Partnership project secures funding to transform homeless healthcare services in Brighton and Hove

A partnership of Brighton-based organisations has been awarded a major grant for Common Ambition, a transformative project designed to radically improve healthcare for people experiencing homelessness in Brighton and Hove.

The three-year project led by Arch Health launches in January 2021, in partnership with Justlife, University of Brighton, Brighton & Hove CCG and Public Health Departments. It is supported by the Health Foundation, an independent charity committed to bringing about better healthcare for people in the UK.

The project will use innovative methods to ensure patients are at the centre of evaluating and designing improvements to the services which they use, including peer research and the use of ‘collaborative pairs’: bringing patients and clinicians together with commissioners and academics in order to better understand the system and its successes and flaws from one another’s viewpoint.

This learning will drive systemic change in the way homeless health services are commissioned and delivered in the city and will ultimately reduce the dire health inequalities which currently exist. Insights will also be used to inform service improvements across the region and further afield.

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 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 disproportionately. 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 last year 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. More formally accessing the voice and experience of those with lived experience of homelessness will enable us to work collectively to improving the health systems available, including transition points between services. We know this

can work – co-production of mental health services with patients has been shown to improve health services (NHS Improvements).

Arch CEO and project chairman Gary Bishop said:
“We are delighted to be able to launch this vital project and grateful for the award of funding from the Health Foundation. This is a unique opportunity for our city to reduce suffering and save lives among Brighton and Hove’s homeless population. It means we will have resources to really understand, from a patient view, where the system and services are performing well, and where we can work together to make improvements. All project partners are committed to creating a health system that really works for people who are experiencing homelessness.”

University of Brighton Principal Lecturer and project academic lead Dr Mary Darking said:
“This project is crucial to our city where so many of us feel frustrated and deeply saddened by the suffering that people experience whilst homeless. To be involved in improving these vital health services over the next 3 years is a huge privilege, particularly given the commitment to ensuring that the project is driven by the voices and needs of those experiencing homelessness, and the use of innovative evaluation and co-design methods. The University of Brighton is proud to offer its academic leadership and to work in partnership with project lead Arch Health, Justlife, Brighton & Hove Clinical Commissioning Group, Brighton & Hove Public Health and funding body the Health Foundation”.

Simon Gale, Chief Executive at Justlife, said:
“Justlife are really excited to partner with Arch Health on this project. We passionately believe people who have experienced homelessness are best placed to ensure that health services aimed to help them are designed and delivered in the most effective way. We look forward to getting started and seeing the impact it has. Our hope is that this project kickstarts the involvement of people with lived experience in co-production of all services aimed at supporting people who are homeless in Brighton & Hove”.