Facts and Figures

• Alcohol related deaths : The Local Authority profile for Newcastle shows there were 427 alcohol related deaths in 2003-05; 321 in males and 106 in females.
• Alcohol related illness or injury accounts for 180,000 hospital admissions per year in England. National estimates show that 17% of all road deaths in 2005 were estimated to have occurred when the driver was over the limit for alcohol. [1]
• Binge Drinking: Excessive consumption and inappropriate drinking of alcohol is a major problem in Newcastle and causes harm to health and increases demands on health services. Almost 30% of adults in Newcastle are estimated to binge drink. It is estimated that 19.5% of drinkers (approximately 44,500 people) drink at hazardous levels and 6.2% (approximately 14,460 people) drink at harmful levels.[2]
• Alcohol-related hospital admissions, chronic liver disease and alcohol-related deaths are all higher in Newcastle than the average for both the North East and England. Locally collected data (Hospital Episode Statistics) show that in 2005/06 there were 1,742 alcohol-related hospital stays by residents of Newcastle. This is approximately 70% higher than the average for England. The hospital admission figures do not include statistics for alcohol related attendance at the Accident and Emergency unit.
• Of these, 45% (792 residents) were aged over 50 years and almost two thirds were White British and male. A small proportion (2.4%) was under 18 years of age. In addition, over a third (39%) of alcohol-related ambulance pick-ups were young people aged under 25 years old; 13% were aged less than 18 years of age and over half were male.
• 51.8% (138) of young people aged 12-18 referred to the D'n'A (Drugs and Alcohol) service in Newcastle in 2007/08 were referrals for alcohol problems; 45% were male and 55% female.

Alcohol and crime and disorder

Excessive and inappropriate drinking can lead to crime and social disorder, with increased demand on Police and other support services. Alcohol is recognised as a contributory factor to many types of crime including violent crime, criminal damage, anti-social behaviour and youth disorder. In 2006/07, there were 2446 crimes where alcohol was a contributory factor, comprising seven percent of all recorded crime. Alcohol is strongly related to violent crime and the 2006/07 statistics show that violence against the person (VAP) crimes where alcohol was a factor accounted for 60% of all recorded VAP  incidents.  40% of all alcohol-related crimes where alcohol played an influential role were in the city centre which contains the highest concentration of licensed premises.

 Alcohol and social and behavioural issues

• Domestic drinking:  A recent survey by the Joseph Rowntree Foundation [3]  found that nearly three quarters of those surveyed regularly drank at home and that drinking at home accounted for 43 % of the drinks market.  Family and friends' homes were also a regular drinking venue for about 63% of respondents.
• Domestic violence: The Newcastle Domestic Violence and Abuse Partnership (NDVAP) support the view that although alcohol abuse does not cause domestic violence, it is a contributory factor for both perpetrator and victim. Findings from the British Crime Surveys revealed 44% of domestic violence perpetrators were under the influence of alcohol during domestic violence incidents. For further information read the Domestic Violence Section.
• Parental misuse and its impact on children: In Newcastle, parental alcohol misuse was acontributing factorin 47.6% of initial child protection conferences in 2006/07.
• Teenage conceptions and sexual risk taking:   Alcohol consumption is known to be associated with risky sexual behaviour.  For more information read the Teenage Conception Section.    

Alcohol and the workplace

• Alcohol Concern (2007)[4] identified that the majority of alcohol misusers are in employment; one in 25 people are dependent upon alcohol and the majority of these are employed.
• The Local Authority Alcohol Profile for Newcastle estimates that there were 560 incapacity claimants attributable to alcohol in 2006.

Alcohol and homelessness

• Data available from the Newcastle supported housing sector (which caters for those who are homeless and people who are excluded from general needs housing) show that in 2006 a total of 468 (22%) of their clients were considered to have a significant alcohol problem. Read more in the Homelessness Section.

 Alcohol and licensed premises

In Newcastle, there are at present 583 licensed premises (including bars and restaurants) that can legally sell and serve alcohol. Over the last five years, there has been an increase in the number of hours licensed to open later in the evening. For example, since 2003 there have been 159 later hours per day and 6.5 earlier hours per day granted to licensed premises across Newcastle. In addition to this, there have been 14 new restaurant type premises granted and one new public house.

[1] Safe, Sensible, Social.  The next steps in the National Alcohol Strategy 2007

[2] Joseph Rowntree Foundation. Drinking places: where people drink and why. Dec 2007

[3] Budd, T (2003), 'Alcohol Related Assault.  Findings from British Crime Survey, Home Office Research',  Development of Statistics Directorate, Ontie Report 35/03.

[4] http://www.alcoholconcern.org.uk

Trends

In Newcastle alcohol specific admission rates have been increasing over time.

Targets

The Newcastle Partnerships Local Area Agreement 2008 - 2021 (LAA 2) indicator the National Indicator (NI) 39 - Alcohol harm related hospital admission rates.  The same target is also contained in the PCTs Annual operating Plan.

 This will be measured by the year on year change in the number of hospital admissions. 

Performance

The Newcastles Alcohol strategy and Action Plan are under development following a city wide consultation in June - July 2008.  Processes for performance monitoring and governance will be set out in the alcohol strategy.

Action plans to reduce alcohol related harm will be put in place in 2008-09 and performance monitored at specified intervals.

Local Views

There have been a series of consultation events and surveys since 2005 about alcohol-related issues and services across Newcastle.  Examples include consultation with young people in the 'Alcohol and young people conference' in June 2006; consultation conducted by Community Action on Health (CAOH) in August 2006 and the Newcastle Community and Voluntary Services in February 2008.

Some of the views expressed suggest that risk taking is a part of growing up, something that needs to be managed and supervised and not stopped. It was felt that young people should be more involved in local committees that oversee young peoples' issues. The celebrity culture was seen as a strong influence on cultural attitudes and behaviour and that" work needs to take place with young people to combat this celeb culture"

 The CAOH consultation summarizes some of key actions needed to tackle alcohol related harm:

 Education and awareness issues

• More education needed in schools and colleges
• More education needed about the effects of binge drinking
• More education/advice for parents
• People should see alcohol as only one of many options for enjoyment

 Support issues

• People need easier referral to support services
• More counselling, treatment, rehab and support in all areas
• Greater early intervention programmes aimed at young people around alcohol
• More support given to family members suffering from an alcohol/drug dependent family member

 Culture Issues

• Party city vs healthy city - Newcastle needs to decide which is more important
• Reduction in social acceptance of binge drinking
• Healthier lifestyles to be promoted as the cool thing to do - not big to smoke, drink or abuse yourself

 Law enforcement issues

• Age limit to buy alcohol increased
• Enforce law better - stricter penalties to those who sell alcohol to underage
• Stop 24 hour access to buying alcohol
• Get rid of happy hours

National and Local Strategies

National policy

• Safe. Sensible. Social. The next steps in the National Alcohol Strategy is the English government's updated alcohol harm reduction strategy, published jointly by the Department of Health and the Home Office in June 2007. This document sets out clear goals and actions that local partnerships should take to promote sensible drinking and reduce the harm that alcohol. It aims to change the drinking culture to one where the majority of the population enjoys alcohol safely and responsibly.  It outlines a comprehensive approach to tackle the different ways alcohol impacts on a community. 

  Key actions include:

o Sharpened criminal justice for drunken behaviour;

o A review of NHS alcohol spending;

o More help for those who want to drink less;

o Toughened enforcement of underage sales;

o Guidance for parents and young people;

o Public information campaigns to promote a new 'sensible drinking culture';

o Public consultation on alcohol pricing and promotion; and

ο Compulsory local alcohol strategies - to be in place by April 2008. 

There are a number of other key national documents that provide a strategic direction to reducing alcohol related harm. These include

• The Alcohol Harm Reduction Strategy for England (2004)
• Public Service Agreements (PSAs) include indicators of relevance to the alcohol strategy that cut across a range of PSAs which are effective from April 2008.  Relevant indicators include:  PSE 13, 14, 16, 21, 23 & 25.  
• The National Crime Reduction Strategy 2008-2011  
• The Police and Justice Act 2006  
• Choosing Health: Making Healthy Choices Easier (2004) 
• Alcohol Needs Assessment Research Project (2006)  
• Licensing Act 2003

 Regional policy

• Better Health Fairer Standards (2007), a health and wellbeing strategy for the North East aspires to a 'culture and environment conducive to safe drinking' the region. It sets out to:  

1. Establish a regional Office for the Safe Consumption of Alcohol;
2. To develop comprehensive, integrated alcohol treatment and support  services, supported by regionally agreed specifications of best practice and by 2010, the North East should have the highest per capita availability of brief interventions in the country; and
3. Build in the longer term, public antipathy to drunkenness, to promote an image of it being both unhealthy and uncool.

• North East Alcohol Misuse: Statement of Priorities (2006)

Local policy drivers

The Local Area Agreement (LAA 2) for Newcastle includes a target to reduce alcohol related hospital admissions.

The Newcastle Ten Year Health Improvement Strategy for 2007 - 2017 aims to encourage and support sensible drinking by: 

o Changing the drinking culture of the city by modifying its party image, making drinking venues more family-friendly and providing more drink-free alternatives for young people;

o Raising awareness levels of the benefits of sensible drinking and the hazards of unsafe drinking;

o Increasing the number of problem alcohol users accessing treatment; and

o Increasing the percentage of people with alcohol problems able to access specialist treatment within five working days.

The Newcastle Alcohol Strategy, Safe Sensible and Social in Newcastle upon Tyne (2008 - 2018) aims to.

 o Developing a preventative approach to alcohol misuse

o Provide services for problem drinkers and their families and carers

o Protect the public through law and policy enforcement

o Prioritise addressing alcohol misuse through working in partnership

Newcastle Council Licensing Policy provides the legislative basis for Newcastle to:

 o Offer a wide choice of high quality, professionally managed entertainment and cultural venues; and

o Provide a safe, orderly and attractive environment, valued by those who live, work and visit the city.

Current Activity and Services

Prevention and education

Schools have responded to escalating problems of alcohol misuse through increasing the emphasis on alcohol education and looking for creative and interactive ways to engage young people in a discussion about the consequences of harmful drinking.  Currently, there is no local coordinated response to prevention for adults in Newcastle. Although certain agencies have developed responses to particular groups, there is no agreed or coherent preventative approach

Newcastle City Council's School Drug and Alcohol Advisor provide curriculum support and alcohol education sessions. They also offer support for school staff in managing alcohol-related incidents and provide training for staff.

D'n'A is Safe Newcastle's drug and alcohol service. It provides targeted prevention and early intervention work with young people to the age of 19.

Streetwise (voluntary sector) provides counselling for young people up to the age of 25 and a drop-in service for advice on drugs, alcohol, sexual health and mental health issues.

General Practitioners provide information and assess and refer patients to specialist agencies.

Tyneside Cyrenians (voluntary sector) provide a range of services and projects that include education and prevention messages (see section 3.2 on adult treatment).

Northumbria Probation Service works with offenders involved in alcohol-related offending in a number of ways including:

• Alcohol Module of Citizen Programme: a one-to-one intervention designed to  address all aspects of alcohol related offending;
• Addressing Substance Related Offending (ASRO): an accredited group work programme designed to help individuals move away from drug and alcohol addictions; and
• Drink Impaired Driving (DIDs): an accredited group work programme for individuals who drink and drive.
• North East Council on Addictions (NECA - voluntary sector) provide support to community groups and carry out some awareness raising

Safe Newcastle's Drug Support Unit has a range of training resources available free of charge and undertake workforce training on alcohol-related issues.

PROPS (voluntary sector) support families and carers who have been affected by substance misuse and many of their clients have been particularly affected by alcohol misuse.

Northumberland Tyne and Wear Mental Health Trust provide in-patient and out-patient detox facilities at the Freeman Hospital and Plummer Court. Plummer Court is a  psychiatrist-led addictions service with Community Psychiatric Nurses, providing a range of  psychological interventions.

NECA (North East Council on Addictions)  provide counselling and alternative therapies for those with alcohol problems.

