Room-to-Breathe & Saving Lives, Saving Money Groundswell
Who are Groundswell? • We enable homeless and vulnerable people to take more control of their lives, have a greater influence on services and play a fuller role in the community. • Since 1996 - Groundswell have been supporting homeless people to be involved in delivering solutions to homelessness • Our work includes: Peer research , client involvement and peer advocacy .
Homeless Health Peer Advocacy “… people think that if he can do it anyone can do it.” – Peer Advocate
Homeless Health Peer Advocacy "As a Peer you can share your experience and show there is a solution, then clients can find their own confidence and begin advocating for themselves.“
Homeless Health Peer Advocacy In 2015/26: • 2000 one to one appointments • 900 Health Promotion sessions • 23 new Peer Advocates trained • 62 volunteers: 25 progressing into training and further volunteering and16 gaining paid employment • Winner of the 2016 GSK IMPACT Awards
It Works! Saving Lives, Saving Money: Key Findings HHPA supports people experiencing homelessness to improved health “If it weren’t for you guys - Increased attendance at scheduled [Groundswell] coming and taking appointments; reduction in DNA rates to the time out and getting myself that of the general population sorted out, I reckon I would have been dead now. That’s how much - Decreased reliance on secondary and it made an impact in my life.” – unplanned care; 42% reduction in HHPA Client secondary care use “It’s made me more confident in - Increased knowledge, confidence and myself and I’m dealing with things motivation to manage health and engage now that I never would have dealt with healthcare with. If no one was there with me I wouldn’t have dealt with it. So in - Increasingly independent healthcare related the long run it’s going to help. It behaviours. really is.” – Client 6
Reduction in DNA rates HHPA support resulted in: Per cent of scheduled outpatient appointments missed - A 68% reduction in missed scheduled 60 appointments 50 40 34 - Bringing DNA rates similar to general 30 population 20 15 12 10 - Associated cost savings for the NHS in 0 General population Homeless Homeless reduced missed appointments population without population with HHPA support HHPA support - Up to £60,000 potential reduction in DNA related costs at GSST & King’s* “So when you probably without it you - Increased attendance at scheduled would have missed it you go because they’ve given that time to come and you appointments supports clients to have that trust with them.” – Peer address health issues Advocate & former client * In a twelve month period across all homeless patients accessing services at the Guy’s and St Thomas’ NHS Foundation Trust and the King’s NHS Foundation Trust. Based on reduction from 34% DNA to 15% DNA. 7
Reduced Reliance on Secondary and Unplanned Care HHPA support results in: - 42% reduction in secondary care use - £870 reduction in secondary care costs per client - For every £1 spent potential reduction of £2.43 in unplanned care activity costs - Reduction in unplanned care due to increased engagement with planned healthcare services and better health management “For twenty years being out on the street, this is the first time I’ve ever been in hospital, and engaging.” – HHPA client 8
Why Breathing? • Peers - unique position to highlight homeless health inequalities. “ Working with clients with breathing problems is really common. We had one guy referred to us from [Day Centre] who was having difficulty breathing. I went to pick him up. Every 5 steps he stopped and lit a fag. I couldn’t get him on a bus… It turned out to be severe chronic asthma. He was coughing up loads of phlegm. He hadn’t been to a doctors for a long while. He was advised to stop smoking but he said he was 60, he had done it all his life and he enjoyed it.” – Groundswell Peer Advocate
Exploring Respiratory Health • Designed a peer-led Project “Breathing difficulties have impact on all your body. You can’t move, • Extensive Literature Review and you can’t leave. And you • 6 Co-researchers cannot walk for a long time… you • Focus Groups get tired. When you have breathing • One-to-one survey difficulties… you have zero energy. Because your body doesn’t get that • In total 322 people with oxygen if you want it. You can’t be a experience of homelessness normal person and can’t look after directly participated in this yourself.” – Focus Group Participant project.
The Respiratory health of participants “Well I have difficulty with sleeping. • 26% use an inhaler (8% in general population) In the night I will be wheezing in my • 20% report to suffer with Asthma (8.4% general chest. I was sweating and so on population). and so forth… initially they thought • 4.9% diagnosed with COPD (1.9% in the general I was having asthma so they give population). me that [inhaler] so I said I use it, • T he longer a participant had spent homeless the but later it stops, so they gave me higher the likelihood that they had a diagnosed condition . some tablets… What I normally do • 64% had chest infections when sleeping rough. is if there is any issues I just rush to the A&E. Then everything is done.” • High rates of hospital admissions – Focus Group Participant
Homelessness & Respiratory Health • 85% current tobacco smokers. ( 18% across the UK) • 35% have smoked crack cocaine regularly in the past • Risky Smoking Behaviours – Smoking ‘Dogends’ and sharing Pipes. • Where you sleep impacts on health - 69% had difficulty breathing traffic fumes. • Concerns around living in hostels & temporary accommodation.
Extent of the problem • Quantities of tobacco smoked places participants at drastically increased risk of COPD, Chronic Bronchitis and Lung Cancer . 43% of participants have a pack year history of over 20. • Drug usage can make detection of illness difficult. 80% of participants find it difficult to know when they are ill. • Rough sleepers explain symptoms as due to their situation not as an indicator of underlying issue . 69% of participants reported that they expect to have a cough when they slept rough.
Access to treatment difficult • Getting to a doctor can be difficult. 63% of participants who have slept rough find it difficult to get to a doctor. • ‘Self-management plans’ for managing COPD and Asthma are not being implemented . Only 40% of people who need a self- management plan have had these created for them. • Increased risk of contracting influenza. Vaccinations need to be comprehensive for homeless people.
Smoking Cessation • Smoking Cessation not available enough. 42% of participants reported that they have access to smoking cessation support in a homeless service that they use. Licensed Medication underused. • Support Workers Missing a trick - 66% have not been advised by a support worker to stop smoking in the last 12 months • Smoking Cessation is not working. Half of participants want to stop smoking. A similar figure to smokers among the general population. • ‘Harm reduction’ – Smokers should be advised to cut down.
Conclusion(s) • Peer Advocacy – and Peer Support in general is an effective solution to tackling health inequalities. • Respiratory Health is a significant health issue for Homeless People. • Smoking Tobacco is one of the key factors that drives this. • Half of homeless people want to stop smoking – just need the opportunity and support to do so. Services & Support workers can play a key role in making this happen.
Thank you! www.Groundswell.org.uk Martin.burrows@groundswell.org.uk
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