The second workshop of the morning was hosted by colleagues in Crisis who have worked with councils on service design and delivery and are a key voice in the sector on best practice for homelessness and rough sleeper services.
Councils were presented with five areas to comment on where improvements could be made locally and where they have identified good practice that works – Prevention, housing-led services, complex needs, restricted eligibility and overarching/other.
Partnership working was the predominant theme in this area. Attendees shared local ideas for national issues such as how to share better data, how to recruit and hold onto staff and what councils can do to better understand the journey towards rough sleeping.
The ideas that were shared at the roundtable are listed below with examples of this working, and associated case studies sourced after the event.
a) Prevention
1. Work with and support community based organisations to identify and signpost people to prevention services
It Takes a City - Cambridge
It Takes a City brings together those with lived experience, managers and front-line workers, members of faith communities, public sector officials, business owners and managers, teachers, academics, students and concerned individuals.
Their Action Groups focus on a specific issue which affects people experiencing homelessness in Cambridge. Each group develops its own collaborative approach to tackling that issue and solutions are designed, bringing together all with a shared interest in a different outcome.
The objects of the charity are to promote for the public benefit the relief of those in need due to their experience of or risk of homelessness in Cambridge and the surrounding areas, in particular but not exclusively by:
• providing information on how and where to access services, supporting engagement with service providers, enabling service providers to better meet need, raising awareness and promoting volunteering
• advancing any other ancillary charitable purpose in such way as the trustees in their absolute discretion think fit.
As a direct and indirect result of the partnerships “Everybody In” work, providing direct services and coordinating and facilitating the work of partners, some 300 rough sleepers were kept safe off the streets for short time or long. The majority of these then began a housing journey away from the street, many for the first time. Many rough sleepers that had been part of the “homelessness system” for a long term, have had their lives transformed. Rough sleeping numbers are halved, or less.
2. All local authority directorates and departments should be required to run new proposals and strategies through a homelessness lense to consider how their actions and decisions could negatively impact.
3. More joined up working, including shared strategies and joint department commissioned services including with schools, youth services and social care.
Manchester Homelessness Partnership
The Manchester Homelessness Partnership (MHP) is an umbrella term for the connected, co-produced and grassroots effort to bring together people who are homeless with the people who are dedicated to ending homelessness. The Partnership is made up of a number of associated initiatives, groups and individuals united by a shared vision to tackle key challenges and ultimately end homelessness.
The Partnership was born out of a conversation which reacted to the increasing numbers of rough sleepers in Manchester, and the coming together of a communicative City Council and charity lead who could dedicate time to making it happen.
Through a number of dedicated, value-led action groups, the partnership has celebrated a number of landmark achievements such as improving the quality of emergency accommodation, ensuring more suitable placements for people with high needs, and providing support to over 800 people affected by homelessness.
4. More community support in place as opposed to only supporting individuals on the crisis end of homelessness. This should encompass low, medium, and high-level support.
Single Homeless Project – Preventing Homelessness
The Single Homeless Project is a charity founded in 1975 by six individuals who had experienced rough sleeping, and works with all single people affected by homelessness in London.
They provide practical housing-related support to help people manage their accommodation. They also empower people to take more control of their lives, equipping them with vital skills and building on their personal strengths to stop problems from reoccurring or escalating.
Their tenancy sustainment work can range from practical help with money management, debt or rent arrears, to intensive support with complex problems such as hoarding.
In Islington, the SHP Hospital Discharge Service supports people who are leaving hospital to maintain their tenancies at a time when they may be vulnerable and at risk of homelessness.
In 2016-17 the SHP Lambeth PRS service successfully supported 233 families formerly identified as homeless by the local council, as they were rehoused in private rented sector accommodation.
Meanwhile in East London, Changing Lanes, an NHS-funded service delivered in partnership with East London Foundation Trust, provides practical housing and education, training and employment support to people with psychiatric care needs.
5. Look locally at what work can be done to identify people at risk of sleeping rough in areas of deprivation
Designing out Homelessness
West Midlands Combined Authority has taken a life course approach to designing out homelessness using the Positive Pathway model, originally designed by St Basil’s to end youth homelessness.
The pathway model looks at five domains: universal prevention, targeted prevention and early help; crisis prevention; recovery and move on, and a sustainable home.
The Framework enables each system to consider what their universal offer is, how successful it is, who is likely to fall out and how could they be prevented from doing so. The focus is on using collective resources to enhance the universal domain and therefore prevent crisis and optimise inclusion.
