Joseph Mochan

Sussex 
NHS Commissioners 

JJ~lJ.

Brighton & Hove
City Council 

Private & Confidential 
Miss Hamilton-Deeley 

By Email only 

Dear Miss Hamilton-Deeley 

Re:  The late Mr Joseph Mochan 

Brighton and Hove Clinical 
Commissioning Group 
Hove Town Hall 
Norton Road 
Hove 

Tel : 01273 238700 
Website: 
www.brightonandhoveccg.nhs.uk/ 

Tha,nk you for your report,  received on  30 March 2020, regarding the Record of 
Inquest for Mr Mochan. 

Firstly, we would like to express our sincere condolences to the family of Mr Mochan. 

Your report requested  us to  consider the following provisions to prevent further 
deaths; 

1.  A safe night shelter, open to all every night of the year, which would be able to 
accommodate 50 to 200 people each night. This should not be available on a 
first come first served basis, and  shou ld  provide proper associated hygiene 
facilities,  food , warmth and  communal areas. 

2 .  A  Homeless Healthcare Hub, which contains all the necessary services under 
one  roof. This would be not unlike the (though it would  be more sophisticated 
than) the University of Sussex Healthcare Hub. 

T he report acknowledged it would not be possible for these to be provided overnight 
and  requested that a discussion with  all stakeholders begins. 

Your report has prompted the  CCG and the Local Authority to come together to 
consider the find ings. Brighton & Hove City Council (BHCC) is  responsible for 
providing the night shelter and  homelessness services, and has therefore considered 
a response to point 1 above.  Brighton & Hove Clinical Commissioning Group  (B&H 
CCG) is responsible for providing healthcare provision  to the street homeless 
population and commission  the Arch Healthcare Hub, and  has therefore considered 
a response to point 2 above. 

 NHS Commissioners 

1.  Night Shelter 

Brighton & Hove
City Council 

BHCC aims to  ensure that no one  has to  sleep rough  in  the city and  that its rough 
sleepers are kept safe during in  the winter months. BHCC currently commissions a 
range  of accommodation provision for rough  sleepers and  single  homeless people 
offering both  short term  (hub) and  longer-term accommodation options.  The vast 
majority of this provision operates year round,  and  includes; 

•  Supported accommodation for adults and young  people. 
•  Somewhere Safe to  Stay - offering  short term accommodation to  those at 
high  risk of rough  sleeping while a solution to their homelessness is found. 
(Funded by MHCLG) 

•  No  Second  Night Out Hub - offering  short term accommodation to those new 
to the street or new to  rough  sleeping while a solution to their homelessness 
is found.  (Part funded  by MHCLG). 

•  365  Nightshelter - offering  15 beds in  shelter type accommodation to  rough 

sleepers.  (Funded for 2 years from  November 2019) 

In  addition to the above where a rough  sleeper or single homeless person  meets the 
thresholds for a statutory duty, they may be  offered accommodation  in  emergency 
provision  (bed  and  breakfast) whilst the duty to  them  is explored. 

BHCC funds or facilitates the funding  of 732 bed  spaces in  the city for single 
homeless people and  rough  sleepers as follows: 

•  504  units of supported accommodation for adults 
•  143 units of young  peoples supported accommodation 
•  60 units of mental health  supported  accommodation 
•  54 short term shelter type accommodation spaces 
•  22 Housing  First units with  an  additional 20 units due to  be  brought 

online in  2020 - 2021 

A further 29 supported accommodation units opened between January & March 
2020 

In  addition,  during the winter period there is a direct access Severe Weather 
Emergency protocol shelter, which  is open when the temperature is  predicted to be 
'feels like' zero or below or there  is  an  amber weather warning. 

The current provision ensures that,  during the poorest weather, there are sufficient 
bed  spaces to  mean no one should  have to  sleep rough  in  the  city. 

