On 19 May over 30 councils attended a morning roundtable to discuss their priorities for the new rough sleeping strategy, due to be released later in the year.
The roundtable was broken up into three workshops to look at what central government, local government and the third sector can do to help end rough sleeping.
Prior to the workshop, the Local Government Association (LGA) worked with various internal and external partners working across the sector and in councils to highlight some areas where policy change would be beneficial to ending rough sleeping which have been included. These suggestions were included in the digital whiteboard used for the first workshop and were voted as positive areas of change by councils taking part.
Ask for central government
A commitment from all central government departments to end rough sleeping is needed to deliver on the manifesto promise to end rough sleeping by 2024. It is the LGA’s view that every government department needs to make a number of national commitments to prevent homelessness, including developing an implementation plan, monitoring and reporting their contribution, and ensuring their local delivery agents contribute to prevention activity and targets through local homelessness strategies.
As part of this workshop, we asked councils to consider which specific central government policies need to be implemented, and which existing policies make it difficult to end rough sleeping in their local areas. During the prioritisation section of the workshop, a lot of councils highlighted the need for central government to set the vision for cross departmental working on rough sleeping, as some agencies and departments are not part of the conversation.
A common theme among the conversations was concern around the effects of the cost of living crisis and a need for the Government to recognise the wider issue of homelessness as opposed to being focused on the crisis end of homelessness both in terms of strategies and funding.
The war in Ukraine and subsequent new arrival schemes are also placing pressure on homelessness services. Given that sponsorship stays will now be extended, and because of the reality that there will be breakdowns in some of the host family situations, many Ukrainian new arrivals are threatened with homelessness and therefore owed a prevention or relief duty by the local authority. There are also a significant number of placements made under the Ukraine Family Visa scheme that are breaking down, leading to homelessness presentations. According to the latest data, a total of 1040 Ukrainian households have been owed a homelessness duty since 24 February.
Local councils have been given responsible for ‘rematching’ under the Homes for Ukraine scheme where there are failed placements. As a result, many councils have mobilised expertise and officers to implement prevention strategies in collaboration with communities and charities to provide guidance and wrap-around support to both host and Ukrainian families. In terms of workload and resourcing, this is an unexpected addition and responsibility which is not yet clearly resourced. Any strategy on ending and preventing homelessness needs to address this emerging issue.
There were also comments around the need to move provision more into upstream prevention as opposed to focusing on the crisis end of homelessness. Working more with people with lived experience and understanding the journey and determining factors for becoming a rough sleeper will be essential for informing what kind of services need to be commissioned. This needs to be underpinned by joined up data sharing between services and a commitment to a trauma-based approach.
There will inevitably be some overlap, particularly when considering issues such as non-UK nationals, however where possible the suggestions have been broken down by department.
Department for Levelling Up, Housing and Communities (DLUHC)
a) Increase affordable move on provision
A concern about the lack of move on options and lack of social housing available for households threatened with and experiencing homelessness was the number one priority for councils outlined in the round table. A number of councils mentioned they are in the position of being unable to move customers on from temporary accommodation, with some staying for years with no viable options for move on. This is placing a burden on homelessness services and increasing the likelihood of rough sleeping. Increasing the supply of housing options is critical to helping prevent homelessness and rough sleeping as part of an ambition to also help deliver housing led options including Housing First. This includes:
- Increase new supply through targeted allocation of grant via Homes England (& GLA); relaxing a range of Housing Revenue Account restrictions – including use of Right to Buy receipts – for specific suitable housing, and review capacity to add supply via developer contributions.
- Ensure the current and urgently needed review of exempt accommodation delivers a secure funding model that secures existing provision and promotes future supply to meet local needs. For instance, phase in delivery through transitional arrangements that involve piloting local authority commission in a number of areas, or other means for ensuring local authority oversight of the total offer.
Councils are concerned that unscrupulous non-commissioned providers are not providing good quality, value for money exempt accommodation for vulnerable people. Currently councils have very limited levers to address their concerns. Strengthened local oversight and enforcement will save money for the public purse by eradicating unreasonably high rents, ensuring people’s support needs are met and mitigate the impacts of poor provision.
