Reducing Inequalities – A Shared Purpose for Housing and Health
A response to two important, long awaited and much needed White Papers, launched in the last week.
On the 2nd February, I was extremely pleased to note that the government’s new Levelling Up White Paper highlighted the fundamental role of good housing in reducing regional inequalities. Although it is hard to predict how the Levelling Up agenda will be actually felt by the residents at Tyne Housing, we support its ambition while we look forward to further details from the national government, and our important partners in local and devolved authorities.
Then on the 9th February, we saw the release of a White Paper which begins to set a course for the integration of Health and Social Care. Again it’s hard to visualise how people’s day-to-day experience of these services will change based on a central government ambition which promotes local decision making and accountability. It was notable that both the Secretary of State for Health and the Secretary of State for Levelling Up, Housing and Communities provided the foreword to this paper.
“We will work with stakeholders to develop and introduce a framework with a focused set of national priorities, and an approach for prioritising shared outcomes at a local level, focused on individual and population health and wellbeing”.
With such a focus on local priorities, the imperative must now be for all local leaders to work out how best to engage in these important matters for the benefit of the communities we serve – no matter how difficult it sometimes seems to see the end point.
So, while I am not sure how the government’s ambition to integrate Health and Social Care will play out, I am extremely heartened to see the intent the NHS has already set out in their vision to reduce health inequalities. It’s called ‘Core20PLUS5’ and it’s a national framework that supports local areas to identify key groups that experience the worst health outcomes. This includes the most deprived 20% of the national population as identified by the national Index of Multiple Deprivation (IMD). It also includes ‘Inclusion health groups’ – and this includes some of Tyne’s core residents such as people in coastal communities, people experiencing homelessness, people dependent on drugs or alcohol, people in contact with the justice system and other socially excluded groups.
Given the complexity of the NHS, it’s easy for a Housing Association to feel intimidated by collaborative work with health colleagues, but at Tyne Housing we have long felt that we have no option but to collaborate.
The following should illustrate my point, if you consider the profile of residents in Tyne’s supported housing: over 45% are aged 40-60, 93% male, and most experiencing multiple exclusions.
- In their latest data releases, the Office of National Statistics (ONS) report, “for the seventh consecutive year, the North East had the highest rate of any English region for alcohol-related deaths”. Males aged over 45 were particularly over represented.
- It’s a depressingly similar picture with drug-related deaths, basically you are more likely to die of drug related poisoning if you are male, aged 45-49 and living in the North East of England – “the highest rate of drug misuse of any English region for eight consecutive years”.
- Finally, deaths by suicide – perhaps the saddest of all of these – we find the same North Eastern story, that “age 45-49 has the highest rate in both genders”, and, “suicide in England and Wales is three times more common among men than among women”.
Does this surprise you? These facts are shameful, but not especially surprising to me and I make no apologies for the unrelenting focus we have on a very disadvantaged group who I often think of as suffering from hopelessness as much as homelessness.
So, our focussed work with health partners is not part of a strategy to diversify – it falls directly out of the needs of our core residents, and our organisation’s purpose –
‘we are here to help people get to a better place’.
What we do at Tyne
Supported Housing! The single most effective resource we deploy is providing our residents with a support worker as well as their safe, secure home. We recruit our people based on their values rather than their work history, and we invest a lot in staff training, from trauma informed care, to mental health first aid and suicide prevention. The people who live with us consistently tell us that it is our staff who make the difference.
Supported Housing generates excellent holistic outcomes for its residents, and is extremely cost effective for government – but at Tyne we also deliver some more targeted interventions with our partners in health;
- Reduce harm
In partnership with Newcastle Gateshead CCG, we provide the Joseph Cowen Health centre, specifically focussed on people who feel they cannot access primary care. Harm reduction advice and a needle exchange are part of this and we need close working relationships with our treatment and recovery partners. There are no appointments or barriers to entry and the fact that this service stayed open throughout the pandemic is a source of pride for us here at Tyne. Additionally, at the request of our resident’s consultation group we will launch an abstinence based recovery house this month – so watch out for that!
Both in our health centre and on an outreach basis, our staff work closely with a range of health partners to bring advice, counselling, testing and vaccinations to our residents. We know that signposting is not enough, and by bringing health services closer to people with the greatest needs we feel we can meet those needs much more effectively. The service is really well loved by the people we serve, and it also provides amazing value for money for the commissioner. Furthermore, our independently commissioned Impact Report indicates that every £1 invested into the Joseph Cowen Centre creates £11.28 in social value.
Whether it is from mental health forensic services, or long term secure wards, we work with our local mental health trust to provide safe, secure accommodation which bridges the gap between a long term institutional setting to full integration back in the community, with a success resettlement rate of around 85%. We have also recently delivered our first home under the Transforming Care programme, in which a man with significant challenges caused by his autism was able to leave institutional care for the first time in 20 years and closer to his family.
- Investing in community
As well as housing we already run a community farm, a creative arts studio, a progression hub and a carpentry workshop. In our latest Strategic Plan, ‘Putting People First’, we are investing in wellbeing, community and learning services to add value to the supported housing that keeps people safe, and our move-on homes which help people move into employment. The alignment of our capital and revenue investment plans are complex – but the social return is great.
In our new strategic plan, we are committed to encouraging members of our local communities to volunteer, and support our residents into community based activities. Bringing the skills of our local community together with the interests and aspirations of our residents will be transformative for both parties.
- Valuing people’s life experiences
What we have seen is that a roof, a good worker and the right professional relationships with health commissioners is still not enough. People who live in supported housing have just the same hopes and aspirations as the rest of us. A sense of progression, of connection with other people in their community and the means to navigate what is available to them – whether work and volunteering, or picking up old pastimes or discovering new hobbies – is what gives people a sense of belonging. From here, positive relationships can be developed and, for many, their time with Tyne might be a footnote in the story of their lives – they certainly shouldn’t be defined by it. Indeed, by supporting people in this way we believe they will go on to develop the resilience they need to cope with life’s ups and downs and know where to get help when they need it.
How Government can support this
All of the above is only possible because of our core business in Supported Housing. A new, long term government revenue plan for supported housing is essential if we are to provide a solid platform for our people to flourish. Joining up Health and Social Care, as well as Levelling Up our regional inequalities, must take this vital part of our housing system into account.
What housing leaders can do – and why they should
People without homes die young. Experimental statistics from the ONS on the number of deaths of homeless people in England and Wales indicate the mean age at death was 45.9 years for males and for women it was 41.6 years. Given the health inequalities faced by our residents, I believe now is the time for housing leaders to engage more fully with our partners in the NHS – a partnership based on shared outcomes rather than being led by income.
Two questions to get you thinking about how to do that:
- Is there anything you could do to engage with your local health delivery systems?
- Which groups of your residents can you evidence are the most excluded in your area?
CEO Tyne Group