In  January 2020 a report was prepared which  considered the provision of a year 
round  night shelter for all  rough  sleepers.  This identified a number of risks and 
barriers,  including  resources (financial and workforce needed), the  lack of an 
available suitable building, and the impact on  the wider community. An  important 

 NHS Commissioners 

Brighton & Hove
City Council 

consideration was the evidence base that this model will  have a positive impact on 
the outcomes of rough  sleepers.  Evidence of the  impact of Night shelters on  rough 
sleepers is  currently very limited.  The data provided by Homeless Impact concludes 
that Nightshelter provision does not have a positive outcome on  health  or substance 
misuse outcomes for rough  sleepers. 

Anecdotal feedback about Nightshelter provision in  Brighton shows that many of the 
most vulnerable rough  sleepers choose not to  access the provision  available.  Many 
rough  sleepers do not feel comfortable in  large shared sleeping environments and 
many of those who are most vulnerable such  as women  and those with  mental 
health needs will not access even the safest and  highly staffed service. 

Brighton &  Hove City Council is,  however,  exploring models of shelter provision 
being  provided  in  other areas of the  UK and  is  looking at evidence based  practice to 
design services which gives rough  sleepers the  best opportunity to  recover from 
homelessness. This  includes the expansion of Housing First a model of support with 
a strong evidence base  of positive outcomes for rough  sleepers. At present,  there  is 
no  identified budget or building for the provision  of a Nightshelter for all rough 
sleepers. 

2.  Homeless Healthcare Hub 

B&H  CCG  is committed to ensure that the patient population (in  particular those that 
are the  most vulnerable) receive the  right care,  at the right time,  in the right place. 

The city continues to  see high  numbers of rough  sleepers despite existing  provision 
and  strong  links between  health and  social care to  provide an  integrated support 
offer.  BHCCG and  BHCC jointly commission a range  of services aimed at reducing 
health  inequalities and  achieving positive outcomes that empower individuals to 
recover from  homelessness and end the need to sleep rough. 

The CCG commissions a successful and  integrated service model through Arch 
Health, who provide integrated healthcare to homeless people in  Brighton & Hove.  In 
February 2017,  Arch took over the Integrated Homeless Healthcare Hub contract, 
which includes a GP surgery,  hospital in-reach services,  community health 
engagement,  outreach to  day centres and citywide  leadership. 

The GP surgery has around  1,400 registered  patients, with the organisation 
employing  2.3  FTE GPs.  The organisation  adopts a very broad view of health  and 
wellbeing in  order to promote 'inclusion  health' amongst the city's most deprived and 
vulnerable population. Therefore, works very closely with  BHCC and  the Voluntary 
and  Community Sector to  ensure that a streamlined service is  available to  meet the 
holistic needs of all homeless people. 

In  2019, Arch  Care received  an  'outstanding' rating  from the Quality Commission 
(CQC) and  continues to  aim  high with  an  ambition to  become renowned for its 

 :'..':. r"'-'  Sussex 
T '' 

N H S  Commissioners 

j 

Brighton & Hove
City Council 

expertise on  the design and delivery of integrated care, research,  training  and 
innovation in  homeless healthcare. 

Homeless Healthcare services in  the city are recognised  as an exemplar model by 
NHS England/Improvement with the potentia l to  be replicated across the country. 
The CCG acknowledges the need to develop a homeless healthcare hub with all 
necessary services under one roof.  We believe the current commissioned service 
could be enhanced to develop a more integrated service with the  Local Authority.  A 
Feasibility Report has been  commissioned to develop a strategic definition  and 
preparation of this brief on  behalf of Arch Health CIC for the development of a new 
healthcare facility for homeless and disadvantaged people in  Brighton. 

The Feasibility Report will consider options to further the integration of services,  and 
acquire the necessary estate/space to expend the clinical offer and house various 
services under one roof. The proposals include access for homeless people of the 
following  services: 

•  Homeless mental health services (SPFT) 
• 
Integrated primary care team (SCFT) 
•  Substance Misuse Services 
•  Health engagement team (Justlife) 
• 

In addition , hosting visiting services such as Dentists, Dermatology,  Hepatitis 
C  specialist support, Benefits Support and Midwives, amongst others. 

