Shared Health Foundation 
Welcome to our podcast ‘Hope in the Deep End’, brought to you by the Shared Health Foundation.
In this podcast series we are exploring all the different complexities of working in areas of deprivation, poverty and entrenched health inequalities. From clinicians to youth workers, we want to inspire, challenge and give inspiration to all those that work in the deep end.
A day of clinical training and inspiring stories about achieving quality healthcare in the areas that need it the most.
Due to our passion for training those who work in tackling health inequalities, we have been able to secure further funding that has enabled us to offer FREE tickets for this event. Places are limited so please book ASAP before 20th June 2022.
Any tickets already bought will be re-funded in full.
A certificate of attendance will be awarded digitally to all participants after the training day.
The pressures on Primary Care have increased year on year, and there is no sign of this stopping, especially in areas hit the hardest by the pandemic lockdowns, and the rise in cost of living. Amongst talk of “levelling up” and targets to “reduce health inequalities” – what is it we can actually do?
Shared Health Foundation, along with friends in the Primary Care world, are hosting a one-off day of clinical training for those working in the toughest of areas on Tuesday 28th June 2022.
The training day will feature talks about health inequalities and safe clinical practice in areas of deprivation – and of course great food and networking. We will talk about possible interventions at both population level and individual level, and hear from people that have had success whilst talking frankly about the challenges we face.
Whether you are a GP, Practice Nurse, practice manager, PCN CD, or anyone else working in healthcare in the North West, we would love to host you in this day of inspiring talks and training.
Training Day Speaker List:
– Dr Laura Neilson, Director – Shared Health Foundation
– Professor Monica Lakhanpaul, Professor of Integrated Community Child Health – UCL
– Simon Watts, Public Health Registrar – Oldham Council
– Rev Charles Kwaku-Odoi, Chief Officer – Caribbean & African Health Network
– Christina Worle, Trauma Informed Dentist – Plymouth
– Dr Ben Atkins, Dentist – Revive Dental Care
– Beth Myring, General Manager – Lifecentre Salford.
Deadline for FREE ticket purchase is Monday 20th June 2022.
Lunch and refreshments are included.
This event is hosted by the Shared Health Foundation
Shared Health Foundation began working with Oldham Council’s Housing Team in April 2020, during the initial lockdown period of the pandemic, with our unique ‘Focused Care’ model. This report outlines the benefits of this local authority partnership and celebrates the health outcomes of our families.
Families Experiencing Homelessness: Notification System
Initial Concept Document: Operation Affinity
Background
In 2019, Shared Health Foundation published their Gold Standard Report1 which explored the difficulties facing homeless families and the agencies supporting them. The report proposed recommendations which would improve safeguarding, health, social and educational outcomes for families.
It was recognised a whole systems approach, incorporating multiagency and multidisciplinary working would support seamless and integrated service delivery. Current services are best placed to deliver care and support, with levels of trust and rapport already being established.
However, there is currently no system which enables key services, primarily health and education providers, to be alerted to housing and homelessness status their service-users are in. As such, existing services are unable to respond appropriately.
The need for a notification system was increasingly evident during the peak of the Covid-19 pandemic, where children who were already barely visible to the state support system were no longer receiving visits from community services2, safeguarding referral numbers dropped, health care systems prioritised vulnerable patients (where homeless families were not included), and homeless children were not automatically classed as vulnerable to access additional educational support3.
We propose a notification system which ensures at the point families register homelessness, relevant existing services are informed. With the onus being placed on systems, not families or children.
Evidence
Our proposal is based on the success of Operation Encompass4. Operation Encompass is a police and education early information safeguarding partnership enabling schools to offer immediate support to children experiencing domestic abuse.
Operation Encompass ensures there is a simple telephone call or notification to a school’s trained Designated Safeguarding Lead /Officer (known as key Adult) prior to the start of the next school day after an incident of police attended domestic abuse where there are children related to either of the adult parties involved.
They have shown the sharing of information enables appropriate support to be given, dependent upon the needs and wishes of the child, which secures better outcomes for children. Additional training offered enables schools to better understand the impact living with domestic abuse be able to support and nurture each child. 4
Operation Encompasses has near full police force coverage nationally.
Potential Methodology
We propose a piloting of a notification system (Operation Affinity) in 1-2 boroughs of Greater Manchester before rolling out across all 10GM boroughs and wider.
Housing Team Responsibility:
Step One: At the point of homeless application
NB: The reason for information sharing should be made clear, that this is about surrounding families with appropriate support at a difficult time, rather than ‘reporting them’ to various agencies. Parents may be experiencing shame and fear so this conversation should be handled with clarity and sensitivity to remove any barriers to consent. Shared Health will be issuing guidance to schools and GP’s detailing best ways to offer support to homeless families, and this information will also be shared with housing officers to help inform their conversations.
Step Two: Within 48 hours of initial contact (exception only where initial contact made on Friday, step two to be completed following Monday).