The approach is based on the principle that we need to make the universal domain that we all occupy inclusive for everyone, including the most vulnerable.
6. Pre-emptively look at families where there is a referral to social care with a view to preventing any future homelessness.
7. Ensure involvement of homelessness officers/services in boards and strategies of other directorates and agencies.
b. Housing-led
- Place housing-led services on a delivery plan as opposed to competing with other homelessness services (such as housing options or refugee resettlement) for the private rented sector.
- Make Housing First part of every local authority strategy to prevent and relieve rough sleeping.
Housing First in Preston
The Foxton Centre has been working with rough sleepers in Preston for the past 20 years. Through its outreach work, which is partly funded by Preston City Council, the charity identifies rough sleepers, and offers them support and safety.
In 2015, Foxton launched its Housing First project. Foxton worked with a local property management company, MITEC, to develop the project. MITEC supplied the properties with Foxton, then used a dedicated team of 4.5 full-time equivalent case workers to provide intensive support for them. Housing benefits that clients are entitled to have helped pay for the scheme.
The number of properties in the Housing First project is increasing all the time. Around 70 per cent of people provided with accommodation stay for at least 12 months.
One of the people who has been helped is John. He had been in prison and was struggling with drug addiction when he was referred to the scheme by the probation service.He started doing some voluntary work repairing bicycles, which together, with help from the drug and alcohol treatment service, allowed him to get on top of his substance misuse while being in stable accommodation.
After 14 months, he was ready to move into independent accommodation and went on to find employment. He describes the support he received as the “perfect steppingstone” that allowed him to take control of his life.
Mr Marsh cases like this illustrate the impact a Housing First approach has. “It has made a huge difference to the people we help. The fact we have other services too is really beneficial. It helps to build up a strong relationship, which increases the chances of positive outcomes.”
3. Implement a dual delivery approach between NHS and local housing/homelessness services.
4. Work with providers such as student accommodation providers to use empty accommodation for a few months.
5. Work closely with housing association partners to ensure a decent amount of homes are being allocated to households facing homelessness.
believe and Durham County Council New Start model
New Start is a housing model used by believe housing association and Durham City Council (DCC) that enables applicants that would normally be disqualified from the council’s housing register access to social housing, given tenancy support from believe and a rent guarantee from DCC. A change of past behaviour must be evidenced by a professional organisation/person who is currently working with the individual.
c) Complex needs
- Embed complex needs support workers with ability to prescribe medication to patients.
- Commission specialist health services for those experiencing street homelessness which addresses complex medical and social care needs.
BRICCS - Bradford
Bradford Respite Intermediate Care Support Service (BRICSS) was established to address the complex needs of homeless people being discharged from hospital and prevent the ‘revolving door’ of admissions.
BRICSS developed as a partnership between Horton Housing Association and BHC. In December 2013 a 14-bed unit opened for homeless patients with continuing healthcare needs on hospital discharge.
Clinical, social and housing practitioners provide integrated healthcare and social support. The BRICSS health team has evolved in response to need, comprising GP, mental health / substance misuse nurse and physical health nurse.
Six representative case studies were evaluated in detail by York Health Economics Consortium. The management of these patients’ health needs through intermediate care was estimated to reduce average secondary care costs for each from £46,800 to £11,000. The average cost of a BRICSS stay including primary care was £5,633.
Quarterly client outcome monitoring data demonstrates a high proportion of patients reporting better physical and mental health and marked reduction in hospital admissions in the 90 day period post BRICSS compared with the same period pre BRICSS stay.
3. Train all staff on how to work effectively with those who have complex needs.
4. Utilise a person centred approach, as demonstrated by Everyone In, to ensure those unable to access services are supported with services built around them.
5. Co-locate services to build up partnership working to further wrap services around the individual.
6. Develop trauma-informed networks across all services and sectors.
7. Jointly commission services relating to those with complex needs to ensure different directorates have similar goals.
Pan London Programme of Substance Misuse
A programme is being delivered by Public Health England and the City of London, in partnership with the Greater London Authority and London boroughs to deliver services to the most marginalised cohort of Londoners facing some of the most extreme health inequalities.
So far, using funding from central government, the partnership has delivered:
- The Addiction Clinical Care Suite 1 (ACCS 1) is provided by Guy’s and St Thomas’ NHS Foundation Trust at St Thomas’ Hospital and is the first of the pan-London services to open its doors. The ACCS offers five elective in-patient detoxification and stabilisation beds for people who sleep rough, are at risk of return to the street, or at risk of homelessness and are dependent on drugs and/or alcohol who also have high levels of co-occurring complex physical/mental health medical need.