The  Feasibility Report was concluded in February 2020. Subsequently, the CCG has 
had  to focus on  the response to the Covid-19 crisis . As we enter the recovery period 
following the initial phase of Covid response, we will be reviewing the feasibility 
· 
report to include learning from the Covid  response in  relation to supporting the needs 
of the homeless population in  Brighton and Hove. 

I hope this information provides the assurance that the CCG and  Local Authority 
have acted on  the directions within  the report and we would be  happy to provide 
further information on  request. 

Yours sincerely 

Clinical Chair 
Brig'hton  &  Hove CCG 

-

· Health & Adult & Social Care 

Brighton &  Hove City Council 

 Response to Regulation 28  - Report to Prevent Further Deaths issued by Senior 
Coroner Veronica Hamilton-Deeley following investigation into a drug related 
death. 

1. 

BACKGROUND AND CONTEXT 

1.1 

This response is a joint response by Brighton & Hove CCG (BHCC)  and  Brighton 
& Hove City Council (BHCC) to the paragraph 7,  s5 direction under the Coroners 
and Justice Act 2009 and  regulations 28 and 29 of the Corners (Investigations) 
Regulations 2013. 

· 

1.2  On  the 25th  March 2020,  the CCG and  BHCC were given 56 days to  respond to 
the Coroners Regulation 28  Report to  Prevent Further Deaths.  The report and 
Records of Inquest related to a deceased individual accessing Homeless 
services and The Arch Healthcare GP Practice. The cause of death was 
determined to be drug related,  however the Coroner reported that evidence 
provided during the inquest revealed  matters that gave rise to concerns.  In the 
Coroners opinion, there was a risk that future deaths will  occur unless action is 
taken. 

1.3 

This response examines the direction provided by the Coroner's report to 
consider the following  provisions to prevent further deaths; 

a)  A safe night shelter, open to all every night of the year,  which would  be 

able to  accommodate 50 to 200 people each night. The direction 
stated that it should  NOT be available on  a first come first served  basis 
and  should  provide proper associated  hygiene facilities,  food,  warmth 
and communal areas. 

b)  A  Homeless Healthcare Hub, which contains all the necessary services 
under one roof.  This would be not unlike the (though it would  be more 
sophisticated than) the University of Sussex Healthcare Hub. 

1.4 

1.5 

2. 

2.1 

Brighton  &  Hove City Council (BHCC) is  responsible for providing the night 
shelter and  homelessness services, therefore is  responsible for delivering a 
response to and actions towards direction A. 

Brighton & Hove CCG  is  responsible for providing healthcare provision to the 
street homeless population and commission the Arch Healthcare Hub, therefore 
is  responsible for delivering a response to and  actions towards the direction  B. 

BRIGHTON & HOVE CITY COUNCIL RESPONSE - DIRECTION (a) A SAFE 
NIGHT SHELTER 

BHCC aims to ensure that no one has to sleep rough  in the city and that in  rough 
sleepers are kept safe during in the winter months.  BHCC currently commissions 
a range of accommodation provision for rough  sleepers and  single homeless 
people offering both short term  (hub) and  longer-term accommodation options. 
The vast majority of this provision operates year round,  and  includes; 

 •  Supported accommodation for adults and young  people. 
•  Housing  First accommodation and  support to  provide a specialist 

response to people with  multiple and compound  need 

•  Somewhere Safe to Stay - offering short term  accommodation to those at 

high  risk of rough sleeping while a solution to their homelessness is 
found.  (Funded  by MHCLG) 

•  No Second  Night Out Hub - offering short term  accommodation to those 

new to the street or new to rough  sleeping while a solution to their 
homelessness is found.  (Part funded  by MHCLG). 

•  365  Nightshelter - offering  15 beds in  shelter type accommodation to 

• 

rough  sleepers.  (Funded for 2 years from  November 2019) 
In  addition to the above where a rough  sleeper or single homeless person 
meets the thresholds for a statutory duty they may be offered 
accommodation in  emergency provision (bed  and  breakfast) whilst the 
duty to them  is explored. 

