Pause and reflect fails to allay concerns

As a group with some of the poorest health in our communities, there is a clear case for improving health outcomes for homeless people. However, as the NHS undergoes wide-scale reform we are concerned that despite the recent 'pause and reflect', not enough has changed to ensure the needs of homeless and vulnerable people are being considered.

In its recent report to government, the NHS Future Forum made a series of recommendations which have the potential to improve the health of homeless and disadvantaged patients. These reflect a series of concerns which the homelessness sector has campaigned on throughout the listening exercise: greater accountability for reducing health inequalities at every level of the NHS; better integration of commissioning across health and social care; removing the duty of competition to ensure that 'cherry-picking' does not discriminate against more vulnerable patient groups.

Acting on these recommendations will be crucial. We have already seen commitments from the Ministerial Working Group on Homelessness to improve how homeless people are included in commissioning, and the new Inclusion Health Board promises to ensure homeless people remain at the heart of its priorities in tackling health inequalities.

Yet it is at the local level that the reforms will play out. Local restructuring is already happening in earnest, with many of the early implementer programmes already shaping how commissioning will happen in the future. We want to make sure local commissioners take responsibility for identifying the health needs of their local homeless population and ensuring these are acted on through accessible and high quality services. This must be monitored, with targeted action put in place where progress has not been made. The implementation of the Joint Strategic Needs Assessment and the inclusion of homeless people's health needs will be critical to drive this forward.

We also need to remember that the poor health of people who are homeless is rarely improved only by clinical interventions. For those with multiple needs, we require a wider perspective which takes into account an individual’s housing, welfare and wider wellbeing. Health and Wellbeing boards and other commissioning bodies must work with housing and other related support services so that holistic services become the norm. They should look to jointly commission multi-disciplinary services which meet multiple health problems. Partnership working should be the core value of the NHS, not competition; agencies should demonstrate and be measured on how they work together.

Throughout recess, ePolitix.com will be focusing on a different policy theme each week. This week we are featuring articles with a focus on health and social care.