Joining up housing and mental health

The role of housing goes far beyond physical shelter and safety. It introduces people to a community to which they can belong, a space which is their own, a communal setting where they can make friends, form relationships and a place where they can go for support, social interaction and reduce feelings of loneliness and anxiety. Housing  stable, safe housing  also provides a springboard for people to begin to re-integrate with society. An address allows them to register with services, including claiming benefits, registering at a local job centre, registering with a GP, and applying for jobs.

Housing and health, both physical and mental, are inextricably linked. A 2015 blog from the Mental Health Foundation put the relationship between housing and health in some of the clearest terms:

“Homelessness and mental health often go hand in hand, and can be a self-fulfilling prophecy. Having a mental health problem can create the circumstances which can cause a person to become homeless in the first place. Yet poor housing or homelessness can also increase the chances of developing a mental health problem, or exacerbate an existing condition.”

Single homeless people are significantly more likely to suffer from mental illness than the general population. And as a result of being homeless they are also far more likely to rely on A&E services, only visiting when they reach crisis point, rather than being treated in a local setting by a GP. They are also more likely to be re-admitted. This high usage is also costly, and increasingly calls are being made for services to be delivered in a more interconnected way, ensuring that housing is high on the list of priorities for those teams helping people to transition from hospital back into the community.

Not just those who are homeless being failed

However, transitioning from hospital into suitable housing after a mental health hospital admission is not just a challenge for homeless people. It is also the case that people are being discharged from hospital to go back into settings that are unsuitable. Housing which is unsafe, in poor condition, in unsafe locations or in locations away from family and social networks can also have a significant impact on the ability of people to recover and prevent readmission.

Councils are facing an almost constant struggle to house people in appropriate accommodation. However, finding a solution to safe, affordable and suitable housing is vital. Reinvesting in social housing is a core strategy councils are considering going forward to try and relieve some of the pressure and demand. Gender and age specific approaches, which consider the specific needs of women, potentially with children, or old and young people and their specific needs would also go a long way to creating long term secure housing solutions which would then also impact on the use of frontline NHS services (by reducing the need for them because more could be treated in the community). Suitable housing also has the potential to improve employment prospects or increase the uptake of education or training among younger people with a mental illness. It would also provide stability and security, long term, to allow people  to make significant lifestyle changes and reduce their risk of homelessness in the future.

A new relationship for housing and health

A number of recommendations have been made for services. Many have called for the introduction of multi-disciplinary teams within the NHS, recruited from different backgrounds, not only to create partnerships with non-NHS teams, but also to act as a transitional care team, to ensure that care is transferred and dealt with in a community setting in an appropriate way, and to ensure housing is both adequate and reflects the needs of those who are most vulnerable.

In June 2017 the King’s Fund held an online seminar to discuss how greater integration between housing and mental health services could help accelerate discharge from hospital and reduce the rates of readmission for people suffering from mental illness. The panel included Claire Murdoch, National Mental Health Director at NHS England and Rachael Byrne, Executive Director, New Models of Care at Home Group.

Final thoughts

Increasingly the important link between housing and health is being recognised and developments are being made in acknowledging that both effective treatment and a stable environment are vital to helping people with mental illness recover and re-integrate back into their community, improving their life chances and reducing the potential for relapse.

Housing can be an area of life which can have a significant impact on mental health. It can cause stress, and the financial burden, possibility of being made homeless, or being placed in temporary accommodation can have a significant and lasting negative effect on people’s mental health. However, safe and stable housing can also have a significant positive impact on mental health, providing stability, privacy, dignity and a sense of belonging.


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If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help

SPP screenshot2016 has been described as “make or break time for the NHS”, and with pressures on finances increasing, social care and public health are in the spotlight. Around £1 in every £5 of NHS spending is estimated to be the result of ill health attributable to the big five risk factors of smoking, alcohol, poor diet, obesity and inactivity. Investing in prevention, and understanding the complex wider community and social factors that lead to poor health, is therefore important. In cash-strapped local authorities however, investment in preventative projects can be sidelined in the face of tackling acute issues.

Prevention and behaviour change are linked

Recent health policy has included an expectation that individuals should take greater responsibility for their own health. But where we are talking about behaviour change, there is no quick fix. Glib use of the term ‘nudge’ to promote change can suggest that laziness is the only issue. However, research such as that by the King’s Fund has highlighted that motivation and confidence are essential if people are to successfully modify their health behaviours.