2.2 

BHCC funds or facilitates the funding  of via grant from the Ministry of Housing, 
Communities and  Local Government  a total of 732 bed  spaces in the city for 
single homeless people and  rough  sleepers 

•  504 units of supported accommodation for adults 
•  143 units of young peoples supported  accommodation 
•  60 units of mental health supported accommodation 
•  54  short term shelter type accommodation spaces 
•  22  Housing  First units with  an  additional 20 units due to be brought online 

in  2020 - 2021 

2.3 

2.4 

2.5 

In  addition,  during the winter period there is  a direct access Severe Weather 
Emergency protocol shelter, which  is  open when the temperature is predicted to 
be 'feels like' zero or below or there is  an  amber weather warning. 

The current provision ensures that,  during the poorest weather,  there are 
sufficient bed  spaces to  mean no one should have to  sleep  rough  in the city. 

The night shelter and  hub accommodation  is accessed  by referral through 
Housing Options or our commissioned  Street Outreach Services and provide 
intensive resettlement work to find  people sustainable solutions to their 
homelessness or reconnection to  safely reconnect people to their area of 
connection, this includes ensuring there is  a sustainable accommodation offer. 

2.6 

The direction of the coroner seeks to expand this provision. 

2. 7 

The current budget for the H&ASC Commissioning team with oversight for all 
accommodation outlined  above is £7,467,127.00 per annum this includes £2.3 
million of grant funding from the Ministry of Housing Communities and  Local 
Government for 2020/2021. This budget includes the accommodation outlined 
above and services  including rough sleeper street outreach, day centre staff, 
housing advice for young people, floating  support to people in their own  homes, 
clinical  psychologist support,  peer support and work,  learning and employment 
support services.  We do not yet know if there will  be a further round  of grant 
funding. 

 2.8 

2.9 

2.10 

This winter an  average of 40 people a night used the Severe Weather 
Emergency Protocol shelter but we know that between 80'."86  people sleep 
rough in  Brighton & Hove on  any one night.  Community partners and we are 
pro-active in  ensuring  people are informed of the shelter but a significant 
number of people choose not to come in. 

Over the recent Covid-19 pandemic from  24th  March to 23 rd  April the council 
accommodated  189 rough  sleepers in  self-contained accommodation. 

Brighton & Hove City Council have made representations to central government 
on  the need for a co-ordinated  national approach to end  rough  sleeping 
recognising that this is a nation crisis which  requires a national as well  as  local 
response. 

2. 11 

Extending Night Shelter Provision 

During the winter of 2019/2020,  the winter night shelter services were expanded 
to provide an  open  access weekend winter shelter in  recognition that day 
centres were not open during the weekend and  people were therefore less able 
to access food and  other services.  This was at an  additional cost of £25,000 for 
an  additional  18 nights.  Consideration was given during this period to expanding 
a night shelter service for year round  provision  but this was inhibited by a lack of 
funding  and the lack of a suitable building. 

In  January 2020 a report was prepared which considered the provision of a year 
round night shelter for all  rough sleepers. The report considered two potential 
models and the associated costs.  Neither model includes the costs of a building 
nor the expenses associated with  running  and  maintaining a building. 

The first costing  is of £23,510 per calendar month (total £283k per year) for a 
shelter service only with  no meaningful support to engage the users in  resolving 
their homelessness or support to access services. This would  provide an 
emergency Night shelter model from  7pm to 7am - 7 days a week with  capacity 
for 90 people. 

The second costing  is of £30,635 per calendar month (total £365k per year) for 
an  enhanced model with trained  staff able to offer direct support around ending 
people's homelessness and  ensuring they were effectively linked  in with 
services. This would provide a Supported Shelter model from  7pm to 7am - 7 
days a week capacity 90  people 

Additional  running  costs between  105k - 222k per year are applicable to both 
models. The estimated costs of running  a year round  night shelter for a 
maximum of 90 individuals would  be between £500,000 and  £600,000 per 
annum not including the costs of leasing or purchasing a building  large enough 
to accommodate 90  people,  maintenance,  repairs and  refurbishment to bring  it 
to a useable standard 

2.11 

2.12 

2.13 

2.14 

2.15  Beyond costings· there are a number of potential risks  and  barriers to the setting 

up of a winter shelter for all  rough  sleepers which  are detailed below: 

 Risk / Barrier: 

.. 

