Health and Homelessness standards
Section 4: Principles of the Standards
In order to assist in the application of the Standards this section outlines some of the underlying principles which should be taken into consideration by NHS Boards and partners.
The Health and Homelessness Standards are designed to assist NHS Boards to continuously improve their services to homeless people and those at risk of homelessness. They build on the development of service responses achieved through the implementation of Health and Homelessness Action Plans. Each of the individual Standards is of equal weight and importance. Each Standard represents one element of a whole and they will be considered both individually and collectively in assessing overall performance.
The Standards also reflect the Scottish Executive's determination that tackling health inequalities, and the health needs of homeless people in particular, should be embedded in Boards' strategies and services in the long term.
The voice of service users is very important to the development of services and strategies across the NHS. Boards should ensure that homeless service users participate in the development of services; their views should not only be heard in relation to specific services for homeless people, but also, proportionately, in the development of all services.
In considering health and wellbeing services NHS Boards should address the whole range of services provided. This will include primary and secondary care services covering both physical and mental health, the services of allied health professionals, and important services linked to wellbeing and the health improvement agenda such as health promotion, healthy eating, smoking cessation and physical activity.
More widely, NHS Boards should recognise that the improvements they make in both access to, and delivery of, services for homeless people will benefit a range of marginalised groups; likewise service improvements for other hard to reach groups will also bring benefits for homeless people. Boards should also be clear that homelessness involves an intensive set of compound risks to health and wellbeing which make it much harder for homeless people, compared to the general population, to maintain good health in the sense of physical, mental and social well-being.
Children in homeless families are particularly vulnerable. NHS Boards should therefore ensure effective and timely access to services such as maternity services, child health screening, surveillance and immunisation, and should also take account of the impact of homelessness or living in temporary accommodation on the mental health, self esteem and emotional development of children in these circumstances.
In all cases delivering the Health and Homelessness Standards will involve working with partners in related fields (e.g. housing, social work and the voluntary sector) to address the whole needs of households, in order to reduce health inequalities and promote well-being.
NHS Boards will have an increasing role to play in inspection and performance management in relation to Community Health Partnerships as the primary means of delivering Boards' strategic priorities. The Health and Homelessness Standards should therefore assist Boards in developing appropriate reporting mechanisms. In considering overall performance measures, NHS Boards will have in place a number of existing reporting mechanisms. It is expected therefore that Boards will ensure that, where appropriate, existing systems can provide, or be adjusted to provide, a suitable level of evidence to enable reporting against the performance requirements in these Standards.
Some Boards will have in place specialist services for homeless people, others will not, depending on local circumstances, and the Standards do not require the creation of further specialist responses unless these are identified at the local level as being the effective response. However, all Boards must provide mainstream services to homeless people and should be able to identify that such services are appropriate and accessible for those who are homeless.
In areas where specialist services are established, Boards may wish to pose questions of such services and invite responses which include SMART objectives against which they are measured. Some of the principles of quality services to consider should include:
Accessibility: In what way is the service more accessible to homeless people than alternatives?
Effectiveness: What does the service aim to achieve, and is it succeeding?
Acceptability: Do service users and staff find the service acceptable?
Efficiency: What does the service deliver and what resources are used?
Clinical governance: What arrangements are in place to make services accountable for continuously improving the quality of their services and safeguarding high standards of care?
The household composition and health-related needs of homeless households are so diverse that Boards should policy proof all strategies to take account of their needs. Whilst in some strategies homeless people may comprise one of the most significant groups to be addressed, in others their relevance may be more peripheral, though still important. Clearly Boards will need to ensure that homeless people's needs are addressed in a wide range of strategies and plans, for example the Local Health Plan including the Joint Health Improvement Plan, the Equality and Diversity Strategy, Health Inequalities Strategy, Community Plans, Drug and Alcohol Plans, Mental Health frameworks and Community Health Partnership plans.
However, this list is not exhaustive. NHS Boards must ensure that all strategies and plans are policy proofed to ensure that they take account, proportionately, of the needs of homeless households.