Practitioners within the field of both public health and social care need help understanding what works – but as two great recent blogs from the Alliance for Useful Evidence noted, change can be achieved in multiple ways and evidence shouldn’t be used to prove a service works but as part of a journey of improvement and learning.

We talk about the “caring professions”, but it seems that it can be difficult to maintain a focus on the ‘person not the patient’ when budgets are being cut. Well-reported issues such as the rise in the use of 15-minute home care appointments are just one symptom of this. More generally, making time to consider alternative approaches or learn from good practice elsewhere can be hard. That is where having access to a trusted database can help.

Trusted source of research and ideas

The Alliance for Useful Evidence, most recently in its practice guide to using research evidence, has highlighted the importance of using trusted sources rather than “haphazard online searches”. One of these resources is Social Policy and Practice, a database which we have contributed to for twelve years.

“SPP is useful for any professional working in the field of social care or social work who can’t get easy access to a university library.” Alliance for Useful Evidence, 2016

The partners who contribute to the database – Centre for Policy on Ageing, Idox Information Service, National Children’s Bureau, the NSPCC and the Social Care Institute for Excellence – are all committed to sharing their focused collections with the wider world of researchers and to influence policy and practice.

Social Policy and Practice is the UK’s only national social science database embracing social care, social policy, social services, and public policy. It boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature.

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports the ability to take a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.


Find out more about the development of the Social Policy and Practice database in this article from CILIP Update. Update is the leading publication for the library, information and knowledge management community and they’ve given us permission to share this article.

If you are interested in using the Social Policy and Practice (SPP) database for evidence and research in health and social care, please visit www.spandp.net for more information and to request a free trial.

Read some of our other blogs on evidence use in public policy:

Should the UK introduce a tax on sugar?

An assortment of liquorice allsorts sweets.

by Stacey Dingwall

Recent months have seen two enquiries to our Ask a Researcher service for evidence on sugar consumption in the UK. Namely: should this be taxed?

Sugar has become somewhat of a villain in the UK, with magazine articles, research and governments all telling us that we should be greatly reducing, or even eradicating completely, our consumption of added sugars in particular. The week beginning 30th of November even saw the first National Sugar Awareness Week, part of a campaign to encourage the government to establish a sugar reduction programme in the UK. However, is a ‘sugar tax’ really necessary?

Sugar consumption: a public health issue?

According to the Royal Society for Public Health (RSPH), absolutely. Last month, they published a review of how to tackle obesity in the UK, which included the introduction of a sugar tax. The report notes that, according to the latest forecasts, half of all adults in the UK are expected to be classed as obese by 2050. Key to reversing this trend, it is argued, is to tackle issues around diet and nutrition among children, who are now spending double the amount of time per day in front of screens than children in 1995 (something that has been shown to increase cravings for food and drink, but not for nutritionally sound items). Alongside other developed nations, the UK is also seeing an ever increasing rate of consumption of high-sugar carbonated drinks.

While the RSPH recommends placing restrictions, or ending, the use of advertising and sponsorship by junk food and drinks companies around family and sporting events, it also argues that this is not enough to tackle the country’s obesity problem. The RSPH supports the introduction of a tax on sugary drinks of 20%, or 20p per litre. Their report highlights evidence which suggests that this could prevent or delay around 200,000 cases of obesity per year, and points to the experience of Mexico, who introduced a tax of 10% at the start of 2014. During that year, sales of sugary drinks declined by 6% overall, and by 9% among those living in the most deprived areas of the country (the demographic group most likely to be obese).

What does the government think?

After a delay, the UK government published Public Health England’s (PHE) review of the evidence for action with regards to sugar reduction in October. The report:

  • agrees that too much sugar is consumed in the UK
  • favours a reduction in advertising to children
  • recommends the introduction of a tax on full sugar soft drinks of 10-20%

This, combined with a range of other measures, it is argued, could save the NHS £500 million per year. The PHE recommendation was also supported by the House of Commons Health Committee, in their recently published Childhood obesity – brave and bold action report. Having heard evidence from parties including Sustain and Jamie Oliver, a key figure in the campaign for the introduction of a sugar tax, the Committee recommended that such a levy should be introduced at 20%, in order to achieve maximum impact.