Mitigation: 

Accommodation: 
Officers in  the city council have been 
searching for SWEP / Nightshelter 
venue for the last three years and have 
been  unsuccessful in  sourcing an 
appropriate building on  anything more 
than  a temporary basis. 

New services being  set up in the city for 
homeless people with  complex needs 
have faced  significant community 
opposition. 

Staffing: 
A dedicated staffing and  management 
team would  need to  be recruited and an 
on  call  management system put in 
place.  If there was an  increase in  use 
we may need to  revise our predicted 
staffing above and recruit additional 
staff. 

Service Capacity: 
The number of rough  sleepers likely to 
access the  service per night is  unknown. 
However in  the last month (from 24 
March to 23 April 2020) BHCC 
accommodated 189 rough  sleepers,  this 
was during lockdown when travel 
restrictions were in  place and is  unlikely 
to reflect the full demand outside of 
lockdown. 

Identify dedicated resource within the council to  search for 
a building,  negotiate lease terms and consult with the 
community.  An  estimate of £10,000.00 has been  made 
for this resource and the community impact work detailed 
below. 

An  impact assessment would  need to be undertaken on 
any property identified to assess its suitability as a shelter 
and the possible impact on  the community.  Community 
consultation would  need to take place prior to  an 
agreement being signed on  the premises. 

There are two options for the provision - the first is that a 
council employs an experienced service manager to 
recruit and train  staff and volunteers and run  the service 
or a competitive tender is  undertaken for a provider with 
relevant experience to run the service and  recruit and train 
staff.  This would  need to have flexibility to increase 
staffing if that became necessary. 

We would  need to  ensure the identified venue had 
sufficient space to  accommodate all  rough  sleepers safely 
(health & safety issues ) and that staffing levels were 
sufficient to deal with the numbers accessing and an 
anticipated rise  in  numbers once the service is widely 
known about. 

There is the potential for people to come  We would  need to ensure the identified venue had 
in  from  neighbouring local authorities 
which do not provide a similar or any 
access to  a Nightshelter.  This is  likely to  numbers accessing and  an  anticipated  rise in  numbers 
have an  impact on  the  number of rough 
sleepers in  the provision. 

sufficient space to accommodate all  rough  sleepers safely 
and that staffing levels were sufficient to deal with the 

once the service is widely known  about. 

Possibility that over time the service 
reaches venue capacity and  has to turn 
away rough  sleepers. 

If we attract people in from out of area 
but do not have capacity for the 
increased demand we could  increase 
our overall  number of rough  sleepers in 
city and  our Street Outreach Service 
and  Reconnections services would  be 
unable to work effectively with the 
increased demand for their service. 

Impact on the Community: 
There is the potential for people to come 
in  from  neighbouring local authorities to 
access a Nightshelter.  This may impact 
on  the number of rough  sleepers on  the 
streets of the city in  the daytime and the 

SWEP service will  continue to operate in  severe weather 
for anyone unable to  access the shelter. 

We may need to look at increasing the size of the  Street 
Outreach Service to meet increased demand;  but this is 
not within current budget. 

Additional  Reconnection workers and/or Street Outreach 
Workers have an  annual cost £44,880.  The cost of 
relocating  an  individual varies but on  average £150 per 
person to meet travel and resettlement costs is  required. 

The rough  sleeper team will continue to work with rough 
sleepers to find  solutions to their rough  sleeping. 

 Risk / Barrier: 

Mitigation: 

number of rough  sleepers who remain  in 
the city. 

There is a potential impact on  the  local 
community from  large numbers of rough 
sleepers queueing outside the provision 
prior to opening and  leaving  in  the 
morning.  There is the potential for anti-
social behaviour in  the  local area. 

