of complexity that results in disproportionate access to acute healthcare services. People experiencing homelessness attend A&E six times more often, are admitted to hospital four times more often and stay in hospital three times longer than people in secure accommodation (Faculty for Homeless Health). The combination of extremes of poor health and difficulty engaging in healthcare services has deadly results: the average age of death for a man experiencing homelessness in the UK is 45 and for a woman it is 43 (ONS 2018). These national statistics are reflected in the current figures for Brighton & Hove where in 2019, 36 people died while homeless (2019 Arch patient data) - these deaths were largely preventable.

However, even where excellent services exist, the needs of people experiencing homelessness are not well met (Advisory Council on the Misuse of Drugs, 2019). This is because the time needed to address their health issues (the severity of need can make for slow progress) means that people experiencing homelessness can get ‘lost’ in the system, or at the transition points between services. This is true in Brighton and Hove, despite the steps taken to improve homeless healthcare. Arch clinicians and Justlife support workers report feedback from people experiencing homelessness, that whilst individual services are of a very high standard, the overall local health service is complex, disjointed, inflexible, inadequate for the needs presented and ultimately very difficult to navigate. Arch patients often offer insights on how this can be improved

Project Aims and Objectives
The Brighton and Hove Common Ambition project (BHCA) will work with people with lived experience of homelessness, frontline providers and commissioners to develop a new approach to co-production within homeless health services, in order to improve health services and outcomes for people experiencing homelessness in Brighton and Hove.

The key objectives are:
●Develop a greater understanding of the needs and experiences of homeless patients.
●To (better) understand how people feel when using health services, ensuring that feedback is invited, welcomed, valued and used in a positive way to improve the whole experience.
●Integrate the expertise and experience of people who use the services into evaluation, improvement and development of homeless healthcare in Brighton & Hove.
●Deliver a strengthened homeless healthcare system which better meets the needs of patients.
●Improve the governance of the overall system, working with patients, providers and commissioners.

The project is coordinated by Arch Health, a GP surgery and Brighton-based community interest company, in partnership with Justlife, Brighton and Hove Clinical Commissioning Group, Public Health Brighton and Hove, and the University of Brighton.

Brighton and Hove Common Ambition will create a platform so that the voices of people experiencing homelessness, currently the least represented group in the English healthcare system, can be heard and their feedback used to establish ways of co-creating system and service improvement.