EXECUTIVE SUMMARY

  From the consultation with our members there is a clear message from Foyers that the NHS has an important role to play in tackling the health inequalities experienced by disadvantaged young people. Also, that the NHS has an important role in enabling organisations, like Foyers, to increase their impact on health through training, information and partnership working. NHS services are, in some instances, implementing effective initiatives in partnership with Foyers in particular outreach health services. However, the message is that NHS organisations need to reach out to the voluntary sector more, and be better resourced to undertake health improvement initiatives with disadvantaged groups and communities. Mental health is also a particular area that has had limited attention and investment in terms of health inequalities, and young people's access to mental health services is a major concern reported by Foyers.

INTRODUCTION

  1.1  The Foyer Federation develops and encourages new approaches to support young people as they make the transition to adulthood, particularly those who are at risk through homelessness, family breakdown or other factors. We work through a network of over 130 accredited Foyers providing holistic services to around 10,000 young people a year around the UK. At the heart of the Foyer approach is a formal commitment between the young person and the Foyer. For more than a decade, we have helped develop accredited learning programmes, initiatives in areas such as health and wellbeing and early intervention and quality assurance. Our campaigning and advocacy work draws directly on the experience of young people themselves.

  1.2  The Foyer Federation is now attempting to apply the holistic Foyer approach more widely and develop new approaches that better meet the needs of those young people whose journey to adulthood is particularly difficult eg care leavers, young offenders and other vulnerable young people.

  1.3  Foyers address the determinants of health insofar as they work with young people who are unstably housed, providing them with safe and secure accommodation while they undertake the transition to independent living. They also offer in-house training programmes in functional lifeskills and personal development, and refer young people on to external training provision and to employment.

  1.4  The views expressed in this response are the outcome of consultation with our network. In this consultation response we respond to questions 1, 2, 3 and 5 of the key questions of the committee, but also discuss the specific issue of young people's access to mental health services and the particular health barriers faced by young people as identified in a survey conducted in Spring 2007.

The extent to which the NHS can contribute to reducing health inequalities, given that many of the causes of inequalities relate to other policy areas eg taxation, employment, housing, education and local government:

  2.1  From our consultation response, it is clear that Foyers perceive other policy areas as such as ensuring stable housing, income and access to employment, education and training as having a greater impact on the health of disadvantaged young people than access to health services. Only 2 of the 23 responses argued that access to NHS services has a greater impact on health than stable housing, income and employment, education or training.

  2.2  Moreover, the responses also made it clear that stable housing was a prerequisite for accessing health services. One Foyer stated that "Without stable housing it is difficult to access medical healthcare and advice".

  2.3  The responses also highlighted the experience of successful work by NHS organisations to address health inequalities through improved targeting of services, outreach and developing services that are flexible and young people friendly. These initiatives were welcomed and seen as effective in increasing young people's access to health services. Overall, Foyers would like to see a greater emphasis by the NHS on prevention. Foyers argued that here is a need for "much more preventative and educational work" and that "We need more to offer young people in crisis. Better still we need more preventative services which will build self esteem, self confidence and educate people about looking after themselves".

  2.4  A specific example of the latter comment is made by one Foyer: "In recent weeks we have had 4 separate occasions when we had to take a resident to A&E because of threats of suicide or actual self harm. While they all seemed to receive a reasonable service, they all needed intervention much earlier on".

  2.5  Foyers were very positive about experiences of NHS staff providing training to them and workshops to young people to increase skills and knowledge for health improvement, but they noted that the availability of this was often lacking due to the stretched resources of health improvement staff in PCTs.

The distribution and quality of GP services and their influence on health inequalities, including how the Quality and Outcomes Framework and Practice-based Commissioning might be used to improve the quality and distribution of GP services to reduce health inequalities:

  3.1  15 out of 23 Foyers who responded described the access that young people had to GP services as `good' or `excellent'. Positive experiences included GPs who were understanding of young people, co-operative and had built positive relationships with the Foyer. Less positive experiences included those where doctors have been dismissive, rude and inconsistent with young people (a specific example was around management of pregnancy). One Foyer mentioned difficulties with access to specialist referrals and also difficulties were noted with access GPs due to unhelpful appointment systems.

The effectiveness of public health services at reducing inequalities by targeting key causes such as smoking and obesity, including whether some public health interventions may lead to increases in health inequalities; and which interventions are most cost-effective:

  4.1  Where public health services have targeted Foyer residents as a priority group, these initiatives are reported as effective in increasing young people's access to preventative services and health care. A common example given was sexual health services, which have targeted disadvantaged young people as part of Teenage Pregnancy strategies and funding. A significant number of Foyers are access points for condom distribution schemes, Chlamydia screening and outreach sexual health services. Examples of this include:

  4.2  "We work with sexual health services in the Foyer and they are generally very good, with good access for young people"

  4.3  "We have regular visits from the Sexual health team. The sexual health nurse visits the Foyer once a month".