Step Three: Changes during Homelessness Journey
GP Practice Responsibility:
School Responsibility:
Parallel Work Required:
Additional Offer of Support
We recognise housing teams are stretched and more needs to be done to ensure wider understanding of cross-sector working and systems.
We, in partnership with Focused Care CIC, have been providing additional care and support to families experiencing homeless within Oldham and Salford housing teams. With health and social care backgrounds we straddle housing, education, health and VCSE sectors with an elastic remit and in-depth understanding of different systems.
Whilst we believe a sustainable model will be to ensure housing teams are equipped to implement Operation Affinity, we are happy to provide additional personnel (if additional funding can be secured) within housing teams across Steps One to Three, whilst this pilot is trialled.
Conclusion
We recognise there will be an initial commitment in time, and potential costs, however, are confident the long-term costs savings to the system through improved safeguarding and better health and social outcomes, reducing demand at a later date.
The Operation Affinity notification system will improve collaborative multi-sector working and research which will improve the lives of thousands of families, supporting them to break the cycle of homelessness.5
Additionally, through working together and sharing information we can support the safety and improvement in homelessness services.
We look forward to discussing this proposal further and ensure we continue to take this forward in a positive direction.
Contact Information
Charlotte Cockman
Manager and Clinician – Shared Health Foundation
Charlotte.cockman@sharedhealth.org.uk
Sam Pratt
Partnerships and Stakeholders – Shared Health Foundation
Sam.pratt@sharedhealth.org.uk
References
Our “Network of Champions” is growing! Connect with doctors who share your passion for seeing the person behind the diagnosis and receive free trauma-informed training to empower your practice. Click here* for more info.
We are passionate about supporting those from areas of deprivation to engage in health and science as a career option. We offer work experience placements as well as sessional talks at schools and colleges.
We deliver teaching about health inequalities across the North West. We teach to an array of clinicians and professionals (e.g., medical students, junior doctors, nurses, dietitians, midwives). If you are interested in teaching please get in touch.
This article explains how a clinician-led third sector organisation in Greater Manchester has issued a call to action requiring healthcare providers and service commissioners to adapt to improve health outcomes
A review of literature and suggestions for further research.
The complexities of how poor housing may be impacting the use of paediatric health and social care services are discussed and suggestions made for better practice and integration.
Racism is a public health issue. This has been undeniable since the advent of the health inequalities movement. Yet, the increasing traction of the Black Lives Matter protests and their juxtaposition with the realities of the COVID-19 pandemic has brought it to the forefront of the world’s imagination.
In April, analysis by the Guardian found that 19% of patients who had died in hospital with COVID-19 were Black, Asian and minority ethnic (BAME). This was followed by an Office of National Statistics report on 7 May, which further confirmed the devastating reality that black people are more than four times more likely to die from COVID-19 than white people.
On 2 June, months after knowing the devastating impact COVID-19 was having on BAME communities, the government-ordered inquiry ‘Disparities in the risk and outcomes of COVID-19’ was released by Public Health England. It confirmed what was already known: British people from minority ethnic groups are the worst affected by COVID-19.
The inquiry failed to add anything new to the discussion. It stated that ‘these analyses were not able to include the effect of occupation […] comorbidities or obesity’. It made no attempt to analyse the underlying socioeconomic or health causes of the disparities. Its publication is a belated and symbolic gesture that accompanied by inaction will not contribute to improved health outcomes for BAME people.
An article in the Health Service Journal stated that a section from an earlier draft of the report which detailed contributions of over 1000 organisations and individuals on the underlying causes of the inequality had been removed, effectively censoring evidence of structural racism.
The report simply restated the outcomes without investigating solutions which shows that the government is complacent in the continued death of BAME people. The government is ignoring the influence of structural racism and relinquishing any responsibility that these outcomes could have been prevented with their intervention. This is not good enough.
So, why are more BAME people dying of COVID-19?
BAME people are more likely to be working in frontline roles, including healthcare. According to the Institute of Fiscal Studies over a third of black African people are employed in key worker roles. BAME people are more likely to live in housing which is poor quality or overcrowded and are overrepresented in homeless family figures. BAME people are more likely to live in cities and thus have greater reliance on public transport. These factors leave BAME people at increased exposure to coronavirus.
Ethnic minority groups experience poorer overall health, are more likely to have a long-term health condition, in addition to poorer access to and quality of healthcare services. This greater burden of disease increases their likelihood to die from COVID-19.
It is vital to also consider those who because of their immigration status have No Recourse to Public Funds – cannot receive welfare support, furlough payments or accommodation if they become homeless. Those in this situation, and their children, have no lifelines to maintain their health.
The underlying current of all these factors is socioeconomic disadvantage – poverty – as a result of racial biases that exist within the fabric of society and government policy.
The marginalisation, stress and poverty that accompany racial discrimination have profound effects on the health of BAME people. The effects of COVID-19 highlight the inextricable links between structural racism and health inequality.
Shared Health Foundation supports calls on the government to investigate causes of the stark inequalities in COVID-19 outcomes, claim responsibility for the lack of preventable action taken to protect BAME people’s lives, and offer solutions to build a more equal society.