The Prime Minister, however, is still not convinced, stating that he believes there are “more effective” ways of tackling obesity. The government is due to publish a strategy on childhood obesity in the New Year.

What does the evidence say?

A number of countries have implemented a form of taxation on sugar or saturated fats. These include:

  • a tax on saturated fats in Denmark
  • Finland’s tax on sweets, ice cream and soft drinks
  • Hungary’s public health product tax
  • France’s tax on sugar- and artificially-sweetened beverages

According to a review of using price policies such as these to promote healthier diets by the World Health Organization, food pricing policies are feasible, and can influence consumption and purchasing patterns as intended, with a significant impact on important dietary and health-related behaviour. Crucially, however, the same review notes a lack of formal evaluation in this area.

A report published earlier this year by the activist group Taxpayers’ Union of New Zealand, Fizzed out: why a sugar tax won’t curb obesity,  questioned the validity of nutrition related taxes. Reviewing the experience of Mexico, they suggested that the reduction in consumption of sugary drinks following the introduction of an excise tax of one peso per litre in January 2014 had been overplayed.

It’s also the case that the Danish tax on saturated fats was repealed by the government after only one year. This was due to a number of economic impacts that quickly became apparent after the tax was implemented, and resulted in plans for similar taxes to be abandoned. In fact, fat consumption in Denmark has been on a downward trend for some time now, therefore no tax incentive was required. And according to the Danish minister of finance, “to tax food for public health reasons [is] misguided at best and may be counter‐productive at worst”.

Whether the UK Prime Minister will be swayed on this matter remains to be seen. It’s likely that a ‘sugar tax’ will continue to be deemed too politically sensitive to introduce, especially as one in five people continue to live below the poverty line.


Related reading
Child obesity: public health or child protection issue?

Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in policy and practice are interesting our research team.

What’s happening to make big data use a reality in health and social care?

data-stream-shutterstock_croppedBy Steven McGinty

At the beginning of the year, NHS Director Tim Kelsey described the adoption of new technologies in the NHS as a ‘moral obligation’. He argued that the gaps in knowledge are so wide and so dangerous that they were putting lives at stake.  It’s therefore no surprise that the UK Government, the NHS, and local governments have all been looking at ways to better understand the health and social care environment.

The effective use of ‘big data’ techniques is said to be key to this understanding. Big data has many definitions but industry analysts Gartner define it as:

“high-volume, high-velocity and high-variety information assets that demand cost-effective, innovative forms of information processing for enhanced insight and decision making”

However, if health and social care is to make better use of its data, it’s important that an effective infrastructure is in place. As a result, changes have been made to legislation and a number of initiatives introduced.

Why is it important to know about big data in health and social care?

The effective use of data in health and social care is a key policy aim of the current government (and will most likely continue under future governments).  The changes that have been made so far have had a significant impact on the policies and practices of health and social care organisations. The vast majority focus on information sharing, in particular how organisations share data and who they share data with.

What changes have been made to support big data?

Care.data

This was the most ambitious programme introduced by NHS England. It was developed by the Social Care Information Centre (HSCIC) and set out to link the medical records of GP practices with hospitals at a national level. It was expected that datasets from GPs’ records and hospital records would be linked using an identifier such as an NHS number or a person’s date of birth. However, due to concerns raised by the public, particularly in regards to privacy, the programme was delayed. The programme has now resumed but new safeguards have been introduced, such as the commissioning of an advisory board and the ‘opt out’ provision, where patients can opt out from having their data used for anything other than their direct care.

The Health and Social Care Act 2012 and the Care Act 2014

The Acts have both introduced provisions that impact on data. For instance, the Health and Social Care Act enshrines in law the ability of the Health and Social Care Information Centre (HSCIC) to collect and process confidential personal data. In addition, the Care Act clarifies the position of the Health and Social Care Act by ensuring that the HSCIC doesn’t distribute data unless it’s part of the provision of health and social care or the promotion of health.

