Mission and Goals
Brighton and Hove Common Ambition (BHCA) brings together people with lived experience of homelessness, frontline providers and commissioners through co-production within homeless health services.
We want to improve health services and outcomes for people experiencing homelessness in Brighton & Hove.
BHCA’s co-produced goals are:
The Challenges - Why is this project so important?
Background Information
The health needs of people experiencing homelessness are complex and multi-faceted. As well as facing greater risks of many chronic and debilitating physical health conditions, data from the Homeless Health Needs Audit 2021, carried out in the city, has shown that 70% of participants experiencing homelessness have diagnosed mental health conditions and 52% use drugs and alcohol to cope with mental health challenges.
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. 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 2021).
These national statistics are reflected in the current figures for Brighton & Hove where in 2019, 26 people died while homeless (2022 Arch patient data) - deaths that 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 means that people experiencing homelessness can get ‘lost’ in the system, or at the transition points between services. Despite the steps taken to improve homeless healthcare in Brighton and Hove, this remains as true here as in the rest of the country.
Feedback from people experiencing homelessness indicates that whilst individual services are of a very high standard, the overall city-wide system is complex, disjointed, inflexible and inadequate for the needs presented and ultimately very difficult to navigate.
Challenges identified by Brighton and Hove Common Ambition
During year 1 of the project, the BHCA Lived Experience Steering Group reviewed the Homeless Healthcare system in Brighton and Hove the key challenges identified are:
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There is a lack of trust in health care services, this comes from misdiagnosis and a lack of joined up services.
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Long waiting lists for treatments, for people experiencing homelessness can lead to people being lost in the system. Letters and communication without a fixed address/phone creates further barriers.
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There isn’t enough Mental Health support, including outreach, crisis support, services and staff available to meet needs.
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There is a lot of judgement and stigma within the system and services. People often don’t feel listened to, there isn’t respect built into communications and interactions.
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There is a ‘tick box’ mentality to accessing services that leads to people not being able to access the services that they need as they dont fit all of the criteria.
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Often people accessing homeless services find that staff are not holistically trained in all areas, e.g. mental health, substance use, dual diagnosis and physical health this leads to them not being treated holistically.
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Care, support and treatment provided through A&E (as that is the main point of access to healthcare for people experiencing homelessness) is not adequate.
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Substance use is a barrier to accessing services because of policies preventing access and a lack of awareness and training.
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Mental distress, neurodiversity, language and terminology barriers can stop people from communicating, accessing and engaging with services. This leads to people not receiving the support they might need.
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There is no continuity of care along pathways, particularly at the end of the housing pathway, particularly finishing rehab or leaving prison.
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It is unclear what healthcare services are available for people experiencing homelessness and how to access them.
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Communication and care between services can be disjointed, databases do not join up and this often results in people having to repeat their story.
The challenges were grouped into themes that BHCA have been working on:
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Barriers to accessing care and support
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Stigma and judgement
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Lack of mental health support
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Lack of continuity of care along pathways
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Capacity and training opportunities for staff working in the system
Timeline
Brighton & Hove Common Ambition is a three year project that started in March 2021.
March 2021 - June 2021
Phase 1 - Engagement
Raise awareness and form Steering Group.
July 2021 - April 2022
Phase 2 - Reviewing the System
Where are the challenges and barriers?
May 2022 - August 2023
Phase 3 - Designing Change
Working together to make improvements.
September 2023 - March 2024
Phase 4 - Evaluating Our Work
Understanding what works well to share.
Our Partners
The Health Foundation
Brighton and Hove Common Ambition is part of the Health Foundation’s Common Ambition programme.
The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.
Arch Healthcare
At Arch we understand the devastating impact a period of homelessness can have on health.
We offer tailored healthcare and support for people facing homelessness in Brighton & Hove, empowering patients to take control of their health and move towards wellbeing.
Justlife
We make people's experience of temporary accommodation short, safe and healthy.
We run services in Brighton & Hove and Greater Manchester helping people experiencing homelessness to identify and improve their health, housing and wellbeing needs. We also operate nationally, carrying out research, developing partnerships and campaigning for change.
University of Brighton
The University of Brighton is a complex and diverse institution based in three locations across the south coast of England.
Our ethos is defined by four core values: inclusivity, sustainability, creativity, partnership. Our students are part of a dynamic, diverse and creative community that embraces partnership working and that makes a positive difference to society.
The School of Humanities and Social Science has demonstrated excellence in teaching and learning. We are proud of our reputation for producing highly employable and adaptable graduates and postgraduates. We offer students an interdisciplinary and applied approach to learning and have excellent links within the local community.
NHS Sussex
We are a new organisation, set up on 1 July 2022.
Our main role is to agree the strategic priorities and resource allocation for all NHS organisations in Sussex. This involves leading the improvement and integration of high-quality health and care services for all communities.
NHS Sussex have taken on the commissioning functions previously carried out by Clinical Commissioning Groups (CCGs).
Brighton and Hove City Council Public Health Department
Brighton and Hove’s Public Health team works with residents and organisations in Brighton and Hove to promote health and wellbeing.
Our main aim is for everyone to have the opportunity to live a healthy, happy and fulfilling life.