  4.4  "Training is provided by the NHS for staff in the Foyer for issuing condoms and giving sexual health advice. This allows staff to distribute condoms outside office hours".

  4.5  It is notable the reported difference that the investment and targeting of sexual health services has made in improving access to sexual health services for young people. In our survey 15 out of 23 Foyers responding stated that young people's access to sexual health services locally was `excellent' or `good'. By comparison, 15 out of 23 Foyers said that young people's access to mental health services was `fair' or `poor'.

The success of NHS organisations at co-ordinating activities with other organisations, for example local authorities, education and housing providers, to tackle inequalities; and what incentives can be provided to ensure these organisations improve care:

  5.1  Partnership working, outreach health services and capacity building in the voluntary sector through information and training were the key mechanisms used by the NHS to address health inequalities experienced by Foyers. Foyers consistently highlighted the importance and value of partnership working with health services in order to meet the needs and improve the health of disadvantaged young people. However, it appears that the quality of the partnership relationships can be hit and miss, with some very good experiences and some very poor or non-existent. Even within the same locality, a Foyer may have excellent relationships with an outreach nurse who runs a clinic in the Foyer, but find it impossible to engage with mental health services.

  5.2  18 out of 23 Foyers said that the success of their local NHS organisations in working in partnership with them was `fair' or `poor'. Foyers cite the following examples:

  5.3  "Can't even get a representative to sit on our sub-committee. Some pockets of good relationships—Health Visitors and Young Parent project staff work well together".

  5.4  "Some links have been developed with both PCT and NHS services—but these are often initiated by the Foyer. When advice is sought both services can be accommodating but there need to be more strategic partnerships—which have a lasting effect on the quality of services offered and accessed by our residents".

  5.5  "We have established some good links in the past but we have to work extremely hard to keep the relationship going. This in part due to lack of resources in the NHS and also due to constantly shifting staff meaning it is difficult to maintain relationships".

  5.6  "I know there is the potential to do more".

Issues of access to mental health services for vulnerable young people:

  6.1  As noted above 15 out of 23 Foyers said that young people's access to mental health services was `fair' or `poor'. The majority of comments about poor access to services concerned mental health services. Foyers gave the following examples:

  6.2  "Approximately 78% of our residents have mental health issues. These young people are currently facing waiting lists of up to 18 months".

  6.3  "Long waiting list and very limited access".

  6.4  "There does not seem to be the same targeting that there is for general health".

  6.5  In addition, Foyers commented that there seemed to be less alternatives to medication offered for mental health issues. One Foyer commented that "Access to sport and physical activities as alternatives to antidepressant medication seem to be geared to the older adult".

  6.6  Given the high rates of mental health problems amongst the Foyer population, there does appear to be a need to target initiatives to tackle health inequalities in mental health.

Barriers to Health identified by Foyers and Young People:

  6.7  In Spring 2007 the Foyer Federation conducted a consultation with Foyers and young people as part of a (successful bid) to the Big Lottery Well-being Fund.

  6.8  The following tables list the responses given by Foyers when asked what the major gaps in health services for young people were:

Top 8 gaps in services	% response
Lack of a local/affordable gym	40%
Access to appropriate mental health service	19%
Support for lesbian, gay, bi sexual, transgendered young people	13%
Counselling	13%
Funding	9%
Lack of access to outside services due to location	5%
Lack of access to professional agencies due to waiting lists	5%

  6.9  The following tables list the responses given by Foyers when asked what the major barriers to accessing health services for young people were:

Top 8 barriers for young people	% response
Cost of travel, cost of membership of GYM	48%
Confidence	27%
Stigma	20%
Travel	18%
Waiting lists	16%
Being judged	10%
Difficulties associated with being in a rural location	8%
GP and dentist closed lists	7%

  6.10  As part of the survey young people were asked: "If you were given a budget to spend on a health and wellbeing project, how would you spend it?" Residents responded with the following (most popular first):

—  Bring in chef to do cooking lessons;

—  Bring in chef to do weekly dinner on Sunday so you eat well for at least 1 meal and you learn to cook too;

—  Mental health nurse to come into Foyer;

—  Using residents to teach other residents cooking skills;

—  More interesting cooking lessons, tests on hygiene etc;

—  Make fruit and vegetables available for free/cheap to residents;

—  Free membership to gym;

—  More sports equipment available at Foyer;

—  More sports activities with prizes, incentives;

—  Training regarding Spa (beauty and health) treatments.

Recommendations for action:

  7.1  Increased investment in health improvement initiatives that target disadvantaged young people as a priority group eg through outreach and flexible services, in partnership with voluntary organisations and youth services.

  7.2  A higher priority given to partnership working with the voluntary sector in order to address the needs of disadvantaged groups and communities.

  7.3  A higher priority given to health improvement, prevention and early intervention in all areas of the NHS, especially mental health.

  7.4  A review of the access to mental health services for young people aged 16-25.

January 2008