• Tyneside Cyrenians have several projects in Newcastle:
• Ron Eager House provides day care services for problem drinkers;
• The GAP Project is a project working with sex workers including those with  alcohol problems;
• The ACE Project is an outreach service for chronically excluded people including those with alcohol problems;
• Trading Places offers a peer-led day service to vulnerable adults including alcohol misusers, homeless people and those with mental health problems.

Alcoholics Anonymous - members hold regular meetings in Newcastle: their common goal being to stay sober and help other alcoholics achieve sobriety.

Adult Social Service Drug and Alcohol Social Work Team provides case management and assessment for residential rehabilitation.

The City Council as the Licensing Authority, has endorsed a number of key strategies to tackle alcohol-related problems in direct response to issues raised by residents, businesses, police and other partners. These have included

•  a proactive test purchasing regime;
• the implementation of Designated Public Places Orders across the city, which allow the police to seize alcohol from adults in the street;
• the endorsement and support for 'Alcohol Watch' schemes and 'Challenge 21'.

In addition to these, the City Council's Licensing Policy 2008-2010 stipulates a number of conditions and tactics to be employed to regulate and influence alcohol-related problems, including sections on the Protection of Children from Harm and the Prevention of Crime and Disorder.

Current Funding

The Primary Care Trust leads the joint commissioning for alcohol services.  The PCT's contribution to the joint commissioning expenditure on alcohol services in  2006/07 was £1,133,840 and the amount budgeted for 2007/08 si £ 1,162,913.

What are the key inequalities?

What are the key inequalities?

The North West Public Health Observatory Report: Indications of Public health in the English Regions shows that areas with the highest measures of multiple deprivation have higher levels of health and social outcomes associated with alcohol misuse.[1] In the most deprived fifth of the population alcohol attributable mortality (where alcohol is part of the cause of death) is two to three times greater, alcohol-specific mortality (where alcohol is the main cause) is three to five times higher; and alcohol related hospital admissions are two to five times more than in the more affluent areas.

 However, further work is needed to obtain information on alcohol related inequalities in Newcastle

What are the key gaps in knowledge/services?

 Prevention and Education 

• It is important if we want to influence the drinking culture in Newcastle that we provide people of all ages with clear and simple messages about sensible drinking. Currently there is no coordinated approach across Newcastle to provide reliable and consistent information about safe, sensible drinking and raise awareness of alcohol-related harm. 
• However, information is not enough for most people to make lasting changes in behaviour and such information needs to be given in the context of prioritising early identification and intervention. 
• There are considerable differences in the quality and quantity of alcohol education provided across Newcastle. In addition, it is recognised that a lack of confidence of staff in schools and throughout children's services can lead to a hesitant response or a lack of appropriate action and early intervention when it is required. Supporting staff through training and workforce reform therefore needs to be prioritised.
• Currently, there is no local coordinated response to prevention for adults in Newcastle. Although certain agencies have developed responses to particular groups, there is no agreed or coherent preventative approach.
• There are a series of challenges particularly associated with young people and alcohol misuse. For example, normalisation of heavy drinking in the adult population and the legal status of alcohol means that sensible drinking messages may be less effective with young people. There is an emergent and strengthening street drinking culture amongst young people from the ages of 11 and 12 upwards, particularly across the weekends. Thus, there needs to be wider community context included in future work and a focus on risky behaviour and additional interventions through youth centres and outreach and sports and leisure facilities.
• The needs of children living in families where there is serious parental alcohol misuse have been outlined in the 2007 The Advisory Council on the Misuse of Drugs report: Hidden Harm: responding to the needs of children of drug users report. The recommendations in this report should be a priority. Early intervention in these families can prevent families from being separated and this is prioritised in Newcastle's Safeguarding Children Business Plan.

 Treatment and support services  

• In 2007, Public Health and Safe Newcastle carried out a scoping exercise to identify what services were available for people and families affected by alcohol. Whilst a series of services were identified, including examples of good practice, it is apparent that there is a shortage of treatment and support services, both in the healthcare, social and community settings. 
• Alcohol treatment and intervention services in Newcastle are inadequate for the needs of the population. The Alcohol Needs Assessment Research Project (ANARP) estimated that only one in 102 harmful or dependent drinkers were accessing treatment services in the North East. Although this is a regional figure, it provides an indication of the lack of provision. As a comparison, the equivalent figure for access to treatment for drug misusers is one in every 2.4 problematic drug users is in treatment, compared to one in 102 for alcohol.

• There is at present a huge gap in the provision of Brief Intervention services in Newcastle. A national pilot study is underway in the Newcastle (and elsewhere); initial results look positive and cost-effective. 

Alcohol misuse and homelessness 

• Whilst the supported housing sector in Newcastle provides certain services to support people with alcohol-related problems, there is little specialist provision in the city, e.g. no wet hostel for chronic and chaotic street drinkers and limited outreach services to engage with chronically excluded street drinkers. 

Alcohol services and Information gaps 

• There are considerable gaps in the alcohol misuse intelligence currently available. The 2007 updated alcohol strategy points out "for some of these potentially good intelligence could be generated but systems are not yet fully established or comprehensive; for example, treatment service and GP data, measuring alcohol consumption in children or school exclusions. For others, there is a distinct lack of good intelligence: alcohol economics, industry data on investment in marketing and promotion campaigns and information on the range and evaluation of local interventions"
• In addition, agencies are often unaware of what intelligence partners hold and how this can be accessed. 

What are the risks of not delivering our targets?

If alcohol misuse is not reduced, there are likely to be increasing harm to the health and wellbeing of individuals, families and communities and rising economic costs to society. As people start drinking at younger ages they are likely to develop health problems such as liver cirrhosis and other diseases at an earlier age.

 The LAA target - 'reducing alcohol related hospital admissions' is a proxy measure for alcohol related problems. However it does not in itself give a comprehensive picture of the wide range of social and economic impacts of alcohol misuse.  Nevertheless, in the long term, reducing hospital admissions should reflect better service provision within the community. This includes improving access to intervention, support and preventative services not only in health care but in other areas such as crime reduction, supported housing, cultural change towards more moderate drinking behaviour.

Is what we are doing working?

The Newcastle Alcohol Strategy Safe, Sensible and Social in Newcastle upon Tyne (2008 - 2018) has a series of action plans to achieve the aims to:

• Develop a prevenative approach to alcohol misuse
• Provide services for problem drinkers and theri families and carers
• Protect the pbulic through law and policy enforcement
• Prioritise addressing aclohol misuse through working in partnership

These action plans will be monitored and updates will be provided on progress in the near future.

What is coming on the horizon?

• Following the completion of the alcohol strategy consultation which ended on 31 July 2008, the action plan is now under review and further development.  This alcohol project aims to complete this process by end October so that actions can begin to be implemented in 2008/09.
• An alcohol Health Needs Assessment is underway in the North of Tyne Primary Care Organisations and is expected to be completed by November 08.
• Funding has been obtained from the 2007/08 Choosing Health monies and slippage from the PCT's Annual Operating Plan funds to create an integrated community alcohol team.   
• A North East regional alcohol office (for reducing alcohol related harm) is being set up and is expected to become operational by the end of this year.

What should we be doing next?

1.      Information and education campaigns around sensible drinking

2.      Brief intervention training in health care and other settings

3.      Establishing ‘alcohol policies’ and providing appropriate support in the workplace

4.      An integrated alcohol service pathway development  -  establishing new services and enhancing current provision particularly in the community

5.      Supporting relevant enforcement policies and working with local communities

Facts and Figures

• The main reasons for homelessness inquiries (not only statutory) are: leaving parents and friends, violence, loss of private rented accommodation, non-violent relationship breakdown, rent arrears
• House prices in Newcastle upon Tyne have risen significantly: in the period 2003-2005, with entry level house prices nearly doubling.
• Incomes in Newcastle upon Tyne have not kept pace with house price inflation: with half of the city's households being below £20,000 per year. Socio-economic disadvantage can be both a cause and a consequence of homelessness.
• The need for affordable housing has increased: the latest housing needs survey estimated that additional 500 affordable houses are needed per year for the next 5 years.
• The supply of social housing has reduced by 5,000 units since 2003: A net loss of 800 units per year. This trend looks set to continue with a further reduction of 1,000 units anticipated by 2010.
• Increased repossessions at Newcastle County Court: from 217 in 1997 to 730 in 2007
• Increased risk of home loss: A significant number of households in Newcastle upon Tyne are likely to be at risk from the economic downturn.
• Deprivation remains a significant issue in the city: one third of the city's people live in an area amongst the 10% most deprived in the country. 40% of people in Newcastle upon Tyne live in 20% most deprived area of England. However, deprivation in Newcastle upon Tyne is decreasing. Newcastle upon Tyne has moved from the UK's 20th most deprived city to 37th, the most deprived areas of the City are no longer characterised by desolate estates blighted by hundreds of empty houses and crime and the quality of much of the socially rented and supported housing in the City has improved
• There have been significant numbers of people coming to Newcastle upon Tyne putting pressure on housing: this is mainly students, refugees and workers from Eastern Europe.

• The population of Newcastle upon Tyne has increased to 271,600 in 2007 from a low of 267,100 in 2004 (ONS, 2008). This should be viewed against a population of 284,200 in 1981. There has been an overall trend of decreasing population from 1981 to 2001. Population declined by around 15% from 1971 to 2001. The decline was particularly acute in areas of the Inner West and Outer East of the city.
• Newcastle upon Tyne has a high number of students, refugees and migrant workers that impacts on the availability of housing, for example, the number of students is expected to rise by at least 3,000: students tend to push low income households out of the private rented sector as they can be let to by the room rather than by the property and therefore attract higher levels of rent

Trends

The Social Exclusion Task Force, part of the Cabinet Office defines social exclusion as 'what can happen when people or areas have a combination of linked problems, such as unemployment, discrimination, poor skills, low incomes, poor housing, high crime and family breakdown. These problems are linked and mutually reinforcing' (CO, 2008). Homelessness is recognised as one of the most profound symptoms of chronic social exclusion. We know that there are strong correlations between homelessness and drug abuse, crime and mental ill health, all of which have adverse impacts on the wider community. It is estimated that there are around 6,000 people in Newcastle upon Tyne who require supported housing or who are at risk of homelessness including: 

1. Chronically excluded rough sleepers - this affects a small number of people - up to 10 people on any one night and around 100 per year

2. People living in supported accommodation - at any one time 750 people live in supported accommodation beds and 860 living in general needs accommodation with floating support this covers around 3,000 people per year

3. People living in general needs rented and owner occupied accommodation who are at risk of losing their accommodation. There are a range of estimates of the impact of the economic downturn and at present it is too early to precise as to the effect upon homeowners in Newcastle. However given that Newcastle has relatively high accommodation costs and low wages the impact is likely to be considerable. At present around 3,000 households a year receive advice aimed at preventing homelessness the level of need is indicated by the 30,000+ phone calls a year to HAC.

Statutorily homeless

The number of households applying and being accepted as homeless by the Newcastle upon Tyne local authority is decreasing (shown in Figure 1 under PERFORMANCE). The majority of statutorily homeless are families with children (79% in 2006-07). However, there has been a decrease from 486 households in 2003-04 to 379 in 2007-08 in line with the decrease in acceptances.

Rough sleepers

There are low levels of rough sleeping in Newcastle upon Tyne - estimated to be less than ten people per night. However, a high proportion of those presenting as rough sleeping have an offending background (42% last year), alcohol problems (39%), and/or drug problems (29%). A formal count required to be conducted by local authorities and homeless agencies in April 2008 found 2 people were sleeping rough.

Homeless from Black and Minority Ethnic (BME) backgrounds

People of ethnic minority background are around three times more likely to become statutory homeless than are the majority white population (ODPM, Causes of Homelessness Amongst Ethnic Minority Populations, September 2005), and there is consensus that ethnic minority communities often find it difficult to approach statutory services.  National research highlights differences in the rates of homelessness between various ethnic minority groups.  People of black African and African Caribbean origins are twice as likely to be accepted as homeless as people of Indian, Pakistani, and Bangladeshi origins.  However, research into these differences is limited.

