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Guest authors bring different perspectives and diverse voices to our blog. They do not always represent the views of The King’s Fund.

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Home is at the heart of inclusion health – here's why

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Jackie Stevens, Associate Director of strategic work programmes, at Hampshire and Isle of Wight Integrated Care System writes about work to make home the heart of inclusion health in one integrated care system.

Homelessness, reoffending, addiction and poor physical and mental health are intrinsically linked, with each often the cause and effect of the other. With this in mind, partners across Hampshire and the Isle of Wight Integrated Care System (ICS) are looking at the link between reoffending and health and the role partner organisations, such as the Office of the Police and Crime Commissioner, have to play in health inclusion. By recognising all our differences and our backgrounds and the skills and knowledge that we bring, we can include and treat people equally and fairly in a more person-led way.

'By recognising all our differences and our backgrounds and the skills and knowledge that we bring, we can include and treat people equally and fairly in a more person-led way.'

Through our ‘Minding Every Gap’ programme we are starting to see a change as partners come together to transform the way they engage and support people living with multiple disadvantages. We have shared ambitions to transform the way we engage and spend time with people with lived experiences of multiple disadvantages. The intention is to commission together, act together and change together, enabling people to step out of what can often be a ‘revolving door system’ and lead fulfilling and flourishing lives.

Internal analysis finds that work to tackle and prevent homelessness alone costs the Hampshire and Isle of Wight ICS an additional £38 million per year, and we are already able to demonstrate that by working together we can shift and make best use of our resources. The multi-sector team are seeking to change the support offer for people who fall into cycles of homelessness, imprisonment and inpatient stays, people who are often discharged/released from services without care and attention paid to their next step. Throughout 2022 we spent time spent collectively understanding where strategic and tactical objectives interlink. Based on our research it was evident that the greatest impact was to focus on people with poor mental health, previous contact with the criminal justice system and experiencing homelessness/living in insecure homes.

The voice and experience of people navigating the system is telling us that we do not currently support them to achieve a better, more meaningful, life. The current operating environment compounds and multiplies the challenges faced by people wishing to ‘step out’ of the system. At 47 years old, Leon1 is coming to the end of a four-year prison sentence at HMP Winchester, and the thought of leaving what he calls ‘institutional life’” is severely impacting his mental health.

'I was stupid. I got involved in something I shouldn’t. I’ve lost everything – my marriage, my family, my home… there’s nothing left, I feel completely broken. I’m leaving prison in two weeks’ time and while I’ve organised to stay back with Mum and Dad, they live in Yorkshire. I’ll be released just after lunchtime on a Friday, and somehow have to get from Winchester prison to the train station – and I don’t know where this is – find a train to Guildford to attend my probation appointment before they close for the weekend. I’ve literally got about four hours to make the appointment or I’m street homeless until they open again on Monday morning. I have no idea what to do if I miss them.'

Across the ICS geography, despite all the formal protocols of the duty to refer, 77 per cent of prison leavers are released from prison into homelessness. Without targeted support to resettle into community life, people often resort to sofa surfing, sleeping rough or returning to abusive or exploitative relationships, only for the cycle of crime that led to their arrest and imprisonment beginning again. Evidence shows that 54 per cent of people released from prison into homelessness reoffend within a year of leaving prison, compared to 43 per cent released to a permanent home.

Through our programme we have developed ‘Step Out’ – a housing model to find more suitable housing for someone as a key building block of their recovery, enabling them to be discharged from rehab and/or acute mental health services into their own permanent home. Feedback shows that not only is there improved patient experience and that it safeguards their recovery journey, but it also reduces demand on the local housing register, and demand across police, fire, ambulance, 111 and 999 services.

Now we are exploring how to offer this model as standard for people leaving prison to improve their health and wellbeing and reduce reoffending rates by helping them ‘step out’ from services to lead independent and flourishing lives. Suitable and stable housing provides the opportunity for someone to have a home, providing the cornerstone and stability required for them to lead a healthy, purposeful and fulfilling life. That home is a vital piece of a broader jigsaw of health and support needs that need to be put in place if we are to tackle the level of reoffending rates and health inequalities across our footprint.

Hampshire and Isle of Wight ICS are one of seven systems contributing to a national learning set on Inclusion Health, co-developed by Pathway, Groundswell and The King’s Fund.  This blog reflects the author’s views.