Homelessness and citizenship: exploring the meaning and negotiation of place, space and geography for rough sleepers.

This doctoral thesis, drawing on a detailed ethnographic study of a small voluntary day-centre for rough sleepers in West Dorset, sets out to explore and elucidate the relationship between contemporary citizenship and 'on-street' homelessness. From this empirically grounded basis I show how the vocabulary of rights and responsibilities is profoundly intertwined in the local governance of homelessness. I situate this mode and style of governance within the contours of public policy efforts that seek to recode behaviour and lifestyles deemed to be deviant, irresponsible and, ultimately, self-excluding. In doing this, I offer a critique of the moral economy of responsibility that draws extensively on the perceptions and experiences of homeless people. Ethically, and in conclusion, emphasis is placed on the importance of pursuing critically engaged and empirically sensitive scholarship which takes homeless people's agency into account in ways that have the potential to 'subvert' political and policy judgements linking contemporary citizenship with 'on-street' homelessness

Two buses and a short walk: the place of geography in recovery

Purpose – As UK substance misuse policy has increasingly focused on the concept of recovery, policymakers, service providers and service users have found “recovery capital” a useful concept to understand the barriers to and facilitators of recovery from substance misuse. There is a rich strand of research that considers the composition of recovery capital in terms of the relevance of resources such as access to mutual aid, familial support and friendship networks, stable housing, structured psychosocial support and education, training and employment. However, such general accounts have tended not to engage with the potential spatial element of recovery capital; that is, how location contributes to the acquisition and management of recovery capital. The purpose of this paper is to add nuance to more generalised accounts through a critical interrogation, exploration and analysis of the role of geography in recovery. Design/methodology/approach – The paper draws on in-depth interviews with service users and service providers in a predominantly rural county in the south-west of England. Findings – The ability to build and sustain recovery capital is shown to be marked by a complex web of social and spatial inclusions/exclusions. Originality/value – This paper makes three important contributions to prevailing understandings of recovery capital. First, it shows how narratives of recovery are intimately tied to perceptions and experiences of place. Second, it reveals some of the important challenges and complex dilemmas that local drug and alcohol commissioners face in designing and delivering recovery-orientated treatment systems. Third, and finally, it argues that there is a pressing need for a more nuanced appreciation of the social and spatial dynamics of recovery capital

Homelessness and citizenship : exploring the meaning and negotiation of place, space and geography for rough sleepers

This doctoral thesis, drawing on a detailed ethnographic study of a small voluntary day-centre for rough sleepers in West Dorset, sets out to explore and elucidate the relationship between contemporary citizenship and 'on-street' homelessness. From this empirically grounded basis I show how the vocabulary of rights and responsibilities is profoundly intertwined in the local governance of homelessness. I situate this mode and style of governance within the contours of public policy efforts that seek to recode behaviour and lifestyles deemed to be deviant, irresponsible and, ultimately, self-excluding. In doing this, I offer a critique of the moral economy of responsibility that draws extensively on the perceptions and experiences of homeless people. Ethically, and in conclusion, emphasis is placed on the importance of pursuing critically engaged and empirically sensitive scholarship which takes homeless people's agency into account in ways that have the potential to 'subvert' political and policy judgements linking contemporary citizenship with 'on-street' homelessness.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The care act, personalisation and the new eligibility regulations: a discussion paper about the future of care and support services for homeless people in England

As funding for Housing Related Support (formerly Supporting People) services continues to shrink, it is timely to revisit the question as to whether ‘homeless people’ are eligible for publically funded care and support, including personal budgets, organised through the local authority. The Care Act 2014 due to be implemented from April 2015 in England, heralds some positive changes which may serve to open the door to this funding stream which has rarely been used in support of ‘homeless people’. As the law currently stands ‘homeless people’ as a service user group are not eligible for community care assessment (though people who are homeless and who fall into one of the ‘eligible groups’ by virtue of having a mental health or drug and alcohol problem may be). The Care Act 2014 removes reference to ‘eligible’ and ‘ineligible’ groups so that any adult with any level of need will have a right to an assessment. Exploring some of the ways in which homeless people have been excluded from care and support in the past, this paper outlines how homeless organisations can work with local authorities to ensure fairer and more consistent access and in so doing, potentially secure their own futures in the face of fewer ‘block contracts’ and more individualised forms of commissioning

Beyond clinical trials: extending the role of the clinical research nurse into social care and homeless research

Aim: Clinical research nurses work at the fulcrum of clinical trials with clearly defined roles and responsibilities. In England, the National Institute for Health Research (the main funder of health research) has broadened its scope to encompass social care research. The expectation is that clinical research nurses will expand their skill set to support these new studies, many of which will employ qualitative and mixed methods. This discussion paper explores the challenges of facilitating this clinical academic workforce development through a case study of a homeless health and social care research project. This was one of the first studies to engage clinical research nurses in this new and expanded role. Background: Much of what is known about the research nurse workforce has been generated through studies of clinical trials in oncology. The ‘caring-recruiting’ dichotomy has been used as a heuristic device for identifying workforce issues that can impact on study delivery such as how intense pressure to recruit study participants leads to low job satisfaction. Design: This case study reflects on the authors' experiences of employing a clinical research nurse in a social care research project concerned with the discharge of homeless people from hospital. The ‘caring-recruiting’ dichotomy is used to generate new information about the relationship between workforce development and the successful delivery of social care research. Conclusion: The case study illuminates how social care research can generate different pressures and ethical challenges for research nurses. The time and skill it took to recruit study participants identified as ‘hard to reach’ was suggestive of the need to move beyond performance measures that prioritise recruitment metrics. The need for different types of staff supervision and training was also warranted as supporting study participants who were homeless was often distressing, leading to professional boundary issues. Relevance to workforce development: This study highlights that performance management, training and supervisory arrangements must be tailored to the characteristics of each new study coming onto the portfolio to ensure research nurses are fully supported in this new and expanded role

Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]

Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes.  Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group). Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0).  The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600).  The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512). Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions

Outcomes of specialist discharge coordination and intermediate care schemes for patients who are homeless: analysis protocol for a population-based historical cohort

Introduction People who are homeless often experience poor hospital discharge arrangements, reflecting ongoing care and housing needs. Specialist integrated homeless health and care provision (SIHHC) schemes have been developed and implemented to facilitate the safe and timely discharge of homeless patients from hospital. Our study aims to investigate the health outcomes of patients who were homeless and seen by a selection of SIHHC services. Methods and analysis Our study will employ a historical population-based cohort in England. We will examine health outcomes among three groups of adults: (1) homeless patients seen by specialist discharge schemes during their hospital admission; (2) homeless patients not seen by a specialist scheme and (3)admitted patients who live in deprived neighbourhoods and were not recorded as being homeless. Primary outcomes will be: time from discharge to next hospital inpatient admission; time from discharge to next accident and emergency attendance and 28-day emergency readmission. Outcome data will be generated through linkage to hospital admissions data (Hospital Episode Statistics) and mortality data for November 2013 to November 2016. Multivariable regression will be used to model the relationship between the study comparison groups and each of the outcomes. Ethics and dissemination Approval has been obtained from the National Health Service (NHS) Confidentiality Advisory Group (reference 16/CAG/0021) to undertake this work using unconsented identifiable data. Health Research Authority Research Ethics approval (REC 16/EE/0018) has been obtained in addition to local research and development approvals for data collection at NHS sites. We will feedback the results of our study to our advisory group of people who have lived experience of homelessness and seek their suggestions on ways to improve or take this work further for their benefit. We will disseminate our findings to SIHHC schemes through a series of regional workshops