Measuring Health and Homelessness

- in FifeDr Neil HamletConsultant Public Health MedicineFife Health & Homelessness Leadneil.hamlet@nhs.net

Substance Misuse

Dental Care

Foot and skin careAlcohol Abuse

Mental HealthIssues Nutrition and diet

Homelessness

Homelessness - a cross cutting agenda

Community HealthPartnerships Social Work

NHSAcute Services

Registered SocialLandlords

Council HousingDepartments

Voluntary Agencies

Health & Social Care

Integration Bodies

HousingVol Sector

NHSHSCP

Linkage of Hospital data and Homelessness data in the Kingdom of Fife

Bryan Archibald, Senior Information Officer barchibald@nhs.net

Bryan Archibaldbarchibald@nhs.net

The Data Sources

Fife Council• HL1• National data set for each homeless

application• Based on the application (not the number of

homeless individuals)

NHS Fife Acute Hospitals

• eOASIS (patient administration system)

• SMR data submitted to ISD (information Services Division of NHS Scotland)

• Based on Patient Episodes

http://www.scotland.gov.uk/Topics/Statistics/15257/22833

NHS Data (OASIS)• A&E (and Minor Injuries Unit [MIU])• Inpatients & Day cases• Obstetrics• Mental Health Inpatients• Outpatients• Mental Health Outpatients

Under 20 20 to 29 30 to 39 40 to 49 50 and over

-

100

200

300

400

500

600

700

800

2006

2007

2008

2009

2010

2011

Results: A&E

Under 20 20 to 29 30 to 39 40 to 49 50 and over

-

20

40

60

80

100

120

140

160

180

Inpatients & Day cases

Obstetrics Outpatients

Under 20 20 to 24 25 to 29 30 and over

-

50

100

150

200

250

2006 2007

2008 2009

2010 2011

Under 20 20 to 29 30 to 39 40 to 49 50 and over

-

100

200

300

400

500

600

700

So far so good but what does this mean?

• We need a comparator for the homeless population

• Fife’s ‘securely - housed’ population• Try to compare by similar age profile• Started with Fife population 15-64 as our

crude method of ‘standardisation’• Further refinements planned in

‘standardisation process’ • Aiming to compare ‘apples’ with ‘apples’ by

security of housing as defined by HL1 registration

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

-

200

400

600

800

1,000

1,200

1,400

A&E Attendance Rate per 1,000 Popula-tion

Number of attendances at QMH and VHK

MaleFemale

The value of shared data analysis

‘Insecurely Housed’ ‘Securely Housed’

HL1

Fife

(Age

d 15

- 64

)

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

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

Emergency Services GP Other HospitalSelf Referral NHS24

Abuse ?

Pragmatic ?

£££

HL1

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

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

Under 20 20 to 29 30 to 3940 to 49 50 and over

Over 50% are under 30 yrs

Over 80% are under 40 yrs

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

-

50

100

150

200

250

Patient Multiple Attendance Rate per 1,000 PopulationPatients who have attended A&E more than once within

specified year

Male Female

The FrequentFliers

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

-

50

100

150

200

250

300

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

£

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

-

5

10

15

20

25

30

35

40

Multiple Emergency Admission Rate per 1,000 PopulationPatients who have been admitted as an emergency more

than once in specified year

Revolving Hospital Door effect

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

-

15

30

45

60

75

90

0%

5%

10%

15%

20%

25%

30%

Alcohol-related Admissions rate per 1,000 and % of AdmissionsAdmissions with diagnosis related to alcohol based on ISD definition

%Rate

Rate

per

1,0

00 P

opul

ation

% of Adm

issions

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

-

10

20

30

40

50

60

0%

5%

10%

15%

20%

Drug Misuse-related Admissions rate per 1,000 and % of AdmissionsAdmissions with diagnosis related to drug misuse based on ISD def-

inition

%

Rate

Rate

per

1,0

00 P

opul

ation

% of Adm

issions

Clear role for Community Safety Partnerships ?

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

-

10

20

30

40

50

60

70

80

90

100

Emergency Admission Rate relating to Injury & Poisoning per 1,000 PopPatients admitted as emergency relating to injury and poisoning (ICD10 codes

S00 - T99)

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 44)

-

50

100

150

200

250

300

350

400

450

Obstetric Admission Rate per 1,000 PopulationAdmission could be for birth, antenatal or

postnatal care

HL1

Fife

(Age

d 15

- 44

)

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

Age Distribution of Obstetric Admissions; 2013Age of admitted patient, admission could be for

birth antenatal or postnatal care

Under 20 20 to 24 25 to 29 30 and over

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

-

20

40

60

80

100

120

Psychiatric Admission Rate per 1,000 PopulationAdmissions to Psychiatric specialty including read-

missions, excludes Learning Disability

MaleFemale

The very tip of the mental distress homeless iceberg

2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013HL1 Fife (Aged 15 - 64)

0%

5%

10%

15%

20%

25%

30%

35%

40%

% New Outpatient Appointments DNANew 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

Making a Difference On call nurse manager gets a text alert on her

work phone when a homeless person is seen in Accident and Emergency Dept.

A daily report is now generated listing all the patients in the hospital at 8am who have a temporary homeless accommodation address .

Admissions to Fife Hospitals with Homeless Accommodation AddressBased on Current Homeless Accommodation List & Patient Address in Oasis at time of report refresh

Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15

Electiv

e

Medical 2 3                  Orthopaedic 0  

Surgical 0 1  Theatres 0  

Women & Children 0                    Total 2 4 0 0 0 0 0 0 0 0 0

   

Emergenc

y

Medical 8 5 5                Orthopaedic 4 5 3  

Surgical 2  Theatres 1 1  

Women & Children 5 10 14                Total 20 21 22 0 0 0 0 0 0 0 0

Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-150

5

10

15

20

25

Elective

Emergency

Resilience Factors• Supportive friends / family• Strong social networks• Appropriate support services• Savings or access to financial help• Available advice & advocacy• In stable employment• Personal empowerment/capacity

'Houseless and Hungry' by Luke Fildes depicting homeless paupers queuing outside the casual ward of a London workhouse

Meet needs of safety, nurture, belonging and purpose