In Newcastle, Black and Minority Ethnic (BME) households account for around 20% of homeless applications from families with children, and a quarter of applications from those have 3 or more children.  

Supporting People client record data shows that of people who accessed housing-related support during 2006/7 due to a primary need of single homeless, a drug or alcohol problem, or offending history, 10% (184 people) defined their ethnic origin as different from white British.

Homeless young people

There was a high level of homelessness among 16-17 year olds in 2003/04 - 209, which reduced to 75 in 2006/07. However, young people remain a group of concern as they are likely 'to have a range of other problems, including offending, experience of violence or other abuse, problems relating to teenage pregnancy, drug use, a history of care'[1]

People with an offending history

There has been a steady increase in the number of offenders seeking accommodation via Newcastle Homelessness Liaison Project (NHLP); many also have mental health needs or problems with drugs or alcohol. One third of offenders in 2006-07 came from outside Newcastle upon Tyne (in 2006/7, just under 400 offenders seeking accommodation came from Newcastle, with 124 people coming from other areas of Tyne & Wear, 50 from elsewhere in the North East region, and 32 from outside the region).

Other data from NHLP shows that in 2006/7, 43.6% of all referrals for temporary and supported accommodation were from people with a history of offending. NHLP data also reveals that during 2006/7, 53% of all evictions from temporary and supported accommodation were for people with an offending history. 

The Probation Service's analysis of Multi-Agency Public Protection (MAPPA) cases shows that Newcastle accommodates twice as many cases as any other authority in the region. 

Invariably for this group there are multiple correlations of need and one of the longer term aims of the Homelessness Strategy is to develop a better understanding of cross cutting needs.

People with drugs and/or alcohol problems

In 2006/7, 1,488 people received drug treatment services in Newcastle upon Tyne. Between 1 January 07-31 March 07, Newcastle's Drug Intervention Project (DIP) assessed the accommodation needs of 164 DIP clients. The snap shot in Figure 1 revealed that 14% of the clients assessed had no fixed abode, whilst 18% were living in temporary accommodation.  However more needs to be done to establish a common verification framework of need.

[1] Newcastle's Homelessness Review Summary 2008, Newcastle City Council, 2008

Figure 1 – Accommodation need of DIP clients in Newcastle upon Tyne – Jan-Mar 07

Supporting People Client Record Form data indicates that the number of people with a primary need relating to drug problems has reduced year on year since 2004/5 (2004/5 - 115; 2005/6 - 92; 2006/7 - 66), and now represents 2% of the total number of people who accessed a service in 2006/7. In the context of this decrease, however, the number of people coming to Newcastle upon Tyne from other authorities has increased from 17 (18.48% of the overall figure in 2005/6) to 22 (33.33% of the overall figure in 2006/7).

The data reveals that the number of people with a primary need relating to alcohol problems has reduced from 71 in 2005/6 to 52 in 2006/7, although since 2003 these figures have shown a tendency to fluctuate. The 2006/7 figure is 40% of the 2003 baseline (77), in real terms this is 2.3% of the total number of people accessing services in 2006/7. In addition to this, the number of people coming into Newcastle upon Tyne from other authorities has also dropped, previously this figure has remained stable and 2006/7 is the first year to have seen a decrease.

The incidence of alcohol and drug problems being cited as a secondary need for accessing a service is 27.6.7% (440) and 21.5% (343) respectively; of all secondary reasons cited. 

Targets

National indicators

1. NI 141 - Number of vulnerable people achieving independent living

This indicator measures the number of people making a planned move to independence from an accommodation-based supported housing that is intended to provide short term support (i.e.: up to two years).

2. NI 142 - Number of vulnerable people who are supported to maintain independent living

This indicator measures the number of people sustaining independence as a result of Supporting People funded long-term services or floating support.  These services may facilitate move on from services relevant to indicator 141.

The Sustainable Community Strategy and Local Area Agreement (2008-11[1] for Newcastle upon Tyne highlights the performance measure and targets for NI141 and 142 in Figure 2:

Figure 2 – Local Area Agreement targets

[1] Newcastle Sustainable Community Strategy and Local Area Agreement 2008-2011, Newcastle Partnership, 2008 

[1] Baseline based on quarter 4 of 2006/07 and quarters 1,2,3 of 2007/08

The Department for Communities and Local Government (DCLG) provided Best Value Performance Indicators (BVPIs) and as part of Newcastle's Homelessness Strategy, it is recommended that Newcastle upon Tyne retains BV213 as a local cross cutting indicator. This has been included in the SCS & LAA 2008-2011 as shown in Figure 3:

3. BV213 - Number (%) of households who considered themselves as homeless, who approached the authority's housing advice service(s), and for whom housing advice casework intervention resolved their situation.

Figure 3 – Local Area Agreement targets

Performance

1. Independent Living

2. Statutory homelessness

The number of households applying and being accepted as homeless by the Newcastle upon Tyne local authority is decreasing (Figure 6).

3. Temporary accommodation

Newcastle Homeless Liaison Project (NHLP) collects data which relates to activity within temporary and supported accommodation for homeless people, and referrals from agencies for clients seeking accommodation (Figures 6 and 7).

Until 2007, over 90% of applicants who the Council owed a statutory duty to were accommodated in its own temporary accommodation. The Homelessness Review Summary demonstrates a decrease in 2007-08 because of an 'increase in access to the voluntary sector and the success of prevention initiatives particularly via YHN reducing the number of tenants presenting as homeless'.[1]

Newcastle upon Tyne has the lowest level of temporary accommodation (56 units) of all the core cities and the Council continues to strive to meet the Communities and Local Government's (CLG) target to reduce the amount by 50% in 2010 (Figure 8).

[1] Newcastle's Homelessness Review Summary, Newcastle City Council, 2008

Figure 8:  Temporary accommodation use per 1,000 population 2007

Source: Newcastle’s Homelessness Review Summary 2008

Figure 9 shows an increase in other supported accommodation which is taken up by households referred by Housing Advice Centre (HAC), again in line with the 2003 strategy: 

4. Use of beds by people from outside Newcastle upon Tyne         

As regional capital, Newcastle often attracts vulnerable and excluded people from outside of the area. Figure 10 from NHLP shows that the proportion of beds being taken by non-Newcastle upon Tyne residents fell from 40% to 23% for all supported housing, and from 54% to 29% for direct access (DA) accommodation. This was in line with the aims of the 2003 Strategy.

5. Other outcomes

• No B&B accommodation used since December 2006

[In 2006/7, 1,232 days were used, with an average spend of £50,000 per annum between 2002 and 2006]

• Increase in prevention

[Homeless acceptances down 38% from 939 in 2004/5, to 584 in 2006/7]

• Number of homeless 16-17 year olds decreased

[Down 65% from 209 in 2003/4 to 75 in 2006/7]

• Increase in BVPI 213 prevention cases

[Increased from 405 in 2005/6, to 1,758 in 2007/8]

• Low levels of rough sleeping

[2008 formal count found 2 people sleeping rough]

• Housing Association nominations on target for the first time in 2007/8
• Increased bed spaces in temporary accommodation

[From 689 in 2004, to 750 in 2008]

• Increased floating support

[From 529 units of support in 2004, to 860 in 2008]

• Increased number of people moving to settled accommodation

[From 284 in 2005/6, increased to 340 in 2007/8]

• Improved facilities

[e.g. YHN's Stepping Stones hostel, Crisis Skylight Centre, BBHA new hostel, Cyrenians' self build hostel]

• Over £5m of capital funds attracted since 2003 for temporary / supported housing and other building projects

Local Views

Engagement with other agencies

There are a number of means of consultation attended by representatives from the voluntary sector (supported housing, advice, education and learning, counselling, and others), housing associations and private landlords, employment link agencies, and other statutory agencies including the local authority, health, police, probation, YOT, and Safe Newcastle.  The following list is an example of the existing consultation forums, although this list is not exhaustive:

• Newcastle Homelessness Forum - quarterly meetings with all agencies with an interest in preventing homelessness;
• Homelessness Prevention Network - an alliance of more than 62 agencies that has developed protocols, policies, information sharing and training;
• Housing Associations/Housing Corporation Liaison group - a monthly meeting with city's major associations and a quarterly review meeting with the Corporation;
• Housing Strategy Review Groups (HSRGs) - two/three-monthly meetings involving agencies including service providers, staff from other commissioning agencies, service user representatives, which discuss service provision for groups including offenders, drug and alcohol users, young people, children and families, and people with learning disabilities or mental health problems. These groups are the primary forums to which officers involved in developing the City's Housing and Supporting People strategies will refer to gain a voluntary and community sector perspective on proposed and existing provision;
• Supporting People Provider-led forum - 6 monthly meeting for supported housing providers;
• Youth Homelessness Forum - user-led forum involved in the quality review of supported housing services, delivery of service-user led training; involved in developing and influencing strategic developments and aims around young people's issues;
• YHN protocol meeting - a quarterly meeting between the City and Your Homes Newcastle (the City's Arms Length Management Organisation)

The Supporting People sector briefings which underpin the Supporting People Strategy 2008/09 -2012/13 set out a number of other groups and forums through which direct and indirect service users and stakeholders can be involved in the Supporting People programme. A comprehensive list of these engagement forums are also available at www.newcastle.gov.uk/supportingpeople.  The Supporting People Involvement and Communication Strategy sets out how the City will continue to work to improve opportunities for service users, providers, partners and stakeholders to participate in planning, developing and reviewing supported housing services at a range of levels.

Consultation events

The review of homelessness, and the development of Newcastle's Homelessness Strategy 2008-20013 and Supporting People Strategy 2008/09-12/13, were carried out through the following activities:

• An analysis of issues raised about homelessness in the Housing Strategy Review Groups (HSRGs)
• Consultation with the HSRGs, other strategic groups, staff in the homelessness service, and partners in the Homelessness Prevention Network and Newcastle Homelessness Forum. This was done through a questionnaire which asked for comments on the priorities drawn from the analysis of issues raised by the HSRGs, and for feedback on particular problems, gaps, and what more we could do to prevent homelessness and help homelessness people to move successfully into settled accommodation.
• Discussion at two Homelessness Prevention Network events
• Consultation with service users and service user forums through focus groups and an exit survey of people using services at the City's Housing Advice Centre. Circulation of the draft Homelessness Review and Strategy to key partner agencies, for comment
• Consultation through the Supporting People Core Strategy Development Group

National and Local Strategies

National policy

The Homelessness Act (2002) requires Councils to act strategically to prevent homelessness. Specifically local authorities are required to develop a strategy every five years based on a thorough review, and for that strategy to plan to address and prevent homelessness across all client groups.

The Supporting People (SP) programme replaced the Housing Benefit-based funding regime for supported housing. SP contracts with accommodation and floating support providers are based on strategic planning, and have been critical in helping to achieve the aims of the Newcastle City Council Homelessness Review and Strategy 2003. Homelessness services are the second largest group of services funded by Supporting People

Local policy

The Newcastle Homelessness Review 2008 and subsequent Homelessness Strategy 2008-2013 recognises that addressing poverty and deprivation are key to reducing homelessness, specifically by:

• consolidating and extending the prevention of homelessness
• increasing the supply of housing options available to prevent homelessness
• increasing the amount and quality of accommodation available for those at risk of homelessness
• improving governance and strengthening partnerships to meet cross cutting needs

Newcastle's Homelessness Strategy 2008-2013 sets local targets through its Action Plan to address these key objectives

The Sustainable Community Strategy (SCS) (2008) recognises that sustainable housing is a pre-requisite of sustainable communities. The prevention of homelessness is included as a local indicator in the 2008 Local Area Agreement (LAA) in addition to the two indicators which cover people moving on to and sustaining independence.  