Community engagement prior to the service commencing 
and while it is  in  operation will  be key.  Prior to any 
proposed  new service provision,  the council would engage 
with the  Police,  Health and other statutory and non-
statutory stakeholders.  The service will  need to maintain 
regular communication with  Sussex Police and The Safer 
Communities Team. 

Impact on  Rough Sleeping: 
There is the potential for people to come  This will  be difficult to  mitigate against people from 
in from  neighbouring local authorities to 
neighbouring authorities already come to  Brighton & 
access a winter Night Shelter.  This may  Hove.  The street outreach team  and staff within  the 
impact on the  number of rough  sleepers 
on  the streets of the city in  the daytime 
and the number of rough sleepers who 
remain on the streets once the winter 
provision  has closed.  This may place an 
unsustainable burden on our Street 
Outreach  Service. 

enhanced shelter model will work to reconnect people 
back to their area of origin. 

Those who access the  shelter who do 
not have a local connection will gain a 
local connection if they remain  in  the city 
for 6 months putting additional pressure 
on  local services. 

The shelter could  include dedicated reconnection  and 
move on  staff who will work with  individuals to find 
sustainable solutions for their homelessness (see costings 
for the enhanced service).  However,  with  guaranteed 
accommodation rough sleepers may choose not to 
engage with  support to reconnect. 

There is the  potential for people to come  We will consult with  partners and ensure we are 
in from  neighbouring local authorities to  monitoring any impact on  health services and other 
access a winter Night shelter.  This may 
agencies. 
affect the numbers of people with 
complex health needs needing access 
to  health and  mental health services, 
A&E and  hospital. 

Safety Considerations: 
Shelter provision offers a shared eating 
and  sleeping space for multiple people. 

An experienced and consistent staffing team will  need  to 
be employed to ensure a safe service for both  users and 
staff. 

Experience of Nightshelter provision has 
shown that the longer people share a 
small space the more issues arise with 
behaviour and  interpersonal 
relationships.  A shelter service which 
operates on  an ongoing basis even with 
experienced staff in  place will see some 
issues with  behaviour and relationships 
and an  increased  number of exclus,ions.  who are excluded and those who do not wish to  access a 

Additional space in the venue will be  needed to  allow for 
separate sleeping spaces for vulnerable people or those 
who struggle in  busy environments along with some quiet 
spaces. 

SWEP provision  (provided  in  addition to the 7 day a week 
Nightshelter service) will continue to ensure that those 

large shelter have somewhere to go in  severe weather. 

3. 

IMPACT OF  NIGHTSHEL TER PROVISION ON  OUTCOMES  FOR ROUGH 
SLEEPERS. 

 3.1 

The final  consideration for the provision of a Nightshelter for all  rough  sleepers is 
the need for evidence that this model will  have a positive impact on  the outcomes 
of rough  sleepers.  Evidence of the impact of Nightshelters on  rough sleepers  is 
very limited.  The data provided by Homeless Impact in the link below concludes 
that Nightshelter provision does not have a positive outcome on  health or 
substance misuse outcomes for rough  sleepers. 

https :/ /www. homelessnessi m pact. o rg/i ntervention/shelters#h ig h I ight 

3.2  Our own anecdotal feedback about SWEP and  Nightshelter provision  in  Brighton 

which shows that many of the most vulnerable rough  sleepers choose not to 
access the provision available.  Many rough sleepers do not feel  comfortable in 
large shared sleeping environments and  many of those who are most vulnerable 
such as women and  those with  mental health needs will  not access even the 
safest and  highly staffed service. 

3.3 

In  Brighton & Hove we  use shelters and  hub provision as a time-limited 
intervention to quickly move someone off the streets and  onwards into 
sustainable accommodation, preventing them becoming entrenched.  Anecdotal 
feedback about shelters which  offer accommodation to all without parameters for 
engagement and positive move on  suggests that rough sleepers do not make 
progress towards recovery and  improved  health. 

4. 

DIRECTION (a) - RESPONSE CONCLUSION 

4.1 

4.2 

4.3 

5. 

5.1 

BHCC aims to ensure that no one has to sleep  rough  in the city and that rough 
sleepers are kept safe during  in  the winter months.  We are working towards 
ending the need to rough  sleep  in  the city. 

