APPENDIX 34
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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