Supporting People currently fund[1]:

• 199 emergency access beds for homeless people (including 33 units for women and women and children and 47 units for all household types);
• 332 non emergency access beds for homeless people (including 12 beds specifically for people with drug and/or alcohol problems and 6 units for women at risk of domestic violence);
• Advice services supporting up to 478 people at any one time;
• Floating support for up to 108 units at any one time, including 6 units specifically for offenders, 37 units specifically for people with drug and/or alcohol problems; 10 units for women at risk of domestic violence
• 10 refuge beds for women at risk of domestic violence

In addition Supporting People also fund a number services specifically for vulnerable young people aged 16-25:

• 10 emergency access beds:
• 125 non emergency access beds (including 10 LGBT specialist units and 63 Foyer units), plus 10 supported lodging units
• 555 hours of floating support specifically for young people, including young people with more challenging needs

NB: Due to some clients needs falling into more than one group some Supporting People services maybe described as "homeless" by the NHLP but by another category by Supporting People e.g. if the primary need is a learning disability.  Hence the discrepancy between the Supporting People and NHLP figures. 

Council homelessness and homelessness prevention services

The main homelessness services provided by the City Council are based at the Housing Advice Centre (HAC).  Details of the services provided are in Appendix 1. Services are provided to respond to enquiries from people who are homeless, may become homeless, or have other housing problems.

Homelessness Prevention Officers (HPOs): a team of 8 HPOs responds to all enquiries including out of hours and from people in prison, hospital, care, or in the forces. The initial aim is to give advice to resolve a problem if possible, or making an appointment or a referral to another service if needed. The Prevention options on offer are described later.  A homelessness application is taken where it is clear that homelessness cannot be prevented or where the applicant wishes to make a homeless application.  For people not in priority need, help is given to identify suitable other supported housing, and to take steps towards accessing settled accommodation. 

In 2006-7, HPOs saw a total of 1,641 households, gave housing advice to 812 households, and accepted 584 households as homeless.  Homelessness was prevented in 252 cases.

Tenancy Relations Service (TRS): In 2007, TRS saw 580 tenants and 111 owner occupiers and tenants threatened with repossession. The two Tenancy Relations Officers offer:

• advice
• help to mediate or negotiate with landlords on rents and repairs
• court representation in possession proceedings
• action to prevent illegal evictions

The TRS is also part of a court duty representation system which is coordinated by the Newcastle Law Centre. 1,102 households were represented by the Newcastle Scheme in the 2007/8. This is an increase of 300 on the previous year. During the last six months, the TRS has successfully represented people in 22 mortgage repossession cases.

Newcastle Homelessness Liaison Project (NHLP) is a clearing house for accommodation vacancies available to agencies dealing with homeless people in Newcastle. In 2006-7, NHLP received 4,892 referrals, and noted 2,119 people leaving temporary

accommodation in Newcastle (70.5% from Newcastle). NHLP data is collated into regular reports about trends in homelessness within the city.  NHLP supports the Newcastle Homelessness Forum, which meets quarterly and provides a website with regularly updated information,  

NHLP also facilitates a monthly nomination meeting, which looks at individual cases for example of people moving out of hospital, prison, Young Offender Institutes, or emergency accommodation). The aim is to enable a planned approach to securing accommodation, so reducing the occurrence of crisis homelessness.

Newcastle Homelessness Prevention Project (NHPP) aims to prevent homelessness by developing partnerships, policies, protocols and practices, which promote joint working and long term change.  The list of initiatives developed by NHPP can be found below.

Newcastle Homelessness Prevention Network (NHPP) was established in 2006 and currently has 34 signed-up members and a total of 82 organisations involved. The Network develops, promotes and consults on prevention initiatives.

Voluntary sector housing advice

The following agencies provide housing advice, some as specialists and others providing general advice which covers housing:

Specialist housing advice agencies

• Shelter North East Housing Aid Centre

General advice agencies which cover housing advice

• Citizens' Advice Bureaux
• Newcastle Law Centre
• University of Northumbria Student Law Office
• Gateshead Community Legal Advice Centre
• Solicitors (3 registered with CLS for housing)

Our work with partners has enabled the City to lever in considerable resources e.g. Cyrenians: £300,000 for the ACE project, helping to address social exclusion but more needs to be done.

Your Homes Newcastle (YHN) is the Council's Arm's Length Management Organisation (ALMO) set up on 1 April 2004 with responsibility for the management of 31,000 council homes in Newcastle upon Tyne. The Strategic Housing Service (SHS) takes a city-wide strategic lead. The Newcastle-wide partnership approach is supported by a framework - the Housing Toolkit. The Toolkit incorporates the Newcastle Gateway, to be implemented in the next 12 months and the Capital and Revenue Alignment Register (CRAR) and brings together commissioners' and the voluntary sector. Further information is available on the Supporting People website.

Current Activity and Services

Council homelessness and homelessness prevention services

The main homelessness services provided by the City Council are based at the Housing Advice Centre (HAC).  Details of the services provided are in Appendix 1. Services are provided to respond to enquiries from people who are homeless, may become homeless, or have other housing problems.

Homelessness Prevention Officers (HPOs): a team of 8 HPOs responds to all enquiries including out of hours and from people in prison, hospital, care, or in the forces. The initial aim is to give advice to resolve a problem if possible, or making an appointment or a referral to another service if needed. The Prevention options on offer are described later.  A homelessness application is taken where it is clear that homelessness cannot be prevented or where the applicant wishes to make a homeless application.  For people not in priority need, help is given to identify suitable other supported housing, and to take steps towards accessing settled accommodation. 

In 2006-7, HPOs saw a total of 1,641 households, gave housing advice to 812 households, and accepted 584 households as homeless.  Homelessness was prevented in 252 cases.

Tenancy Relations Service (TRS): In 2007, TRS saw 580 tenants and 111 owner occupiers and tenants threatened with repossession. The two Tenancy Relations Officers offer:

• advice
• help to mediate or negotiate with landlords on rents and repairs
• court representation in possession proceedings
• action to prevent illegal evictions

The TRS is also part of a court duty representation system which is coordinated by the Newcastle Law Centre. 1,102 households were represented by the Newcastle Scheme in the 2007/8. This is an increase of 300 on the previous year. During the last six months, the TRS has successfully represented people in 22 mortgage repossession cases.

Newcastle Homelessness Liaison Project (NHLP) is a clearing house for accommodation vacancies available to agencies dealing with homeless people in Newcastle. In 2006-7, NHLP received 4,892 referrals, and noted 2,119 people leaving temporary accommodation in Newcastle (70.5% from Newcastle). NHLP data is collated into regular reports about trends in homelessness within the city.  NHLP supports the Newcastle Homelessness Forum, which meets quarterly and provides a website with regularly updated information at http://www.newcastle.gov.uk/core.nsf/a/nhf_home  

NHLP also facilitates a monthly nomination meeting, which looks at individual cases for example of people moving out of hospital, prison, Young Offender Institutes, or emergency accommodation). The aim is to enable a planned approach to securing accommodation, so reducing the occurrence of crisis homelessness.

Newcastle Homelessness Prevention Project (NHPP) aims to prevent homelessness by developing partnerships, policies, protocols and practices, which promote joint working and long term change.  The list of initiatives developed by NHPP can be found below.

Newcastle Homelessness Prevention Network (NHPP) was established in 2006 and currently has 34 signed-up members and a total of 82 organisations involved. The Network develops, promotes and consults on prevention initiatives.

Voluntary sector housing advice

The following agencies provide housing advice, some as specialists and others providing general advice which covers housing:

Specialist housing advice agencies

• Shelter North East Housing Aid Centre

General advice agencies which cover housing advice

• Citizens' Advice Bureaux
• Newcastle Law Centre
• University of Northumbria Student Law Office
• Gateshead Community Legal Advice Centre
• Solicitors (3 registered with CLS for housing)

Our work with partners has enabled the City to lever in considerable resources e.g. Cyrenians: £300,000 for the ACE project, helping to address social exclusion but more needs to be done.

Your Homes Newcastle (YHN) is the Council's Arm's Length Management Organisation (ALMO) set up on 1 April 2004 with responsibility for the management of 31,000 council homes in Newcastle upon Tyne. The Strategic Housing Service (SHS) takes a city-wide strategic lead. The Newcastle-wide partnership approach is supported by a framework - the Housing Toolkit. The Toolkit incorporates the Newcastle Gateway, to be implemented in the next 12 months and the Capital and Revenue Alignment Register (CRAR) and brings together commissioners' and the voluntary sector. Further information is available on the Supporting People website.

What are the key inequalities?

Young people

Young people aged 16-17 were a particular concern in Newcastle (209 homeless 6-17 years olds 2003/4). There has been a 65% reduction in the number of statutorily homeless 16-17 year olds between 2003/4 and 2006/07 (75 in 2006/07), however, they remain a group of concern as they are likely 'to have a range of other problems, including offending, experience of violence or other abuse, problems relating to teenage pregnancy, drug use, a history of care' (Homelessness Review 2008).  The 2008 Serious Case Review following the death of a young person who was under the care of the YOT and had lived in hostels for homeless people highlighted the need for a better response to young people who have care needs beyond the capacity of support services

House prices

The sharp increase in house prices has had an impact on the numbers needing or wanting social housing in a city with substantial areas of high deprivation (40% of Newcastle's population live in 20% of the UK's most deprived areas). A particular concern in the current economic climate is the increase in repossessions from 217 in 1997 to 730 in 2007. Business commentators predict increases between 25% and 50% in the number of repossessions in 2008-09. These will hit poorer home owners harder and may reverse the recent decrease in the number of eligible households applying to be accepted as statutorily homeless.

Health

There is an increased risk of poorer physical and mental health including drug and alcohol problems among the homeless resulting in a lower life expectancy. Being homeless, or threatened with homelessness, and the uncertainty of being inappropriately housed, also contribute to poor health.

People in the criminal justice system or leaving other institutions

There is an increased risk of homelessness for most groups leaving institutions such as prison, care, hospital, and the forces.

What are the key gaps in knowledge/services?

The following issues around move on were identified through Newcastle's Homelessness Review Summary 2008:

• The high rates of eviction from temporary accommodation: the most common last address for homeless people is a homeless hostel (307 people evicted in 2007). However, during 2007 the proportion decreased, from 34% at the beginning of the year to 21% by the end of year.
• Low rates of positive move-ons: relatively high numbers of people who leave temporary housing go on to no known address (618 in 2006 37% of all discharges (source: NHLP).
• Exclusions: a small number of people are barred from all temporary and supported accommodation.
• Long stay residents: the length of time people stay in temporary and supported accommodation
• Consolidating and expanding our prevention initiatives: particularly the Pathways to Independence and Prevention from Eviction and Repeat Homelessness Protocols.
• Increasing access to private rented accommodation: this will be difficult without increased resources but is the most cost effective way to secure accommodation
• Continuing to improve the quality of accommodation: the better the physical environment the better the persons chances for change.
• It is likely that mortgage arrears and debt will increase: we need to ensure that our advice services can respond to increased demand

Data collection

Newcastle's Homelessness Strategy 2008-2013 refers to the lack of a definitive baseline of the numbers of people within the region whom services cannot accommodate. It is estimated that there around 10 households a year who are excluded from all accommodation.

CRISIS estimate that there are in the region of 400,000 hidden homeless in the UK.

Government statistics do not include people who satisfy the legal definition of homelessness but have not applied to be classified as such, nor people who were officially recognised as homeless in previous years but were deemed 'not in priority need' (thus not entitled to accommodation).

The legislative split between statutorily and non-statutorily homeless people skews the data on homelessness.  The housing charity CRISIS point out that there is considerable ambiguity about the interpretation of these categories.

Vast numbers of single homeless people can be found in both groups - in England and Wales a person is not entitled to any accommodation unless deemed to be 'vulnerable', so single homeless people have less incentive to apply. CRISIS estimate that there are in the region of 400,000 hidden homeless in the UK.

What are the risks of not delivering our targets?

 - Increased homelessness, compounded by current credit and mortgage issues and particularly for those in deprived areas already 'on the cusp of homelessness' (Newcastle's Homelessness Strategy 2008-2013).

- A stable housing situation has a key role to play in improving physical, emotional and particularly mental wellbeing. The Social Exclusion Unit report Mental Health and Social Exclusion (2004) identifies that 'increasing number of adults with mental health problems are homeless or have housing difficulties ' and highlights through their new Public Service Agreements delivery agreement the importance of ensuring appropriate housing, care and support for people with mental health problems as a key part of enabling them to live independently.