Brighton & Hove City Council's Homelessness and  Rough  Sleeping  Strategy 
places significant emphasis on the need to prevent people from  becoming 
homeless and there is ongoing work to improve prevention and sustainment 
outcomes to reduce the numbers of people becoming street homeless. 

Brighton  & Hove City Council is exploring models of shelter provision  being 
provided  in  other areas of the UK and  is  looking at evidence based  practice to 
design services which  gives rough sleepers the best opportunity to  recover from 
homelessness.  This  includes the expansion of Housing  First a model of support 
with a strong evidence base of positive outcomes for rough  sleepers. At present, 
there is no identified budget or building for the provision of a Nightshelter for all 
rough  sleepers. 

BRIGHTON & HOVE CCG- RESPONSE TO  DIRECTION (b) 
A HOMELESS HEALTHCARE HUB WITH ALL NECESSARY SERVICES 
UNDER ONE  ROOF 

B&H CCG  is committed to ensure that the patient population (in  particular those 
that are the most vulnerable)  receive the right care,  at the right time,  in  the  right 
place. 

 5.2 

5.2 

5.3 

5.4 

5.5 

The city continues to see high  numbers of rough  sleepers despite existing 
provision and strong  links between  health and  social care to provide an 
integrated support offer.  BHCCG and  BHCC jointly commission a range of 
services aimed at reducing  health inequalities and  achieving positive outcomes 
that empower individuals to recover from homelessness and end  the need to 
sleep rough. 

In  responding to the Coroner's Direction, the CCG commissions as successful 
and  integrated service model through Arch  Health who provide integrated 
healthcare to  homeless people in  Brighton & Hove.  In  February 2017, Arch took 
over the Integrated Homeless Healthcare Hub contract,  which  includes a GP 
surgery,  hospital in  reach  services,  community health engagement,  outreach to 
day centres and  citywide leadership. 

The GP surgery has around  1,400 registered  patients, with the organisation 
employing 2.3  FTE GPs.  The organisation adopts a very broad view of health 
and wellbeing  in  order to promote 'inclusion  health' amongst the city's most 
deprived and  vulnerable population. Therefore, works very closely with  BHCC 
and the Voluntary and Community Sector to ensure that a streamlined service is 
available to meet the holistic needs of all homeless people. 

In  2019,  Arch Care received  an  'outstanding' rating  from the Quality Commission 
(CQC)  and  continues to aim  high with an  ambition to become renowned for its 
expertise on the design and  delivery of integrated care,  research,  training and 
innovation  in  homeless healthcare. 

Homeless Healthcare services in the city are recognised  as an exemplar model 
by NHSE/1  with the potential to be  replicated  across the country.  The CCG 
acknowledges the Coroner's direction to develop a homeless healthcare hub with 
all  necessary services under one roof.  We believe the current commissioned 
service could  be enhanced to develop a more integrated service with the Local 
Authority.  A  Feasibility Report has been commissioned to develop a strategic 
definition and preparation of the brief on  behalf of Arch  Health CIC for the 
development of a new healthcare facility for homeless and  disadvantaged people 
in  Brighton. 

5.6 

The Feasibility Report will  consider options to further the integration of services, 
and acquire the necessary estate/space to expend the clinical  offer and  house 
various services under one roof.  The proposals include access for homeless 
people of the following  services; 

Integrated primary care team (SCFT) 

•  Homeless mental health services (SPFT)  . 
• 
•  Substance Misuse Services 
•  Health engagement team  (Justlife) 
• 

In addition,  hosting visiting services such as  Dentists,  Dermatology, 
HepC support,  Benefits Support and  Midwives, amongst others. 

5. 7 

The  Feasibility Report was concluded in  February 2020.  Subsequently, the CCG 
has had to focus on the response to the Covid-19 crisis. As we enter the 
recovery period following the initial phase of Covid  response, we will  be 
reviewing the feasibility report to include learning from the Covid  response in 

 relation to supporting the  needs of the homeless population  in  Brighton and 
Hove.