In Greater Manchester, we're committed to good mental health and wellbeing in our residents. And we know that good quality housing has a positive impact on how we feel. So, in launching our Tripartite Agreement – a joint project between Greater Manchester Heath and Social Care Partnership, Greater Manchester Combined Authority and the city region’s housing providers – we are committing to our residents that we will work with them to address the issues which lead to poor housing and homelessness.

Dr Ruth Bromley, Chair of the Greater Manchester homelessness and health group and clinical lead for homelessness for the city, which oversees NHS investment into the A Bed Every Night scheme, talks about how we’re working towards inclusion on the subject of homeless healthcare.

Many inequalities in our society have been highlighted further by Covid-19 and the more deeply entrenched they are, the more harmful they are to people. The question is, what do we do about it?

Those experiencing most harm need the most attention. And, when the average age of death of a woman who sleeps on our streets is now 42, it is impossible to argue that those experiencing homelessness should not be a high priority for us to address in the coming years. Indeed, anything with that life expectancy warrants our full attention.

Amongst the devastation of the pandemic, we demonstrated that the public sector can mobilise quickly and restructure to meet demand in completely different ways. Within the NHS, we believe the next step is to make the concept of ‘inclusion health’ much more central to our thinking.

As described by NHS England, ‘Inclusion health has been used to define a number of groups of people who are not usually well provided for by healthcare services, and have poorer access, experiences and health outcomes.’

The principles it advocates can, and should, be applied to all our residents who experience the ill-effects of poverty and deprivation. This is particularly important for a city-region like ours. And, it challenges us to have a radically different conversation about how we address problems.

The design of many of our services does impact those who have lived difficult lives. For our part, the separation of mental health, drug and alcohol support and physical health services creates barriers of access and fragmented care which can widen inequality. The impact of traumatic experiences upon physical health and mental wellbeing, which is common in our homeless populations but experienced by many others too, is often poorly taught and not well understood.

As we look to recover our services, and contemplate the future, we need to be bold in how we re-organise to reduce inequality. We need to bravely innovate, always learning and adapting as we go.

Specifically, within our plans for change, we are working to see:

  • Homelessness as a priority in how we triage patients and consider risk to health
  • ‘Multiple diagnosis’ care which includes a broad consideration of mental health, drug and alcohol dependence and physical care
  • Emotionally enabling and psychologically informed approaches built into our approach to redesigning services
  • An enhanced offer for families and children experiencing homelessness and
  • Support for our health and social care colleagues’ own health and wellbeing, acknowledging the emotional load of working in these environments.

Better healthcare provision alone cannot reduce the health inequalities that so many in our society face. The acknowledgment of the wider determinants of health, including personal safety, secure housing, good employment, and prosperity, have informed devolution and public sector reform over the last decade.

Our Tripartite Agreement aims to consolidate this understanding, knowing that collaboration and shared knowledge will take us much nearer to where we need to be. And, as such, this deserves our full attention, with each of us endeavouring to do our bit to end the harm that a disrupted home brings.



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