- Enabling people to get and keep a home is the first step towards helping them address other issues which may affect their own health and wellbeing and that of the wider community, and which by extension also affect the economic prosperity, safety and cohesiveness of their neighbourhood and the City as a whole. 'A home is a human right, and a necessary precondition for the delivery of all the aims of the ... Strategy.' (NCC, 2007a, p38).

Is what we are doing working?

The Homelessness Strategy, in reducing homelessness, appears to have achieved a number of goals based on the better management of demand through prevention initiatives. In terms of the homelessness services themselves, the improvements which have been made include:

• Changing the culture and refocusing the work of the Housing Advice Centre and homelessness staff, so that prevention is a key element of all our work, and homeless officers have become Homelessness Prevention Officers
• Establishing the NHPP to develop prevention initiatives
• Setting up the Homelessness Prevention Network
• Increasing the number of beds for homeless people in temporary and support accommodation in the city
• Improving the quality and design of hostel provision
• Increasing the number of floating support units which help previously homeless people to maintain their homes
• Developing facilities and initiatives which help homeless people to gain skills for independence, employment, and access to mainstream services
• Ensuring that the sector works in a far more co-ordinated way
• Developing a more joined-up approach to commissioning particularly in partnership with Supporting People and the Drugs Support Unit

However, a number of the initiatives are projects and do not have assured further mainstream funding.

Partnership working appears strong and effective.

What is coming on the horizon?

There may be increasing pressure on housing from the current economic situation.

Homes for a sustainable future: Newcastle's Housing Strategy 2006-2021 has resource implications to achieve the planned programme.

What should we be doing next?

Newcastle's Homelessness Strategy 2008-2013 evidences the need to continue with the preventative approach with the emphasis on reducing demand and improving the quality of the supply of services rather than the quantity. 

The Strategy identifies the following core actions for the ongoing successful prevention of homelessness (in no priority order):

1) Consolidate and extend the prevention of homelessness to reduce demand for crisis accommodation

2) Increase the supply of housing options available to prevent homelessness

3) Increase the amount and quality of accommodation available for those at risk of homelessness

4) Improve governance and strengthen partnerships to meet crosscutting needs

In delivering the above four key themes, the city aims to:

Increase the number of people:

• for whom we prevent homelessness and repeat homelessness
• who live in improved buildings that services are provided from
• who receive support to address the causes of their homelessness
• who move from homelessness to independence
• sustaining their independence
• benefit from the range of options available to prevent homelessness
• involved in meaningful activities and entering employment
• who use homeless services and we engage with to seek their views

Reduce the number of people that are:

• accepted as homeless, by offering appropriate options
• evicted from all forms of housing
• in temporary accommodation by 50% by 2010
• who have to sleep rough

and ensure that:

• families with children are not placed in bed and breakfast accommodation
• no 16/17 year olds are placed in bed and breakfast accommodation
• the allocations policy continues to facilitate the prevention of homelessness
• we provide services that meet the needs of Newcastle upon Tyne's residents, including those with complex needs and are at risk of repeat homelessness

Facts and Figures

It is essential that we understand the needs of refugees and asylum seekers in context of the different circumstances and legal statuses that determine their entitlements.  The term, 'refugee' has a precise legal definition under the 1951 UN Convention on Refugees, to which the UK is a signatory. It describes a person who

"...owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country for his nationality, and is unable or, owing to such a fear, is unwilling to avail himself of the protection of that country"

Anyone can claim refugee status in a country which a signatory of the 1951 convention. In addition, the terms 'refugee' and 'asylum seeker' have particular meanings in the context of UK immigration law - the Refugee Council provides a useful, plain English summary:

• An asylum seeker is a person who has left their country of origin and formally applied for asylum in another country but whose application has not yet been decided.
• A refugee is someone whose asylum application has been successful and who has permission to stay in another country having proved he or she would face persecution at home.
• A 'Failed' asylum seeker is a person whose asylum application has been completed but failed and who has no other protection claim awaiting a decision. Some failed (refused) asylum seekers voluntarily return home, the Government forcibly returns other. Some are unwilling or unable to return because it is not safe or practical for them to do so.
• An 'Illegal Immigrant' is someone whose entry or presence in a country contravenes immigration laws. There is no such thing as an illegal asylum seeker - the UK has signed the 1951 Convention on Refugees, which means that anyone has the right to apply for asylum in the UK.

It is also important that we distinguish between asylum seekers/refugees and migrant workers from those countries who have recently joined the European Union. People from these countries, such as Poland and the Czech Republic, are free to move anywhere within the EU to live and work, although there are tight restrictions on the benefits to which they may be entitled in the UK.

The process of getting refugee status is long and complicated, as is the process of appeal. Under the current asylum system, a person who claims refugee status upon arriving in the UK will receive support under section 95 of the Immigration and Asylum Act 1999. If the UK Government decide that the claim meets the criteria laid down in the 1951 UN Convention on Refugees the person will be granted refugee status and have limited leave to remain, usually for five years, after which their case will be reviewed.

Should the UK government refuse the initial claim the applicant can appeal to the Asylum and Immigration tribunal and they will continue to receive support until they have exhausted all right to appeal. If they have exhausted all right to appeal, the Government requires that they leave the country. If the government accepts that it is currently not possible for them to leave the country then they may still be entitled to limited support - see 'section 4 support' below.

There are, in addition, some circumstances were a local authority might support vulnerable asylum seekers under either the National Assistance Act 1948 or the Children Act 1989. This may include failed asylum seekers who would otherwise have no entitlement to public support. The details of these circumstances are set out in the next section.

The Government expects failed asylum seekers to leave the country. Those unwilling or unable to do so are not entitled to any support from public funds and may end up destitute. This means they have no legal entitlement to housing, means of subsistence or healthcare. The voluntary and community sector in Newcastle is working under great pressure to address the basic needs of these destitute asylum seekers.

Legal Statuses

The UK asylum rules entail an often-confusing array or legal statuses for those people applying for refugee status and moving through the system. This section provides a summary of the most common legal statuses and different kinds of support offered to refugees and asylum seekers in Newcastle. Table 1 sets out the number of people in Newcastle supported under the each of the legal statuses set out here.

Newcastle City Council is the lead local authority in the North East Consortium in supporting asylum seekers under Section 95 of the Immigration and Asylum Act 1999. This is the most common type of support wherein the UK Borders Agency funds accommodation and/or subsistence payments while it considers a person's asylum claim. Your Homes Newcastle takes the lead in managing and providing this support in Newcastle and they provide most of the housing although two private contractors provide a smaller amount of accommodation. Refused asylum seekers may continue to receive central government funded support under Section 4 of the Immigration and Asylum Act 1999 - sometimes know as 'hard case support'. These people are supported by the same agencies and in much the same way as they were/would be under section 95 - the principle difference being that they are issued with vouchers rather than cash to buy food and toiletries) to refused asylum seekers who are destitute and either:

• cannot leave the UK (for example because of  illness or lack of a safe route of return) and/or;
• are taking reasonable steps to leave the UK (by, for example, complying with efforts to obtain travel documentation). 

Newcastle City Council supports some failed asylum seekers under Section 21 of the National Assistance Act 1948. This act says that a local authority has a duty to provide support for people aged eighteen or over who because of age, illness, disability or any other circumstances are in need of care and attention, which is not otherwise available to them. However, the Immigration and Asylum Act 1999 amended this in order to disqualify those who are destitute because of a failed asylum claim. This means that in order to be eligible for assistance a failed asylum seeker must have needs which are 'above and beyond' destitution, commonly know as 'destitute plus'. Such circumstances would typically be ill health, disability and old age but there may be others such as domestic violence and /or if an individual is an expectant or nursing mother. There is an increasing amount of case law on this issue. Newcastle City Council is reviewing the cases of all of the people supported under the terms of this act in the light of recent case law. See the "What is coming on the horizon?" section. (Insert link)

The Children Act 1989 says that a local authority has a duty of care to offer support to anyone under the age of 18, regardless of their immigration status. Where there is a carer, the local authority will support a child under section 17 of the act, providing subsistence payments and accommodation but not necessarily any other services. Where there is not a carer, the local authority will support unaccompanied children under Section 20 of the act, which places a duty on a local authority to look after a child if they appear to be in need, by providing them with services and accommodation.

Asylum numbers are fluid with cases being resolved and statuses changing all of the time. The general trend has been for a decreasing number of new cases combined with an effort on the part of government to deal with a backlog. Newcastle hosts the most Asylum seekers of all North East local authorities - 3% of all dispersed asylum seekers in the UK. This is a similar amount, relative to population size, as other regional centres such as Leeds and Liverpool. Table 1 provides a summary of the number of people in the asylum system in Newcastle compared to the region and the rest of the UK.

Table 1 - Summary of the number of people in the Asylum System in Newcastle, the North East and the UK - August 2008. Source: UK Border Agency and Newcastle City Council

The UK Border Agency (UKBA) data shows that current asylum seekers come from many different counties but the largest national groupings are from Iran, Iraq and Zimbabwe. The experience in Newcastle (2001 to 2007) is that the most typical age is 25-34 with very few people over 60.

The number of new asylum claims has reduced in recent years, in part because the Government has tightened border controls and is now much more likely to refuse applications.

Calculating how many people remain in Newcastle when they are no longer in contact with the asylum system is a challenging task. Failed asylum seekers, for example, will lose access to support and be lost to the authorities while those granted leave to remain are able to move freely around the UK. It is also difficult to obtain statistics on completed cases from the UKBA.

Newcastle City Council's Equality and Inclusion team is working on a pilot research project aimed at getting a more accurate picture of the number of destitute failed asylum seekers in the city. We intend to base the research on successful surveys carried out in other cities, including Leeds and Leicester. Until then we are reliant upon best estimates from our partners in the voluntary sector.

It is extremely difficult know how many refugees stay in Newcastle after receiving a positive decision. The Government supplies details of all dispersed asylum seekers to Primary Care Trusts and Newcastle PCT calculates that the Government

• have allocated 6341 asylum cases to Newcastle since 2001. Nationally, around 20% of asylum cases are successful after appeal.
• Research by 'Open Door', a regional charity, estimates that in 2006 there were more than 300 'failed' asylum seekers living destitute in Newcastle. Recent research in Leeds found that the number of destitute failed asylum seekers had increased in that city between 2006 and 2008

Trends

We expect the number of new asylum cases dispersed to the city will remain steady at around 300 - 350 each year. We may need to revise this in light of any decisions by the UK Border Authority (UKBA) about contracts in the region and any increase in difficulties around the world.

Recent research carried out in Leeds found a significant increase in the number of destitute 'failed' asylum seekers in the city. While there are pitfalls in assuming that the Leeds results would be replicated elsewhere they do reinforce the messages that we are getting from the voluntary sector in Newcastle.

The UKBA decision to improve the decision making for new applications has been reinforced by their approach to older cases. The first phase of 'The Case Resolution Programme (or Legacy) resulted in 180 families having their case reviewed by the UKBA. The vast majority were granted refugee status, leading to a difficult period for the City: potential homelessness and high costs in dealing with the private sector when procuring premises. This trend of reviewing older cases will continue for some time to come (2011 is the UKBA Target)

The Governments policy is to distribute unaccompanied minors seeking asylum in the UK across the country and are looking for LA's to apply for Specialist Authority status to accept these young people and meet their needs. Newcastle/The North East are considering applying for Specialist Authority status to provide services to additional unaccompanied minors seeking asylum in the UK.  It has been suggested that up to 300 young people aged 16-18 years could be dispersed to the city/region.  If Specialist Authority status is granted the implications for social care, welfare, health, education and training, both within Children's services and adult services need to be considered and plans to meet these needs should be negotiated with the Government and other North East LA's.

