LGiU Ireland’s Hannah Muirhead explores the key learnings from a workshop looking at the relationship between housing, homelessness and health, and what we in local government might do about it.
Last week I was over in Glasgow for a workshop run by our sister organisation LGiU Scotland, NHS Health Scotland, and ScotPHN on the connections that exist between housing and health, part of which was a presentation by Neil Hamlet of NHS Health Scotland focusing on the relationship between homelessness and health – and the subsequent financial burden. Although the rate of homelessness in Ireland is lower than that of Scotland, it is rapidly growing. Homelessness in Ireland went up by 25 per cent between May 2016 and May 2017, and passed 7,000 for the first time earlier this year, so the issues outlined here are becoming increasingly pertinent for those in local government.
We often focus on things like reducing hospital waiting times or speeding up ambulance arrival rates as key components of wellness, but access to healthcare only accounts for ten per cent of all factors that create wellness. The other 90 per cent comes from several layers of underlying factors, and these are what we as local government have a responsibility for.
Housing sits right at the bottom of this, like a foundation without which you can’t start building wellbeing of individuals or communities, and those without a home are without that foundation completely.
Homelessness has been compared to an iceberg. What we see when we measure it are those who have approached a council and are assessed to be homeless (in Scotland, these people are classified as HL1). We can also measure those who are approaching homelessness (Prevent1) and those who are in temporary accommodation awaiting an actual home (HL3).
Then there’s the “hidden homeless” – those sleeping rough, who have never registered, and we have no way of measuring – the fact that they “choose” to be roofless an indictment of the way homelessness is dealt with in our society and what the “alternative” options are really like. Homeless who are “sofa surfing” are also hidden, as well as those, particularly in rural areas, who don’t register to be housed because they know that there’s no housing available. None of these scenarios are health-empowering places to be, and two councils in Scotland have pioneered an approach to measure what the consequences of this are.
In Fife, they collected data in order to bring the financial impact of homelessness-related poor health to the attention of the budget holders. They measured hospital attendances for HL1 and HL3 homeless people and found that homelessness has a cost.
North Lanarkshire Council built on this with a more robust study linking hospital finance data with figures from hospital admissions, A&E, psychiatric treatment, obstetrics, prescribing, outpatients and dental – and found that in 2014-15 the homeless population cost 71 per cent more that the non-homeless population in North Lanarkshire. They found that just four per cent of the HL1 population accounted for over 50 per cent of total costs, and that 60 homeless individuals cost £1.4 million that year, just in NHS costs.
This is now being run all over Scotland. Every council submitted its data on time and there is now fifteen years worth of data in a dataset 600,000 patients strong. The results of the analysis are imminent, and for the first time there will be comprehensive national statistics on the health impacts of housing and homelessness.
It is likely that the connection between homelessness and health in Ireland is much the same as that in Scotland, and as the number of homeless in Ireland grows, so will the burden on the health budget. In the current times of financial strain, if ever there was a message to get out to decision-makers, it’s this one: that reducing homelessness will reduce costs on the healthcare system. And we all have a responsibility to make sure that the country hears this and responds appropriately.
The challenge now is to go from data to action. We know that housing generates wellbeing, but we also know that this is a multi-faceted relationship requiring more than bricks and mortar and needs to be achieved through the organised efforts of society. Neil identified five building blocks of wellness:
- Rafters – the physical quality of a house/home
- Relationships – with family, with the system, with dogs
- Resources – all the things, places and agencies that create wellness
- Restoration – the need for sleep, for safety nets and springboards
- Resilience – the network of connections that help people up when they fall
Without a quality home or a community to live in, it is not possible for a person to achieve all, or perhaps even any, of these steps, so it is important for the wellbeing of our most vulnerable people, as well as that of the health budget, that we think about the wider impacts of homelessness, and the ways we can address them.