Presentation Title

Speaker’s name

Presentation title

Speaker’s

name

Data matching: understanding the

impact of homelessness

on health services Neil Hamlet – Consultant, Public Health Medicine, NHS Fife

- Lead for Homelessness, NHS Health Scotland

neil.hamlet@nhs.net @Neil_Hamlet

Multiple Exclusion Homelessness is the

visible, deeply damaged and vulnerable tip of

the health inequality iceberg.

Below the waterline lie all the social,

environmental and behavioural drivers and

transition points for prevention and early

intervention.

The Inequality Iceberg

2 pay cheques away from

homelessness

Approaching

homelessness

Prevent 1

Statutory

homeless HL1

Sofa

Surfers

Housed but

homeless HL3

Hidden

Homeless

Rough Sleepers

Together warming the water

Silo-based

chipping

away

“Statutory”

Homeless

Mental Distress

Childhood

Trauma

Addiction Criminal Justice

Relational

Breakdown

Housing Voluntary

Sector

NHS Social

Care

Data – sharing across agencies

-

200

400

600

800

1,000

1,200

1,400

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013

HL1 Fife (Aged 15 - 64)

A&E Attendance Rate per 1,000 Population Attendances at two Fife Acute Hospitals

Male

Female

The impact of homelessness on

health care – proving the case

‘Insecurely Housed’ ‘Securely Housed’

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

HL1

Fife

(A

ged

15

- 6

4)

Referral From Distribution of A&E Attendances; 2013 Source who referred patient to A&E department

Emergency Services GP Other Hospital Self Referral NHS24

Abuse ?

Pragmatic ?

£££

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

HL1

Fife

Age Distribution of A&E Attendances; 2013 Age of patients attending A&E

Under 15 15 to 19 20 to 29 30 to 39 40 to 49 50 to 64 65+

Over 50% are under 30 yrs

Over 80% are under 40 yrs

-

50

100

150

200

250

300

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013

HL1 Fife (Aged 15 - 64)

Emergency Admission Rate per 1,000 Population Patients admitted to hospital as an emergency

-

50

100

150

200

250

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013

HL1 Fife (Aged 15 - 64)

Patient Multiple Attendance Rate per 1,000 Population Patients who have attended A&E more than once within specified year

Male Female

‘Insecurely Housed’ ‘Securely Housed’

The Frequent Fliers Criers

-

5

10

15

20

25

30

35

40

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013

HL1 Fife (Aged 15 - 64)

Multiple Emergency Admission Rate per 1,000 Population Patients who have been admitted as an emergency more than once in specified year

Revolving Hospital Door effect

0%

5%

10%

15%

20%

25%

30%

-

15

30

45

60

75

90

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013

HL1 Fife (Aged 15 - 64)

% o

f Ad

missio

ns

Rat

e p

er

1,0

00

Po

pu

lati

on

Alcohol-related Admissions rate per 1,000 and % of Admissions

Admissions with diagnosis related to alcohol based on ISD definition

%

Rate

10 fold

difference

0%

5%

10%

15%

20%

25%

30%

35%

40%

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013

HL1 Fife (Aged 15 - 64)

% New Outpatient Appointments DNA

New appointments who Did Not Attend (excludes cancellations by hospital or patient)

•Changed address

•Fearful to open official mail

•Appointment too early

•No money for the bus

•It won’t do any good’

Access / Expectation

Chief Statistician funded pilot to test Fife approach nationally

A&E Outpatients

Inpatients Day cases

Deaths

Prescribing

Age/gender

CHI

Linked File

SPARRA

Social Care

SIMD

Linked Health and Social care

file at an individual service

user level (Aggregated

Activity & Costs)

Integrated Data: Health & Social Care Integration and

Information Platform

£costed

Community Housing &

Homelessness

data

www.housingandwellbeing.org

http://www.scotphn.net/projects/previous

_projects/homelessness_guidance_for_

public_health