Targets

The Asylum Seekers Unit (ASU) delivers the service against a Government specification and must report how well it has done. The areas include:

• ensuring the property is of a good standard
• ensuring the ASU has met newly arrived households and they have been taken to their property and had the amenities explained to them.
• provide interpretation when required
• provide useful information on facilities in the locality
• register people with GPs and if required, other health services
• register people with education services
• publicise a complaints procedure.
• provide specified reports to the Home Office.

Performance

Indicators

There has been a strict compliance with the terms of the contract, reducing the exposure to penalties to a minimum - a total of .01% over the past two years of the current contract

Ongoing commitment to the Service Level Agreement with Adult /Children's Services ensures that new cases are supported quickly

In 2006, the Asylum Seekers Unit achieved Charter Mark, which has been verified by ongoing assessment

Local Views

The Asylum Seekers Unit have a range of methods to consult with users of the service and the Unit has been cited as best practice by the Charter Mark assessor.  These include face to fact interviews, customer surveys, drop in sessions and events.

Views are sought 1, 3 and 6 months after clients are dispersed to Newcastle.  The Unit also ask people to complete a questionnaire after they have received a decision on their asylum claim and support is ceased.  Responses are analysed quarterly and the information is used to help plan improvements to the service. Read the 1 month, 3 month, 6 month and exit surveys.

From January to April 2007 ASU carried out an independently assessed Satisfaction Survey which showed that 92% of respondents were satisfied with the services of the ASU. 

The third sector have expressed concern about legislation and have raised a number of issues, particularly:

• The decision making process which is perceived to based upon a wish to 'look tough' on asylum cases - to both refugees and the UK public

 "Failed" asylum seekers who have exhausted all right to appeal - many find themselves destitute, unable or unwilling to leave the country but with no means of support. Third sector agencies have argued that this is a deliberate policy aimed as reducing asylum applications and/or encouraging potential claimants to leave the UK of there own accord.

National and Local Strategies

National policy - Official national policy from the UK Border Agency states that UK policy is to welcome those deemed genuine refugees and quickly remove those deemed false, "The United Kingdom has a proud tradition of providing a place of safety for genuine refugees. However, we are determined to refuse protection to those who do not need it and will take steps to remove those who are found to have made false claims."

Our partner organisations in the third sector have expressed concern about a number of issues, particularly:

• The decision making process which is perceived to based upon a wish to 'look tough' on asylum cases - to both refugees and the UK public
• Pilot schemes to test Section 9 of the 2004 Asylum and Immigration have take place in three areas of the country. Under this legislation, families who have reached the end of the asylum process and exhausted all their appeal rights can have their financial support and accommodation removed if they 'fail to take reasonable steps' to leave the UK. In the event that families are made destitute, they can face having their children removed and taken into the care of social services. The pilot was not well received but the Government is seeking to work with the LGA to move this agenda forward.
• "Failed" asylum seekers who have exhausted all right to appeal - many find themselves destitute, unable or unwilling to leave the country but with no means of support. Third sector agencies have argued that this is a deliberate policy aimed as reducing asylum applications and/or encouraging potential claimants to leave the UK of there own accord.

Current strategies and priorities:

• Continue to deliver the contract to support asylum seekers under sections 95 and 4 of the asylum and immigration act 1999
• Continue to meet our duties in accordance with the National Assistance Act and Children Act.
• Develop direct and campaigning work with and around destitute failed asylum seekers
• The UKBA case resolution program will continue through to completion in 2011. The program is an attempt to deal with a backlog of asylum claims nationally.

Current Activity and Services

Your Homes Newcastle

As previously above Your Homes Newcastle continues to support asylum seekers under the terms of the contract with the UK Border Agency. That is, providing accommodation, services and support under the terms of the Asylum and Immigration act 1999. This includes:

• Managing housing for asylum seekers in the city
• Providing ongoing support as households establish themselves in the community - including registering people with health services
• Working to raise awareness throughout the city in order to tackle misconceptions, misinformation and half-truths that are often exist about people seeking asylum.
• Many third sector agencies in the city provide advice and material support to asylum seekers and refugees including specific projects around employment, integration etc. In addition, many agencies campaign and lobbying in an effort to influence national asylum policy

Newcastle City Council

In addition, as described above, the local authority supports asylum seekers and failed asylum seekers under the terms of the national assistance act 1948 and the children act 1989. Newcastle City Council Adult Services Directorate has two specialist posts to deal with asylum seekers under Section 21 of the National Assistance act. In the first instance, the Newcastle Team checks the immigration status, carries out a community care assessment and, if necessary, a human rights assessment of all new referrals. They also obtain supporting information from the applicant's GP/hospital consultant and arrange emergency accommodation where needed. A failed asylum seekers panel at the city council meets monthly to consider such claims for support and if agreed the City Council arranges accommodation and notifies the UKBA. The Council carries out six-monthly reviews of the person's circumstances. Specialised staff within the Newcastle City Council Children's Services Directorate handles the cases of children and young people supported under the Children Act. They also receive support from other agencies, both statutory and voluntary. Newcastle City Council Children's Social Care department supports unaccompanied asylum seeker children in exactly the same way as any other vulnerable child, using mainstream resources. The initial response team make the first assessment, providing housing and support as appropriate before arranging foster care. When an unaccompanied child reached the age of 16, the Leaving Care Team becomes responsible for their wellbeing. This team have specific resources - three full time social workers, a leaving care worker and one full time CAMHS primary mental health worker who assesses and supports all referrals. 

Newcastle PCT

A member of staff from the BME heath improvement team within Newcastle PCT makes a home visit to each asylum seeker referred to them by the UK Border Authority. At this visit, they ensure that asylum seeker is able to register with a GP practice as well as offering advice on accessing other services and on lifestyle changes such as giving up smoking.

The Voluntary Sector

Local voluntary sector agencies are attempting to support destitute failed asylum seekers with the support of the local authority and statutory agencies where appropriate and within the law. We have three distinct work streams around 'failed' asylum seekers - providing housing & subsistence, legal services and campaigning.

What are the key inequalities?

Asylum seekers and refugees have different entitlements to support dependent upon their legal status - summarised in Table 2 (taken from North East Public Health Observatory 2008[i]). Failed asylum seekers who are not entitled to support under section 4 are in the worst position

Table 2 - Refugee and asylum seekers entitlements

Some refugees and asylum seekers may not have good English skills and therefore find public services difficult to access. A number of voluntary and public agencies in Newcastle are working with limited funds to address this by providing advice and/or interpreting services. In addition, from 2007/2008, the government placed restrictions on the provision of free ESOL (English for Speakers of Other Languages) classes to asylum seekers. Adult asylum seekers are no longer eligible for free ESOL tuition unless they have waited in excess of six months for their claim to be decided.

Discrimination and abuse can be a problem for refugees and asylum seekers regardless of their legal status. This is something the local strategic partnership attempts to minimise through the Safe Newcastle Partnership and the Newcastle City Council Community Cohesion Strategy. Asylum seekers often require legal advice but there is a limit on legal aid available. In addition, the Government refuses the majority of cases at the first application, usually necessitating an appeal.

Even supported asylum seekers receive very limited financial assistance so that even a need to travel can cause hardship. Asylum seekers and, of course, failed asylum seekers are not entitled to work. Homelessness is clearly a problem for failed asylum seekers with no support but even those granted refugee status must leave their supported accommodation and make there own arrangements within 28 days.  For failed asylum seekers destitution is a serious issue - those who feel unable to agree to leave the country are not entitled to any publicly funded support and are entirely dependent upon friends and/or the voluntary sector. A number of voluntary sector agencies are working to provide support to destitute 'failed' asylum seekers. They are supported, were appropriate and within the law, by Newcastle City Council and Your Homes Newcastle Asylum Seekers Unit.  

Recently published research from the North East Public Health Observatory with Primary Care Trusts in the region examines the health issues affecting new arrivals in the region, including Asylum Seekers and refugees. Newcastle PCT has a team within the BME Health Improvement Service who work with refugees and asylum seekers. The NEPHO report found that PCTs in the region were generally knowledgeable about asylum seekers and their health especially in the urban areas, such as Newcastle, that had received the most over time. The research identified the following health issues as being especially prevalent among asylum seekers and refugees across the region. It is important to remember that many of these issues apply equally to children as well as adults.

• Mental Health issues, including post traumatic stress disorder (PTSD), the consequences of trauma and rape, and isolation.
• Sexual Health issues, including Sexually Transmitted Infections (STIs), HIV and unwanted pregnancies. At least one specialised practice, Arrival, make condoms available
• Lack of, or incomplete, screening and immunisations - covering a wide variety of checks from communicable disease, cervical smears, breast screening, hearing, eye checks
• Dental Health - poor dental health and accessing dental care was an issue noted directly in at least four responses.
• Poor nutrition and consequences such as vitamin deficiencies
• Skin diseases and parasitic diseases
• Musculoskeletal problems, particularly of the feet - sometimes from travelling
• Behavioural health problems - opium use, domestic violence, alcohol use, tobacco and smoking 
• Hypertension, H. pylori and diabetes - Sunderland's Health Needs Assessment work has found higher frequencies and earlier onset of these conditions

• As an example, the NEPHO report highlights that in a recent analysis of case records by the liaison psychiatry team at the Royal Victoria Infirmary in Newcastle found that they had seen 50 cases of self-harm in asylum seekers and refugees between 1998 and 2007.
• In addition, Newcastle PCT highlight a number of areas that are of particular concern in Newcastle, notably sexual health and mental health issues, many of which are the consequence of torture or abuse. Dental problems were also highlighted by Newcastle PCT as was the fact that many people also require catch up immunisations and cervical smears. The other major issue highlighted in Newcastle was the task of ensuring access to healthcare:

• Access to appropriate services including GP registration and secondary care services, particularly in relation to sexual and mental health and appropriate initial assessment, clear explanation and discussion with patients.
• Destitute asylum seekers being denied access to secondary care except A&E treatment, proposals to restrict primary care to this group too which has public health implications.
• Those on Section 4 support having vouchers rather than cash which can mean that they must travel long distances to spend them; having less to spend than those on income support and often not being able to buy appropriate provisions for babies.

• Some asylum seekers and refugees come from parts of the world that have high rates of certain diseases. Authorities need to be aware of what these diseases are, who may need to be screened and arrangements for proper control - the Health Protection Agency has responsibility in this area. Infectious diseases that are significant are Tuberculosis (TB), Human Immunodeficiency Virus (HIV), Hepatitis and Malaria.  There are some concerns that not all cases of HIV are being picked up. For example, in the Black African population in the North East living with HIV (290 of the total number of 868), there are 213 women and only 77 men. This is much more likely to represent the ways in which HIV is detected in antenatal settings than the incidence of HIV (NEPHO 2008)

What are the key gaps in knowledge/services?

It is very difficult for us to know where people go when they have been through the asylum application system. If a decision is positive then refugees may move freely around the UK. 'Failed' asylum seekers who the UK Border Authority do not remove from the country will lose access to support and be lost to the authorities.

What are the risks of not delivering our targets?

If we fail to manage and meet the needs of refugees and asylum seekers, we risk

• Increasing numbers of destitute homeless asylum seekers with no recourse to public funds
• Increasing pressure on the third sector organisations
• Social and community cohesion problems
• Public health problems because of
  
  • particular health needs that people have upon arrival and;
  • health problems that may emerge because of destitution

Is what we are doing working?

The Asylum Seekers Unit at Your Homes Newcastle succeeds in supporting asylum seekers under the terms of the contract

Newcastle City Council takes its duties under the National Assistance Act 1948 and Children Act 1989 very seriously and supports more people in this way than all of the other local authorities in the region combined. Newcastle is talking to other authorities in the region in an effort to share the workload more widely.

The recent report by the North East Public Health Observatory [1] found that, like other PCTs in the region, Newcastle PCT has specialist staff, knowledgeable about asylum seekers and refugees

There the numbers of destitute failed asylum seekers who have no recourse to public funds continues to increase but there is a limited to what local public agencies can do address this. We will continue to assist our partners in the voluntary sector in their support and campaigning work.

[1] New Arrivals in North East England: Mapping Migrant Health and NHS Delivery - North East Public Health Observatory (2008)

What is coming on the horizon?