Centre of Excellence for Information Sharing

This initiative came from the ‘Improving Information Sharing and Management (IISaM) project’, a joint initiative between Bradford Metropolitan District Council, Leicestershire County Council and the 10 local authorities in Greater Manchester. The centre has been set up to help understand the barriers to information sharing and influence national policy. They hope to achieve these goals through the use of case studies, blogs, the development of toolkits, and any other forms of shared learning. The centre has already published some interesting case studies including the Hampshire Health Record (HHR) and Leicestershire County Council’s Children and Young People’s Service (CYPS) approach to communicating how they deal with data.

These are just some of the steps that have been taken to make sure 2015 is the year of big data. However, if real progress is to be made it’s going to require more than top down leadership and headline grabbing statements. It’s going to require all health and social care organisations to take responsibility and work through their barriers to information sharing.


Further reading

Read our other recent blogs on health and social care:

Become a member of the Idox Information Service now, to access a wealth of further information on health and social care including best practice and commentary. Contact us for more details.

What’s preventing health and social care from going digital?

Two women using a tablet computer.

Image by Innovate 360. Licensed for reuse under Creative Commons.

By Steven McGinty

In the first of two articles focusing on technology in health and social care, I will be looking at some of the barriers organisations face in adopting digital technologies. Financial pressures such as the reduction in public spending, as well as an ageing society, mean that health and social care will be expected to meet greater levels of demand with fewer resources.

The UK Government believes that the implementation of technology is the solution to helping the health and social care system become more efficient and more effective at delivering patient care. However, before health and social care can reap the benefits of technology, a number of barriers have to be broken down.

Information sharing challenges

Integration has been a main focus of health and social care in England, as well as the devolved administrations. If integration is to work successfully, different organisations must be able to share data securely. At the moment, data is recorded in a variety of ways across a number of different IT systems. We also have a situation where the main method for sharing data securely in local authorities, the Public Services Network (PSN), is not fully integrated with either the NHS in Scotland or England. Eddie Copeland, of the Policy Exchange, suggests that full integration of the NHS with the PSN should be seen as a priority.

Financial costs

The financial costs of rolling out new technology within an organisation can be significant. These costs can include the procurement of hardware and software, internet connections, and the training of staff. For organisations which are undergoing major budgets cuts, it may seem very difficult to justify the investment in technologies, even if there is the potential for savings in the future.

Management issues

The importance of technology in organisations can be underestimated by decision-makers. For example, according to Martin Ferguson, Director of the Society of IT Management (Socitm), the ICT challenges involved in introducing the new Care Act in England are not being given enough priority. He highlights that if organisations are unable to share information safely by April 2015, they risk failing to comply with new reporting regulations.

Local authorities can also have policies that restrict the use of technology. A recent Skills for Care report into the digital capabilities of social care found that local authorities are still wary of certain technologies, including cloud based systems, which can offer low-cost solutions, and social media, which can lead to savings for local authorities if used correctly.

The health and social care workforce

The Skills for Care report highlights that over 95% of staff feel they are confident in basic online skills. However less than a quarter of managers believe that they have staff with enough skills to make use of digital technology. This mismatch means that managers may be hesitant to introduce new technologies over fears that staff may have difficulties in using the technology, as well as the costs associated with staff training.

There is also a suggestion that social care staff may be resistant to the introduction of new technologies, due to concerns that introducing technology may over-complicate things and move the focus away from the patient. As we noted in a recent article on digital services within government, a key part of introducing any new technology is changing the mindset of staff and having effective leadership in place to champion it.

These are just some of the challenges associated with introducing digital technologies into health and social care. In a future article, we will look more at how technologies can be used within health and social care and the benefits they can bring to organisations. We also look at a case study of an innovative technology partnership between Calderdale Council and Idox, which is addressing the shared services agenda in social care.


Further reading:

 

Public Health Information Network for Scotland (PHINS) – 14th Seminar

Image of outside of the Glasgow Royal Concert Hall.

Image by Neil Turner under Creative Commons License, via Flickr

By Steven McGinty

On the 10th October I attended an annual event organised by the Scottish Public Health Observatory (ScotPHO) in the Royal Concert Hall in Glasgow. The event focused on health inequalities and the factors driving them. It brought together individuals from a variety of areas, including academia, public health organisations, local and central government, and the voluntary sector to review current evidence, highlight upcoming research and debate key issues with fellow professionals. Continue reading