- Ensure Registered Providers commit to cooperate with local services in the prevention of homelessness and rough sleeping. For instance, by revising regulations published by the Regulator of Social Housing, and seek a commitment from the sector that no one is made homeless from social housing.
- As part of renter’s reform, undertake a strategic review of the tenancy framework within the private rented sector and its potential role in housing, including in homelessness prevention through tenancy sustainment. This includes additional tenancy security at a national level through the abolition of section 21, and national backing of financial or policy incentives routed through Local Homeless Strategies such as national bond deposit scheme and Help to Rent projects
b) Award long term homelessness prevention funding
Another priority for councils highlighted in the roundtable was a need for the Homelessness Prevention Grant to be awarded on a longer term, multi-year basis to allow councils to reliably commission upstream prevention services.
The recruitment and retention of staff also relies on councils and commissioned services being able to award permanent contracts as opposed to secondments which often deter people from applying or encourage temporary employees to apply elsewhere. Therefore, not only would longer term funding allow more innovative homelessness prevention services, but it would also attract and hold onto talented front-line staff to deliver them.
c) Consider legislative barrier and lack of support for people with complex needs
Within society, there are certain groups of people for whom there is an absence of support and a heightened risk of homelessness and rough sleeping, and the points in their life where support is especially necessary in preventing homelessness. Some councils who took part in the roundtable highlighted that at times the current priority need legislation can be a barrier for these groups. At risk groups for whom there is an absence of support can include people:
- with experiences of childhood trauma
- with mental health issues
- with experience of the criminal justice system
- with underlying health challenges
- under 35, in particular care leavers
- from black and ethnic minority communities
- that are recent migrants
- who have experienced human trafficking and / or modern slavery
- with experience of sleeping rough.
At risk points at which there is insufficient support that increases immediate risk of rough sleeping include people:
- moving out of the criminal justice system, particularly short-term sentences
- discharged from hospital following treatment
- leaving a mental health institution
- with a recent decision on an asylum claim
- transitioning out of support provided by the National Referral Mechanism
- refused or decided not to enter the National Referral Mechanism
- in crisis with nowhere safe to stay that night.
The improvement of supporting these groups requires action from a range of partners well beyond local housing authorities, and success will bring wide-ranging benefit for both individuals and services for whom homelessness can entrench barriers. A few councils on our roundtable highlighted that guidance around determining factors for those who go on to become rough sleepers would be useful when considering priority need and subsequent action.
d) Ensure supported housing and Housing First schemes are universally available
A number of councils highlighted the need for more supported housing and Housing First schemes nationally with one council highlighting that this is currently a “post-code lottery”. By extending support housing schemes and Housing First across the country, not only would it support councils to provide better services, but it may also prevent those rough sleeping from gravitating towards cities and towns where there is more service provision.
e) Extend the duty to refer to a duty to collaborate
To support a whole systems approach to street homelessness, the Government should extend the Homelessness Reduction Act’s Duty to Refer to a Duty to Collaborate with relevant public agencies to both prevent and respond to homelessness. This should include the Department for Health and Care (DHSC), the NHS and the Office for Health Improvement and Disparities, Department of Work and Pensions and its agencies; the Home Office, and Ministry of Justice and its agencies and other government agencies with an involvement in homelessness and rough sleeping services. There was strong evidence that the reasons for the success of “Everyone In” during lockdown, which led to greatest reduction in homelessness for a decade, was that, for the first time, homelessness was treated as a public health issue with cross-departmental collaboration and sharing of information. This needs to continue and be led by national government cross-departmental collaboration. Government needs to continue to treat homelessness as a public health issue or, at least, learn from treating homelessness as a public health issue.
f) Consider the professionalisation of roles within housing need services
Anecdotally, recruitment and retention of staff in homelessness and rough sleeping services continues to be a huge barrier towards delivering successful services. Housing is one key part of the public sector where there is a general absence of need for professional qualification as a pre-requisite for practice. Given the vulnerability of people who are homeless or rough sleeping, the potential complexity of their support needs, and the underpinning role of housing practitioners to provide wrap around support that links various services together, this lack of accreditation is at odds with the calibre of practitioner that is required to provide appropriate support and demonstrates the lack of recognition that many serving high calibre practitioners deserve.