Recent case law on the national assistance act means that up to half of the people currently supported by Newcastle City Council under the terms of the act may no longer be entitled to that assistance. As of December 2008, the authority is engaged in a review of all cases and plans a managed move of all eligible cases onto UK Border Authority support - either section 95 or section 4. The Council is implementing these changes in consultation with its third sector partners. The primary concern arising from this change is that those people unwilling to accept section 4 support may become destitute.

What should we be doing next?

Most of the issues and our plans for what we should be doing next are set out in previous sections.

In summary:

• Continue to help, were possible, destitute 'failed asylum seekers' by working with our third sector partners
• Support asylum seekers while they wait for a decision on their asylum claim and assist them to move on if their claim is successful
• Continue to monitor asylum seeker health needs
• Support the integration of refugees and asylum seekers into the city
• Continue to support vulnerable asylum seekers and children under the National Assistance Act and the Children Act

Many asylum seekers and refugees have serious physical and mental health problems - because of the countries they are from and because of their experiences. However, the relatively successful partnership working between the various voluntary and statutory agencies in the city together with the managed nature of asylum seekers arrival in city means we are confident that we do well at meeting their health needs. As emphasised throughout this report, our principal area of concern is what happens after the asylum application process, particularly the situation of destitute 'failed' asylum seekers who remain in the city.

Facts and Figures

Smoking prevalence

The 2006 General Household Survey suggests a drop of four percentage points in smoking prevalence in the North East from 29% in 2005 to 25% in 2006.  Whilst it is likely that a downward trend may also be occurring in Newcastle, synthetic estimates suggest that smoking prevalence in adults (aged 16+) is 31.7%,  which is significantly higher than the national prevalence of  24.1% . (Table 1)  The North East Public Health Observatory estimates a slightly lower smoking prevalence of 26.8% in Newcastle. (NEPHO, 2004).  In any case, based on these figures, the regional targets for 2010 and 2015 may not be met without additional efforts to reduce smoking prevalence.

Through out this document, data for North Tyneside and Northumberland are also given to aid comparison. It is also important to note that Newcastle Primary Care Trust provides a joint NHS Stop Smoking Service to both Newcastle and North Tyneside.

Within Newcastle, there are considerable variations in estimated smoking prevalence across the city with up to 51% of the adult population smoking in the former Monkchester ward (contained parts of Walker, Walkergate and Byker wards) and 49% in Walker compared to only 17% in the former South Gosforth. In general, smoking prevalence tends to be higher in areas of deprivation.

Smoking prevalence in 11-15 year olds

Data on smoking prevalence for 11-15 year olds taken from the 2006 annual survey of secondary schools in England show that the that the percentage reporting that they are a regular smoker has fallen faster than required to meet the Smoking Kills target.

Smoking during pregnancy

A particular priority for the Government is to reduce the proportion of women who smoke during pregnancy.  Smoking remains one of the few modifiable risk factors in pregnancy, and it can cause a range of serious health problems, including lower birth weight, pre-term birth, and infant mortality. 

Smoking attributable mortality

Newcastle has rates of smoking attributable mortality that are statistically significantly higher than the England rate. The Newcastle Community Health Profile (NHS, 2008) indicates that the death rate from smoking is higher than the regional and national average and on average smoking kills about 566 people each year in Newcastle-upon-Tyne, this equates to 304.50 per 100,000 population aged 35+, (312.10 in 2007) . Areas with the highest smoking prevalence also experience the highest rates of death from smoking. Death rates from tobacco are two to three times higher among disadvantaged social groups than among the better off. 

Self reported four week smoking quitters

The Department of Health's preferred indicator is the rate of self-reported 4-week smoking quitters per 100,000 population aged 16 or over.  An equity audit of the North of Tyne NHS Stop Smoking Services[2] undertaken in 2006 showed that in Newcastle, the proportion of people accessing the service (that is setting quit dates) and successfully stopping smoking at 4 weeks remained similar across socioeconomic quintiles. That is, data do not show selective targeting of the more deprived smokers. This is in contrast to the picture in North Tyneside and Northumberland as illustrated in the graphs below. (Figures 1 - 3)   Quintile 1 includes the most deprived 20% of the population and Quintile 1, the least deprived.

Figures 1 – 3:  Inequalities in smoking:  Estimated smoking prevalence and percentage of smokers quitting at 4  weeks

[2] Corris. V, Ruta D.  Measuring Progress in Reducing Health and Health Care Inequalities in the North of Tyne Area.  Stop Smoking Services.  NHS North of Tyne Commissioning Consortium.  2006.

Trends

Smoking During Pregnancy

Newcastle has made significant progress on this issue over the last five years. The current prevalence is 18%.  (Table 2). However, in general, higher percentages of women smoke throughout pregnancy in areas with higher levels of deprivation.

National Indicator NI 123: Smoking quitters per 100,000 population aged 16 and over.

In 2008/09, the Local Area Agreement and the Primary Care Trust's Annual Operating Plans have agreed to the same target - 2,500 self reported smoking quitters at 4 weeks. This corresponds to a rate of 1,161 quitters/ 100,000 population. (Table 3)

It is important to note that this indicator specifically measures the number of people who stop smoking using the NHS Stop Smoking Services only. (Those who quit on their own or through other sources are not included in the indicator)  

Targets

There are regional, national and local targets related to smoking which include the following: 

National targets

• To reduce adult (16+) smoking rates to 21% or less by 2010, with a reduction in prevalence among routine and manual groups to 26% or less (PSA Target)
• To reduce smoking among 11-15 year olds from 13% (1996) to 11% by 2005 and 9% by 2010
• To reduce smoking among pregnant women from 23% (1995) to 18% by 2005 and 15% by 2010

Regional targets

• To achieve a regional smoking prevalence for the North East of no more than 23% by the end of 2010 To achieve a regional smoking prevalence rate of 20%, or a level below the national average, by 2015.
• To achieve an absolute regional smoking prevalence level of only 10% by 2032.

Local target

Indicator: (LAA 2 & the PCT's Vital Signs indicator)

National Indicator NI 123: Smoking quitters per 100,000 population aged 16 and over.

In 2008/09, the Local Area Agreement and the Primary Care Trust's Annual Operating Plans have agreed to the same target - 2,500 self reported smoking quitters at 4 weeks. This corresponds to a rate of 1,161 quitters/ 100,000 population. (Table 3)

It is important to note that this indicator specifically measures the number of people who stop smoking using the NHS Stop Smoking Services only. (Those who quit on their own or through other sources are not included in the indicator)  

Performance

Health Care Commission report

In 2006, the Healthcare Commission review of tobacco control in Newcastle gave a rating of excellent.

PCT Performance Monitoring

Between April 2007 and end March 2008, a total of 5,134 smokers set a quit date with the NHS Stop Smoking Service in Newcastle, of whom 2,369 people had stopped smoking at 4 weeks

This corresponds to a 46% quit rate. Nationally, the expected success rate range is 35% to 70%.

In Newcastle, and other PCOs in the North of Tyne, the number of people stopping smoking using the NHS Stop Smoking Services has been falling. The reasons for this are not fully understood.  In June 08 the number of smokers successfully quitting at 4 weeks using the NHS Stop Smoking Services was below the trajectory required to meet the vital signs/LAA2  target. A  draft North of Tyne Action plan has been developed to improve performance on this indicator; this process is being facilitated by the North of Tyne  Performance unit

Feedback from the National Support Team on Health Inequalities on Tobacco control activity in Newcastle following a visit from the NST in June 2008 was generally positive. The team made the following points:

• Both Newcastle and North Tyneside have strong committed and accountable tobacco control alliances
• The Health Gain and Health and Wellbeing strategies developed in North Tyneside are exemplars of good practice
• Supported by FRESH North East, both areas are able to address often neglected areas of tobacco control - including smuggling and illicit sales and training for metal health workers
• The Stop Smoking Service (SSS) is operating a 'hub and spoke' model and use of partners ensures diversity of delivery methods to reach the areas where smoking is most prevalent and embedded. Examples include Drop in to Quit, Smoke Free Project Office and BME community workers.
• Good examples of the use of evaluation and surveys to inform development of Tobacco Control

Recommendations from the NST include:

• Developing a Health Gain Schedule used to support a systematic delivery of key stop smoking messages through front line staff;
• Communications planning is integral to delivering on the stop smoking agenda; to enable broader ownership and partnership with all stake holders including the public
• The Stop Smoking Service specification should ensure a systematic approach in meeting the needs of prioritised groups of smokers.

Local Views

A range of methods of public engagement have been employed on the tobacco control agenda, as follows:

• The Newcastle and North Tyneside Stop Smoking Service routinely collects user feedback on its services.
• Community Action on Health carried out consultation exercises with people living within disadvantaged areas of inner West and Outer West of Newcastle and with a group of Community workers to ascertain their knowledge about the NHS Stop Smoking Services.

Findings include the following:

• Participants felt that a 10-20 minute consultation (in Intermediate level services, mostly in General Practices) was not long enough to be effective.

• With regard to stop smoking services in pharmacies, some felt that this may not work because of privacy issues in an enclosed environment; others thought that pharmacists were more approachable than doctors.

• In terms of information leaflets, there is a need to make these more relevant and available in a variety of languages and on video.
• There was general support for specialist stop smoking services but it was felt that they should be community-based rather than in a clinic or hospital; and that they should not be called 'clinics'.
• For BME communities, the need for the service to be culturally aware was mentioned; for e.g. having the same sex advisers and interpreters.
• There was a feeling that people should be able to access support without having to commit to giving up smoking completely.
• Support groups and drop-ins based in the community were seen as a more informal and relaxed set up. It was suggested that smoking advice should be incorporated into 'well person clinics' which could include 'stress relief' therapy, acupuncture, weight management.
• It was suggested that Nicotine Replacement Therapy (NRT) should be free to all.

Read the full report

Community Action on Health (CAOH). Smoking Cessation - what do communities know about the services available?.A report to establish people's awareness and use of accessing NHS Stop Smoking Services in the Inner West and Outer West of Newcastle upon Tyne . June 2008

National and Local Strategies

National policy drivers

• On July 1st 2007, a landmark piece of legislation, 'The Health Bill' came into effect in England making smoking illegal in virtually all enclosed public places and work places. This legislation provided the national and local tobacco control programmes with the potential to make 'not smoking' the norm in England.
• In England, tobacco control activity is guided by the Department of Health's six strand approach, based on international evidence that a co-ordinated and multi-faceted response to the tobacco epidemic is required to effectively tackle tobacco use. These six strands are:
  • Support smokers to quit;
  • Reduce exposure to second hand smoke;
  • Run effective communications and education campaigns;
  • Reduce tobacco advertising, marketing and promotion;
  • Regulate tobacco products; and
  • Reduce the availability and supply of tobacco products

Other key documents include

• Smoking Kills: the Department of Health's (DH) 1998 white paper which set out for the first time in the UK, a comprehensive tobacco control strategy and announced the introduction of a new NHS smoking cessation service. The focus of the service would be to help all smokers quit smoking, whilst specifically targeting young people, pregnant women and socio-economically disadvantaged smokers.
• The 2003-2006 the DH's Priorities and Planning Framework and the subsequent PSA 2005-2008 set smoking cessation targets for Primary care Trusts towards reducing health inequalities by 10% as measured by infant mortality and life expectancy at birth. The revised target was to reduce adult smoking rates from 26% in 2002 to 21% or less by 2010, with reduction in prevalence among routine and manual groups from 31% in 2002 to 26% or less. An additional target was to reduce smoking by 1 percentage point per year in women who continued to smoke during pregnancy.
• Choosing Health: making healthy choices easier (2004),
• The Wanless report; securing our future health. Taking a Long Term view (2002)
• NHS Cancer Plan (2000),
• The National Service Framework (NSF) for Coronary Heart Disease (2000)
• The Acheson report: an Independent enquiry into Inequalities in Health (1998)

Regional policy drivers

• The vision for tobacco control is of a smoke free North East with year on year reductions in smoking prevalence coupled with a comprehensive range of stop smoking support services provided in accessible venues, specifically targeting the more deprived areas North of Tyne. Regional policy documents include
• The 2007 regional public health strategy which highlighted tobacco control as a key area for action.  "The North East will reduce its overall smoking prevalence to the lowest in the country and will narrow the gap in smoking prevalence between social groups." The strategy also aims to "establish regional standards for quantity and quality levels of Stop Smoking Service provision that require the less well performing areas to increase their activity to match those achieved by the best, and to continue improvement in all services to ensure that those in the North East continue to be the most effective in the country

Local policy context

• The Newcastle Partnerships Local Area Agreement (2008 - 2021) contains a target to reduce the number of people who smoke.
• The Newcastle Health improvement strategy (2007 - 2017) sets out to make Newcastle a smoke-free city, by reducing the prevalence of smoking in the population of Newcastle and increasing the number of smokers who quit smoking. 
• Smoke Free Newcastle, the city's tobacco control alliance was established in 2004. In 2005 it produced a comprehensive 3 year tobacco control action plan which acted as the local delivery plan for the regional tobacco control strategy; the Newcastle action plan has been recently updated for 2008/09. 

