Improving the Health of Homeless Populations in Tower Hamlets – A Triple Aim Project

 16th November 2020

co-written by Ché Rosebert, project lead, Louise Noronha and three people with lived experience including Gary Ash

 

“You have to do something to help the homeless” service users told the Tower Hamlets team in 2018, when they held a listening event for service users. Homeless people have a shockingly low life expectancy in the UK and service users recognised something needed to be done for them.  

In August 2019, the team began using a triple aim framework to do just this.  

We know that various populations are over-represented within homelessness such as care leavers, people who have left the armed forces, people on the autistic spectrum and people who identify as LGBTQIA+.  

We also know, due to the Tower Hamlets Local Authority  five-year strategy, published in 2018, that: 

• The population in Tower Hamlets is rising fast 
• Rents are high and there are not enough affordable homes to accommodate people locally 
• Homeless people often have long standing and complex physical and mental health issues driven by compound trauma* and many have un-recognised acquired brain injury**
• Services find it difficult to provide sustained, reliable, accessible services to homeless people 

And this leads to the shockingly low life expectancy of 42 years for women and 44 years for men*** a good 30-40 years less than people who have not been homeless. 

The work, which started last year, looks to simultaneously improve health outcomes, experience of care, and value to a specific population. The focus was on making improvements for people living in homeless hostels. The starting point was to undertake a three part data review, which helps teams look at needs and assets within a population from the following perspectives: 

• Care providers  
• Service users and people with lived experience of staying in hostels 

Part of this approach also requires co-working with hostel staff and residents in generating the ideas for change needed.  

The process has not been simple and the team openly admit making mistakes at the beginning, as Ché, the project lead, recognises, “We made the mistake of engaging only one person with lived experience to the project team. Having received a reality check and armed with a co-constructed role description that included how people would be supported and a financial commitment to recognise their contribution, we now have three people with lived experience and are seeking to recruit three more”.

Then Covid hit in March this year. This meant the team had to make drastic changes to the way the project was structured – conducting interviews remotely. Keen not to pause the project, they took a go-slow approach, rather than stopping their work. Staff had already been interviewed but the analysis was done by the group online. In September, after months of work building relationships with staff that would help encourage residents, the team began interviewing residents themselves. Managers and staff have been key to encouraging residents to participate in interviews. Residents received a small financial token of appreciation for sharing their experience.

This is a positive step, which will now lead to: 

• Looking at the demographic data from resident interviews to try and ensure we are interviewing a representative group 
• Analysing the resident data 
• With the help of our ELFT improvement advisor: facilitate a series of events for staff and residents to improve the driver diagram, prioritise and action test change ideas 

Throughout this work, they have been making links with people and services that have the authority, power, responsibility and accountability to action changes to the policies and procedures that will improve the health of homeless people. Ché notes, “We will cast our net wide. Remember to look out for the wins along the way, however big or small and don’t forget to share and celebrate them.”

Making a sustainable positive change, whatever your focused area for development, takes time and sponsorship from those with the power within and around the communities wishing to change. The ELFT quality improvement (QI) approach provides a way to do this and reinforces our experience that the way to make change is through relationships.

 

With much warmth, 

The Core Project Team: Three people with lived experience including Gary Ash, Dr Louise Noronha & Ché Rosebert – Clinical Psychologists, Dr Kimberley Lobo, ST5 Psychiatrist. October 2020.

 

Thank you to all our people with lived experience for writing this piece and to our sponsors, supporters and enablers: Giannoula Tzanoukaki, Tower Hamlets Integrated Commissioning; Carol Thomas, Mohammed Rashad, Mary Kneafsey, Providence Row Housing Association; Katie Davies, Look Ahead; Dr Sarah Dracass, Dr Patricia Potter, Marion Reilly, Richard Fradgley – ELFT

 

*https://www.researchgate.net/publication/323916485_Social_Exclusion_Compound_Trauma_and_Recovery

**https://www.theguardian.com/housing-network/2016/oct/19/homeless-brain-injury-nhs

***https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsofhomelesspeopleinenglandandwales/2013to2017