Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by The Big Issue in the North Trust (PH 68)

  The Big Issue in the North Trust helps homeless people move into better homes, better jobs, better health and into a better life. We provide services for vendors of The Big Issue in the North in housing, health, drugs and alcohol, education, employment and training, personal development and finance. This evidence is drawn from our research and from our experiences of providing integrated care to homeless people over the last four years from our office in Leeds, Liverpool and Manchester.

  1.  Current public health policy is not reducing inequalities as much as it could do, particularly among the most excluded groups. Our research[73] shows:

    —  29 per cent of vendors are not registered with a GP compared to 3 per cent of the general population;

    —  41 per cent of vendors think it is difficult to gain access to a GP;

    —  33 per cent suffer from chest or respiratory problems compared to 7 per cent of the general population;

    —  28 per cent suffer from the effects of poor nutrition;

    —  26 per cent suffer from skin problems; and

    —  20 per cent regularly suffer from anxiety;

    —  76 per cent regularly or occasionally suffer from depression compared to 16 per cent of the general population;

    —  39 per cent have attempted to commit suicide;

    —  70 per cent use drugs not prescribed to them (53 per cent of all vendors use heroin); and

    —  79 per cent of users of drug services[74] said that their drug use had affected their health. The most frequent problems were abscesses, chest and respiratory conditions, weight loss and depression.

  2.  Public health policy needs to move away from a medical model towards alternative models which address the impacts that social and economic factors have on health and well-being:

    —  The Big Issue in the North has successfully piloted an alternative model. We aim to help people who are homeless move into better health, better jobs, a better home and a better life by addressing the whole range of their needs.

    —  Personal Medical Services (PMS) funding paid for a GP to be based at our Manchester office and work in partnership with our range of other services. These include assistance with accommodation, financial services, education, employment and training and a wide variety of arts and sports activities. Over 500 homeless people registered at the practice (but see section 3 below);

    —  in terms of drug services, we believe that there must be more diversity in the services that are offered, more joint-working with other services, improvements in quality, target setting and genuine consultation with users. 2 We welcome the recent announcement of the creation of a National Treatment Agency.

    —  only 11 per cent of users of drug service users receive help with matters such as employment and housing2.

  3.  Current organisational arrangements can impede rather than encourage the development of alternative models:

    —  Manchester Health Authority has shown an unwillingness to recognise the importance of primary health care services working alongside other services. The partnership funded by PMS has now ended as the medical services were not working alongside our non-medical services in the way that we envisaged. Manchester Health Authority has allowed the GP to continue to use the Personal Medical Services funding. We have employed a new GP but he has not been granted prescribing rights so we are unable to continue to operate the project;

    —  Drug Action Teams and Drug Reference Groups do not always include representatives from a wide enough range of services. Even where they are represented, services are not always delivered effectively in partnership;

    —  GPs report feelings of isolation and feel they need more support from specialist organisations in order to treat drug users effectively; 2

    —  drug service providers feel that competitive methods of allocating funding inhibit joint-working and promote short-termism; 2 and

    —  many areas of public service fail to recognise the needs of people who use drugs. These include many area-based regeneration initiatives which ignore the whole issue completely, social housing providers who seek to exclude drug users and the government's welfare to work programme which does not give enough time for people to adequately prepare for the world of work.

  4.  People who are socially excluded want more effective and integrated health care and see it as vital to their social inclusion:

    —  "GPs accepting homeless people as patients" and "Vendors stopping taking drugs, with support" were the top priorities when Big Issue in the North vendors were asked "What would make the most difference for homeless people?" [75]

    —  97 per cent of Big Issue in the North vendors want to see health care provided at our offices. 1

    —  Big Issue in the North vendors feel that better housing, a better diet and access to a GP are the three main things that would help them take better care of their health.

    —  Big Issue in the North vendors want to see a wider range of provision relating to housing, employment, education, training, benefits and personal development for users of drug services. [76]

73   Big Issue in the North Trust (1998) Health matters. A primary health care study of vendors of The Big Issue in the North. Back

74   Big Issue in the North Trust (1999) Drugs at the sharp end. Back

75   Big Issue in the North Trust (2000) Rebuilding the picture. What would make the most difference for homeless people? Back

76   Big Issue in the North Trust (2000) What would make ideal drug treatment services? A citizens' jury. Back

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