Current Activity and Services

Tobacco Control and Stop Smoking Services

FRESH - the regional office for a Smoke Free North East is commissioned by Newcastle PCT and the other Primary Care Organizations (PCOs) in the region, to implement a comprehensive business plan to reduce smoking prevalence and increase the smoke free initiative

Smoke Free Newcastle is a multi disciplinary and cross agency alliance, co-ordinated by Newcastle PCT (lead agency) and Newcastle City Council which oversees tobacco control issues across the city.  The alliance is accountable to the Well-being and Health Partnership of the Newcastle Local Strategic Partnership.  Smoke Free Newcastle had a three year action plan covering the period 2005-08.  It has recently developed a one year action plan covering 2008/09 whilst the forthcoming National Tobacco Control Strategy is produced.  Once the national strategy is produced a new Regional Tobacco Control Strategy will be written, out of which a local action plan for delivery will emerge.

Current plans for Newcastle focus on the following key areas of tobacco control:

• Build the infrastructure, skills and capacity for local tobacco control across partner organisations in Newcastle.
• Reduce exposure to second hand smoke by supporting all workplaces and public places to effectively enforce the smoke free law and lead the introduction of programmes to reduce second hand smoke exposure in the home and in cars.
• Continue to provide free NHS stop smoking support to people wishing to quit through the Newcastle and North Tyneside Stop Smoking Service, focusing particularly on routine and manual workers and other 'hard to reach' groups.
• Support and develop public education and media campaigns which aim to give the public more information on the dangers of second hand smoke, stop smoking support and to prevent the uptake of smoking among young people.
• Reduce the availability and supply of tobacco products and address the supply of tobacco to children, working with FRESH and the HM Customs and Revenue Service to implement a regional strategy on counterfeit and smuggled cigarettes. Smoke Free Newcastle will continue to take action to reduce illegal tobacco sales to minors by carrying out regular test purchasing of cigarettes.
• Monitor tobacco regulation to ensure that relevant laws relating to tobacco are effectively enforced. This includes legislation on tobacco advertising.
• Reduce the promotion of tobacco by collecting evidence on how cigarettes are legally promoted at the point of sale, which can be fed into to national consultation.
• Undertake research, monitoring and evaluation of the plan to ensure that Smoke Fee Newcastle delivers an effective programme of action which is based on sound evidence.

The Newcastle and North Tyneside Stop Smoking Service has a separate delivery plan for 2008/09.  During this year the service will focus on:

• Targeting marketing to harder to reach groups to address the recent drop in referrals of motivated quitters; and
• Reviewing the less well performing parts of the service (e.g., drop in centres).
• Improving stop smoking quit rates at 4 weeks, by renegotiating Service Level Agreements with General Practices and Pharmacies.

Between 2006/07 and 2007/2008 Neighbourhood Renewal funding was secured for a project focused on Newcastle's NRF areas.  This comprised two main strands:

• Intensive smoke free support to businesses in NR areas to support them to prepare for the smoke free legislation in July 2007; and
• Stop smoking support from a Stop Smoking Advisor who used evidence based community development methods to encourage smokers, at community level, to access stop smoking services.

A Health Gain Schedule (HGS) has been drawn up between  Public Health and the PCT's provider unit,describing measurable ways in which appropriate front line health care professionals can help deliver the '4 week smoking quitter'. and other health improvement targets.  The effectiveness of the HGS will need to be monitored and reviewed at agreed intervals (annual?)

Resources and investment

Newcastle makes the following financial contributions to tobacco control:

• £86k to the FRESH Smoke Free North East Office;
• £230k core funding to local NHS Stop Smoking Services;
• An additional £144k for other stop smoking or tobacco control activity, for example from Choosing Health allocations.

Between 2006/07 and 2007/08 Newcastle through their local authority partners managed to secure time-limited Neighbourhood Renewal Fund grants to support tobacco control activity.  In addition, there is investment in staff time for tobacco control (the costs of which are not captured here).

Partnership arrangements

Smokefree Newcastle is a multi-disciplinary, cross agency alliance run in partnership between the PCT and Newcastle City Council.  The alliance is accountable to the Well-being and Health Partnership of the local strategic partnership.  Tobacco Control is an integral part of:

• The city's local area agreement, with clear links to programmes aimed at reducing inequalities in all age all cause and cardiovascular disease mortality; and
• The Newcastle Health Improvement Strategy.

Barriers and risks

In the section below, barriers and risks are reported for general tobacco control activity and for the NHS Stop Smoking Service.

Tobacco Control

The biggest risk to on-going support and delivery within tobacco control is the view that, with the introduction of the Smokefree legislation on 1st July 2007, we have done everything there is to do.  The on-going support for the tobacco control agenda is evident within the Newcastle Health Strategy and the Local Area Agreement.

Newcastle PCT makes a financial contribution to FRESH Smoke Free North East, but there needs to be a robust service level agreement that ensures this provides good value for money.

Newcastle does not have an identified budget to support the work of a tobacco alliance.  Small grants are available from FRESH or other sources for particular projects; in-kind resources are associated with staff working on the tobacco control agenda.

The current consultation on a new national strategy for Tobacco Control and the recent publication of the ten high impact changes will be taken as an opportunity to review local plans for tobacco control activity.

Stop Smoking Services

The recent Department of Health guidance to NHS Stop Smoking Services recommends that primary care staff should not be paid for stop smoking activity or for the return of data monitoring forms to the stop smoking service, unless the work is being carried out outside normal working hours or by 'bank staff'.  Newcastle PCT is supporting payments to GPs for returning data and is not currently planning to terminate them.  Nevertheless, the service is reporting a reduction in activity through primary care and will be working with both practices and commissioners to address this issue in the coming year.

National policy emphasises the need to target routine and manual workers rather than focusing on area based approaches to tackling inequalities.  This particular focus may be in conflict with local programmes, such as neighbourhood renewal.

Recent NICE guidance in relation to smoking cessation makes clear that all drug therapy treatments including Zyban should be offered as a first level treatment to clients. Currently the PCT offers Zyban only as a second line treatment.

The availability of cheap illicit and counterfeit cigarettes is seriously undermining efforts to reduce smoking prevalance particularly among disadvantaged communities. Fresh is currently consulting on a North of England Action Plan on this subject. It will be essential that the PCT and local tobacco alliance implements the plan locally.

What are the key inequalities?

• The number of people accessing stop smoking services living in disadvantaged areas of the city needs to be increased in order to impact on reducing health inequalities.
• The DH target group for stop smoking services is routine and manual workers where smoking rates remain high and targets for 2010 may not be met.
• Smoking prevalence in pregnancy is higher in the more deprived areas of Newcastle.
• The use of cheap and illicit tobacco by residents living in disadvantaged circumstances is high. This could potentially undermine the tobacco control work undertaken and increase health inequalities further.

What are the key gaps in knowledge / services?

• There are gaps in our knowledge and understanding of why smoking prevalence is higher in deprived communities. Though one in 7 smokers wants to quit, the success rate of quitting at 4 weeks in  the more deprived areas tend to be lower than in the more affluent areas.
• There are gaps in our understanding and information in relation to  smokers using cheap and illicit tobacco and about what would help them to quit. This information could help to inform a social marketing approach to tackle the issue. Fresh is has initiated some work on this.
• It is not clear how routine and manual workers can be most effectively targeted to quit. Smoking is a social norm for a number of communities in Newcastle so interventions need to segment target groups to ensure that messages are most effective.
• Engagement with services involving young people (excluding schools) such as the youth sector needs to be increased to ensure that education/prevention/advocacy programmes better meet the needs of young people and the next generation of teenagers remains smoke free. Key opinion formers in this setting need to be targeted to increase the profile of tobacco control with them.

What are the risks of not delivering our targets?

• Smoking prevalence will not show a significant decline in Newcastle.  As smoking is the single most important preventable cause of ill health and early deaths, this is likely to increase the health inequality gap between Newcastle and England as a whole. In addition, as smoking prevalence is known to be higher among lower socio economic groups health inequalities within Newcastle will increase.
• Young people may continue to take up smoking if the cultural norm in Newcastle does not shift towards 'not smoking'

Is what we are doing working?

• Compliance with smoke free legislation in Newcastle has been above the national average of over 99% both for signage and management response to prevent smoking in a smoke free area.
• The recent fall in smoking prevalence among the whole population in the UK would suggest that the stranded approach to tobacco control, which has clear measures in place at a local, regional and national level is effective. Indeed international evidence supports the approach being taken. The prevalence rate in the NE has fallen faster than in any other region.
• However, with regard to achieving the set LAA / Vital signs target, the number of people successfully quitting at 4 weeks via NHS Stop Smoking Services is showing a gradual decline.  The exact reasons for this is not well understood, but hypotheses include that some motivated smokers may be stopping on their own, without support from the services, that they may be using NRT which is now readily available in supermarkets and other outlets, that the current smokers are the more entrenched smokers who may not want to stop or who find it harder to give up. More research is necessary to get a picture

In relation to the dropping rates.

The PCT needs to monitor smoking prevalence effectively, particularly aiming to increase QOF data returns on smoking to a level of at least 70% in order to ensure the data are accurate as possible. Whilst data on 4 week quitters is used as a proxy for smoking prevalence, this indicator only captures a very specific part of the tobacco control programme; in addition research suggests that only around 10-15% of those who stop smoking at 4 weeks remain non-smokers at 52 weeks.

What is coming on the horizon?

• A public consultation by the Department of Health on a comprehensive 25 year strategy for tobacco control was completed in September. The proposed strategy set out a wide range of measures to effectively tackle tobacco, including new measures on harm reduction and legislation relating to reduce the marketing of tobacco products to young people. The new tobacco control strategy is awaited.
• Smoke Free Newcastle has a clear action plan for delivery in place for 2008-9 which uses the 8 strand approach to tobacco control shown to be effective. In 2009 once the National Tobacco strategy is in place a new regional tobacco strategy will be produced by Fresh from which an action plan for Smoke Free Newcastle will evolve. This is likely to cover a 3 year period 2009-2012.

What should we be doing next?

1. It is important that the PCT continues to invest in the Stop Smoking Service to ensure that stop smoking support is offered to those who have most to gain from stopping. This will impact on reducing health inequalities. Elements of the action plan that are likely to increase the number of smoking quitters should be strengthened in the short term. These include increasing access to stop smoking services particularly in the more deprived areas, through General Practices, Pharmacies and other key community venues.

2. Investment in the communication strategy for tobacco control, including the use of Social Marketing tools is essential to facilitate target groups of smokers (e.g. routine and manual workers; smokers from deprived areas) to stop smoking. Newcastle will be participating in the North of Tyne and regional communication strategies.

3. The funding of the regional office for tobacco control - Fresh, is important and must be continued. Fresh provides a comprehensive strategic direction for effective tobacco control at a regional and local level which is now being modelled elsewhere in England.

4. The PCT also needs to continue to support the community services directorate through the Health Improvement Team, to take a lead role in delivering the tobacco control agenda in Newcastle.