Training and development has been highlighted by a LinkedIn study as a deciding factor in retention of staff, as well as a wage which reflects the complex work that is required. Professionalisation of the role may go some way towards creating an attractive and worthwhile vocational career pathway which will prevent high turnover of staff and create an environment where interpersonal relationships can flourish.
Department for Work and Pensions (DWP)
a) Adapt welfare to make homelessness less likely among key groups
Current welfare policy was the second biggest issue outlined by councils attending the roundtable as a barrier for accessing accommodation both to prevent homelessness and to move people on from temporary accommodation, with local housing allowance being the top deterrent for homelessness prevention.
LGA research from 2020 found that the LHA rate now available for 9 out of 10 private renters across 279 local areas across the country is lower than their rent. This means that in many parts of the country there are no properties available to those entitled to full support with their housing costs.
The four-year freeze has left some families and vulnerable people – including single parents and disabled people – struggling to pay their rent and cover other household bills. In the worst cases, it is causing homelessness.
Some ways to make homelessness less likely among key groups would be:
- Lift the Shared Accommodation Rate restriction for under 35-year-olds, or at a minimum widen existing exemptions for those groups proven to be at a higher risk of homelessness, including all those made a Housing First offer.
- Re-align Local Housing Allowance rates back to the 30th percentile of local rents and link them with rental inflation going forward, and begin a comprehensive review of LHA rates taking into account the Overall Benefit Cap.
- Review housing benefit regulations in relation to service charges. Eg some electricity charges. This would reduce numbers of people leaving supported accommodation if they couldn't afford service charge.
b) Provide financial support for those that are destitute due to no recourse to public funds
Non-UK nationals continue to be over-represented in rough sleeping populations, making up at least 37 per cent of those included in the last street count. There was a suggestion that there should be some specific programmes of employment support for Non-UK citizens as a route out of homelessness.
At the LGA we are currently working on our recommended approach for government in this area by undertaking some research and analysis to support our asks. Government also needs to consider what they can do to financially support those that are destitute to either prevent them from becoming rough sleepers.
Some suggestions for addressing this as identified by the council led NRPF Network include:
- Lift the NRPF condition or use the comprehensive spending review process to understand and provide financial reimbursement to councils when people with no recourse to public funds are provided with accommodation and financial support.
- Enable people with pending EU Settlement Scheme applications (made in time or late) to be eligible for means-tested benefits and mainstream homelessness assistance and enable people with pre-settled status to rely on this as a right to reside in order to be eligible for means-tested benefits and mainstream homelessness assistance.
- Reinstating legal aid for immigration matters for particular groups or types of cases.
- Exempting people receiving local authority support from secondary healthcare charging. Enabling people without National Insurance numbers to be issued these once leave to remain is granted in order to expedite the transition to mainstream benefits when recourse to public funds is obtained.
- Undertaking a more strategic approach to concluding the immigration claims of households receiving support for over 1000 days, including a policy solution, such as a route to regularisation, when people are unable to return to their country of origin but do not meet the requirements of the Immigration Rules.
c) Consider a framework for escalation of cases and better inclusion for those experiencing rough sleeping
It can be difficult for rough sleepers to access the level of benefits they are entitled to and the chaotic nature of a life on the streets exacerbates this. There was a suggestion that DWP should join the rough sleeper support service so there can be a key centralised service to escalate these cases. Other ways DWP could be more inclusive of those experiencing rough sleeping could be:
- Extend the current homelessness easement to all people that are homeless and at risk of homelessness and those who have been helped into a new tenancy, including Housing First offers, to allow Jobcentre work coaches and Housing Options teams to stabilise housing before focusing on employment.
- Monitor and ensure work coaches use flexibility in issuing sanctions to those in precarious housing position, and support to utilise the risk of rough sleeping tool as a determinant within the decision-making process.
- Issue further policy/guidance to require Work Coaches to take into account the haphazard nature of an individual who is insecurely housed, rough sleeping or recently out of rough sleeping.