- The Addiction Clinical Care Suite (ACCS 2) Universal Unit is open to all people who are dependent on drugs and/or alcohol and is not specific to people who are at risk of, or experiencing, street homelessness. This service is intended to address the gap in complex inpatient detoxification provision in London for those with co-occurring physical and mental health needs.
Further ahead, the programme will also commission:
- new recovery-focused intermediate residential care units (following in-patient substance misuse detoxification and stabilisation)
- new ‘Pan-London Homeless Substance Misuse Engagement Team’ to work across London and alongside local community substance misuse teams to provide an expert network and support more people who sleep rough/risk of return to the street/risk of homelessness to engage with treatment as part of the homeless health pathway.
d. Restricted eligibility
- Build on Everyone In which reduced this cohort significantly and allowed the use of direct let. Lack of available housing inhibits this.
- Link to employers to ease access to work for those who are eligible to work.
- Work needs to be done for the sector to understand what work can be done with those with restricted eligibility and this should be standardised across the country.
Oxfordshire Homeless Movement
This is an innovative, inclusive Movement aimed at reducing rough sleeping in Oxford which includes local homeless charities, housing providers, Oxford City Council, health providers, funding bodies, community-based organisations and businesses.
One of their current priority projects is to try and help people experiencing homelessness who have lost or don’t have access to state-funded benefits and housing and is a last resort to help them move on from the trauma of homelessness. This project aims to support these people to lead productive lives in Oxfordshire.
OHM has brought together three experienced local partners to address this unmet need, offering hope to people who really are at breaking point.
Longstanding local charities Aspire, Asylum Welcome and Connection Support are offering dignified housing, advice and advocacy to resolve any legal issues, and personalised assistance to help people overcome the complex issues that led to them becoming homeless.
Local housing association Soha has stepped up to provide 12 beds at a peppercorn rent. Additionally, we have also partnered with Edge Housing who are providing a further three beds and support.
Thanks to the generosity of private donors, and the housing provided by Soha and Edge, they are on track to reach their objective of housing and supporting the entire cohort of 20 people.
e. Overarching/other
- Identify system blockages and resolve through communication and prioritisation at a senior level.
- National roll out of the CHAIN database and funding to support this to improve communication and capture more meaningful data.
- Adult Social Care services included in accountability for preventing and tackling rough sleeping.
- Complete Joint Strategic Needs Assessments for every rough sleeper.
- Take responsibility for improving and using data to profile rough sleeping.
- Develop strategies for recruitment and retention of staff including supporting qualifications and accreditation.
- Fund tenancy ready courses to reduce likelihood of a tenancy failing once it has commenced.
North Dorset Tenancy Training Programme
North Dorset council are creating a pre-tenancy accreditation award for homeless households. A target of their Homelessness and Rough Sleeping Action plan is to develop pre-tenancy training and a qualification to equip households to become tenancy ready, including saving for rent in advance, resolving former tenancy debts or demonstrating sustained improvement in behaviour which would normally be a barrier to being offered a tenancy.
This follows on from a Sovereign Housing Project launched in 2021 which provided six university-style rooms that were been fitted out with all of the facilities that people who have been homeless might need, with bedding, white goods, crockery and cutlery and more provided. The service offers a welcoming and supportive environment for people who have experienced homelessness. Everyone who joins is able to access the tenancy training programme, which gets them ready for independent living. They are also offered a wide range of skills training through a virtual college.
8. Run ‘Everyone In’ style workshops in student accommodation blocks when they are empty for the summer, providing intense support for a couple of months.
9. Put lived experience at the heart of all service design. Ensure involvement of those with lived experience on boards, in task groups and employed as peers mentors.
BCHA Peer Mentor Programme
BHCA is a South West based charitable housing association. BCHA was founded over 50 years ago with a continuing mission to meet housing need and end homelessness.
They have recruited four volunteers as of February 2021 for their peer mentor programme. Volunteers have access to BCHA’s internal online training courses ‘Skillsgate’, as well as training courses run by BCHA’s Employability Skills team, plus they attend Reflective Practice sessions.
BHCA are also developing an offer to involve service-users for whom it would not be appropriate to be a Peer Mentor (because of, for example, one-to-one or lone working issues) and so they have developed a range of other activities in which they can be involved, either as a co-host or a guest, including: a Diary Room, an Expert Panel and Peer Mentor Network Podcasting.