Report of the Director of Public Health and the Executive Director of Adult Social Services

This report provides the Committee with an overview of the work on health and homelessness in Manchester. 

The Committee considered the report of the Director of Public Health and the Executive Director of Adult Social Services that provided an overview of the work on health and homelessness in Manchester. 

Key points and themes in the report included:

·         Describing that work was co-ordinated through the Manchester Health and Homelessness Task Group which had been established in 2016 under the leadership of the Director of Public Health;

·         Reporting that the Health and Homelessness Task Group had been established as part of the Manchester Homelessness Partnership (MHP) and launched with the Manchester Homelessness Charter in 2016;

·         Many people with lived experience of homelessness were involved in co-writing the Manchester Homelessness Charter which was an integral part of the current MHP Homelessness Strategy 2018-2023; 

·         Reporting that to support and accelerate the successes of the MHP, and collaboration with the Greater Manchester Combined Authority, the Council had begun a refreshed transformation programme, A Place Called Home, in 2022;

·         An update on relevant local and national strategies;

·         Key statistics and epidemiological information;

·         Key health statistics from the National Health Needs Audit Report;

·         Describing the work of the various partners on the Task Group; and

·         Conclusion and next steps.

Some of the key points that arose from the Committee’s discussions were:

·         The Committee paid tribute to all partners working across the city to support homeless people;

·         Stating that the government had failed to respond to the issue of homelessness;

·         Noting that this failure placed a significant pressure on already depleted public services;

·         Did the Urban Village Medical Practice track homeless people to ensure they maintained contact with health services and attended health appointments;

·         Commenting that racism also needed to be considered as a health issue;

·         What was the criteria for an individual to access support from Mustard Tree;

·         Noting that when an asylum seeker was granted Leave to Remain they would often then present as homeless as they would lose any accommodation provided by the Home Office; and

·         What were the challenges to the Transformation Programme, A Place Called Home.

Dr Shaun Jackson, General Practitioner, Urban Village Medical Practice described that the Practice had been supporting homeless people for approximately 25 years, servicing 14,0000 patients with an integrated homelessness provision. He described that the approach to this work had evolved over the years by working in partnership with commissioners. He described that the pillars on which they approached this homeless work was delivering primary care; providing in-reach work for homeless people admitted to Manchester Royal Infirmary; providing out-reach services; and advocating on the issue of homelessness and health across the wider health system, both locally and nationally. He commented that the NHS needed to invest in homelessness health services reiterating the point that homelessness needed to be considered as a health problem and that early deaths amongst homeless people was as a result of unmet medical need. In terms of gaps in health provision for homeless people he stated that he would identify appropriate care and support for homeless people with complex needs, particularly older homeless people. He said there was a lack of the correct specialist support in the correct care environment for such individuals. He also commented on the challenge in accessing mental health services and substance misuse services for homeless people.

Dr Shaun Jackson, General Practitioner, Urban Village Medical Practice said that they did attempt to maintain continuity of care for homeless people, recognising that an individual could be temporarily housed in another area of the city or another borough. He said that they would have individual conversations on how to access the most appropriate health care, recognising that travelling to the Urban Village Medical Practice would often not be appropriate for an individual. In terms of supporting homeless people to attend appointments at other settings, he described that homeless people would use the Practice as a Care of Address so they became aware of appointments and the Practice could proactively support individuals.

Liz Thomas, Homeless Health Nurse, Urban Village Medical Practice described that the informal tracking of homeless individuals was undertaken by partnership working and dialogue across a range of agencies.

Reflecting on the comments from Dr Jackson, the Chair noted that the Committee would be considering a report on palliative care at the 7 February 2024 meeting and Dr Jackson would be invited to the meeting to contribute to the discussions. 

Jo Walby, Chief Executive, Mustard Tree addressed the Committee and said that she represented the non-statutory (i.e. voluntary) sector across the city who were working in partnership to support homeless people. She commented that the criteria for accessing support from Mustard Tree was anyone experiencing hardship. She said that Mustard Tree could not refer or allocate accommodation for homeless people, adding that the Homeless Team within the Council dealt with allocations. She said that they supported homeless people to access services, including health services, by helping people register with a GP and access addiction services. In addition, they would case manage more complex cases to support individuals attend appointments etc. She stated that they were recognised as a trusted voice who would advocate on behalf of homeless people. She paid tribute to the work undertaken by the Director of Public Health and the Executive Director of Adult Social Services for the work they had undertaken to bring partners and Council services together in Manchester to respond to this complex and challenging issue.

Jo Walby, Chief Executive, Mustard Tree acknowledged the comments raised regarding Home Office decisions and the granting of Leave to Remain for asylum seekers. She described that there was little or no communication from the Home Office in regard to asylum seekers being housed in hotels in the city and referred to the increased demand on their services when this had happened.

In response to a specific question asked regarding the data provided in relation to old age in the demographic characteristics of people owed a statutory homelessness duty by Manchester City Council, the Director of Public Health stated that further information would be circulated following the meeting. He further commented that the issue of structural racism and discrimination was understood and was a key stream of work as part of the Making Manchester Fairer work that was regularly reported to the Committee.

The Deputy Leader described that the Transformation Programme (A Place Called Home) operated in a challenging context with the cumulative impact of austerity, Covid-19, the cost-of-living crisis, and the impact of national decisions on the asylum and migration process continuing to impact and exacerbate hardship for local communities, more often those with the least resources. She further reiterated the call for an end to Section 21 (no fault evictions) and for the immediate unfreezing of the Local Housing Allowance. She stated that despite these challenges the Homelessness Team was working hard to reduce the number of homeless families being accommodated in Bed and Breakfast settings. In response to the comments made regarding asylum seekers, she said that Manchester displayed a humane and compassionate response.

The Director of Public Health commented that the action plan for the Transformation Programme was provided as an appendix to the report and that the Joint Strategic Needs Assessment would also inform this activity.

Jackie McVan, Head of Services Greater Manchester, CGL (Change Grow Live) stated that one positive outcome from the pandemic had been strengthened relationships between CGL and Mustard Tree. She also stated that another legacy of the pandemic had been the adoption of on-line support services that some people found more appropriate for their circumstances and needs. She described the increasing demand on services, particularly for substance misuse services. She also emphasised the issue of social isolation and loneliness experienced by homeless people placed in accommodation. She commented on the need to challenge the stigma associated with homelessness and substance misuse.

The Committee then heard from Kevin, Dave and Jay who spoke of their individual lived experiences of homelessness. The Committee thanked them for attending and sharing their powerful testimonies.

The Committee expressed their gratitude to all guests for attending and contributing to the meeting.

Decision

That a delegation from Manchester, comprising of partners working to support homeless people across the city visit the Secretary of State for Health and Social Care to highlight the situation in Manchester and to lobby for additional resources to address homelessness.