5th November 2020

Common Ambition

A major new project for homeless healthcare in Brighton and Hove

The Brighton and Hove Common Ambition is now launched and in phase two. This large-scale, city-wide partnership, funded thanks to a grant from the Health Foundation, will transform healthcare for people facing homelessness in our city, through co-production. Co-production involves:

  • A focus on finding shared solutions
  • Those who use the services are in charge of shaping those services, from the beginning of the project to the end
  • The project leader’s main role is to bring people with lived experience together with others in the sector (frontline workers, commissioners, directors, academics) in order to work together
  • This goes against the usual hierarchical nature of large-scale projects, and blurs the boundaries between delivering and receiving services
  • Working from the premise that those who use a service are best placed to give insights into its successes and flaws, and how best to improve it

The project is run by a partnership of Brighton-based organisations including Arch Healthcare, Justlife, University of Brighton, Brighton & Hove CCG and Public Health Departments, and is funded thanks to a major grant from The Health Foundation. Insights gleaned from the project are likely to inform not just health service improvements, but long-term, sustainable changes to all homelessness services, with Brighton and Hove pipped to become a model for other UK cities to learn from and emulate.

As part of our work in keeping supporters informed about the project’s progress we will feature regular blogs:

  • For more information on our first steps into co-production and setting up our lived experience steering group, have a read of our blog from July 2021.
  • For the potentially huge impact that positive healthcare interactions can have on women seeking healthcare whilst homeless, read our blog from September 2021, in which Arch Director and ANP Hannah Bishop summarises her original research for her recent Masters dissertation.

Calling for volunteers and artists

  • This October and November our Common Ambition project will be carrying out the Homeless Health Needs Audit across the city, we are looking for services to help, if your service might be interested in carrying out the audit with your clients please do get in touch – nicky.pyper@nhs.net The Homeless Health needs audit gives those experiencing homelessness the opportunity to tell us about their health needs, what health services they use and whether they get the help you need. This information will help evidence the health needs of people with experience of homelessness in Brighton and Hove, and will be used to help improve services and remove barriers to access.
  • We are also looking for graphic/visual artists to help creatively document and map lived experience of homelessness in Brighton and Hove. Message me or email nicky.pyper@nhs.net
Patient and receptionist chatting in the surgery of Arch, providing healthcare for the homeless in Brighton
The project will use patient voices to provide insights into healthcare experiences

Project background

The project builds on a proud tradition of our city, namely the care for our more vulnerable members, including people who may be vulnerably housed or facing homelessness. Brighton has recently become the first UK city to adopt the Homeless Bill of Rights. Brighton and Hove Common Ambition builds upon this aspiration, where the tradition of our city for tolerance, support of our most vulnerable members and embracing difference, is enshrined in laws, ways of working, and in everyday attitudes.

Common Ambition project leader Nicky Pyper said, “In order for B&H Common Ambition to succeed, it is vital that we get buy-in and participation from people who have lived through homelessness and housing insecurity, as well as those who work with them. As project lead, my role is not to run the project but to bring together those who have lived through homelessness. These are the people who will know what matters, what works and what doesn’t work. At the moment there is no formal channel for patients experiencing homelessness to provide feedback on the healthcare they receive. This project will change this, and embed a system of feedback and collaboration into the future.”

For anyone interested in getting involved in Brighton and Hove Common Ambition, or simply keeping informed, please contact Project Leader Nicky Pyper: nicky.pyper@nhs.net, or call 07517107344.

For further information and press enquiries: contact Louisa Barkla, Communications Coordinator, Arch Health CIC; 07928128056. Download the latest press release here.

A vital project

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.

Homelessness can create a level of complexity that results in people accessing acute healthcare services disproportionately (due to a combination of physical and mental ill-health, drug/alcohol misuse and a lack of secure accommodation). 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 non-homeless people (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 they 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 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).