Ministry of Justice (MoJ)
a) Commit to ensuring support to find accommodation is part of rehabilitative work
Praise for Accommodation of Ex-Offender and Community Accommodation Service Tier 3 was expressed by multiple attendees to the roundtable with an appetite for more even more holistic working and a housing led approach nationwide. There was also an ask to evaluate and expand the Accelerator prisons project as there are currently only 16 nationwide. Some other areas of potential improvement include:
- Introduce the Youth Justice Accommodation Pathway Framework approved by MoJ and DLUHC.
- Obligate Prison Governors to introduce integrated transition plans for all prisoners and set out multi-agency protocols for working in partnership to reduce repeat offending and rough sleeping.
- Set minimum standards for housing advice, information, and support for people on remand, in prison or other custody, using Peer Mentor models to secure maximum engagement from point of entry (in line with Scottish model). This should include a housing outcome, similar to the employment outcome, in the next rehabilitation commissioning strategy.
- Revise approach to sentencing and/or prison release planning ensuring no-one is released from prison on a Friday. Release plans must be strengthened so that support needs and how they will be met are clear to both the prison leaver, support services and the local authority.
- Provide guidance to probation services to clarify what information can be shared with landlords about individuals to help them access accommodation in the private rented sector.
- Pilot a new prison leaver assessment hub service to eliminate rough sleeping among this cohort.
- Place multi-disciplinary teams within prisons.
b) Support the efforts of councils in supporting people begging and sleeping rough
Aggressive begging and other anti-social behaviour (ASB) is an issue that councils continue to grapple with. Not everyone who is begging is homeless and this crossover can be difficult for councils to manage. A few areas which could be developed to this end include:
- Dedicated police officers who use a trauma informed approach and work closely with outreach teams and homelessness services can achieve a great deal of success in helping councils strike the balance between support and enforcement.
- The police have a role in preventing homelessness, as well as supporting councils with individuals who are already rough sleeping. Central government should consider strengthening the duty to refer to a duty to collaborate and adequately fund and support public body services to be able to deliver this.
- Any new legislation implemented as a result of the vagrancy act should have an emphasis on local partnerships and a person-centred enforcement approach that is focused on providing support.
a) Develop an understanding of the links between migration status and homelessness
A significant number of rough sleepers are non-UK nationals with restricted eligibility. Understanding this better as well as the knock on effect to council services is paramount. This includes:
- Joint work across local and central government to fully understand the impacts of the use of the NRPF condition on councils and communities, including the costs to councils of providing accommodation and financial support when people with no recourse to public funds approach homelessness services.
- This needs to include those with pre-settled status and those outside of council’s statutory responsibilities and should explore what can be done to mitigate some of the impacts on councils, communities, and individuals.
- Publish data on homelessness migrants coming into contact with the Home Office, for instance the number of people homeless when detained, number of people who are homeless when released from detention, time taken to make a decision on different applications for leave.
b) Review accommodation-based policies which increase chances of rough sleeping
Individuals should not become homeless as a result of leaving central government provided accommodation. Where possible, Home Office should also consider widening the availability of accommodation to recognise the new eligibility rules and the effect these will have on councils. Some policy amendments could include:
- Extend availability of schedule 10 accommodation to other types of immigration applications.
- Extend 28 day notice in home office accommodation to 56 days.
c) Provide clarity around support for customers with restricted eligibility
Helping the local government sector to understand the work that can be done with people with restricted eligibility would help to standardise the approach nationally and within local authority areas. Currently councils are encouraged to commission immigration advice services, but this must be supported and funded nationally.
Department for Education (DfE)
a) Staying Put and Staying Close should be a legal entitlement and extended to age 23 with an ‘opt-out’ rather than ‘opt-in’ expectation.
There should be a range of housing options open to young people transitioning out of care or who need to return, such as Staying Put, Staying Close and supported lodgings. Staying Put and Staying Close should be a legal entitlement and extended to age 23 with an ‘opt-out’ rather than ‘opt-in’ expectation.
Staying Put is a welcome policy that provides looked-after children with a stable home and support in the same way that most of their peers will have. However, it is significantly underfunded and, alongside pressures on placement capacity, this is impeding our ability to ensure this option for all children. Young people should be able to remain in placements for as long as possible, but this will be reliant on a successful foster carer recruitment campaign and sufficient funding.
b) Remove the Local Connection test for care leavers
Care leavers are often placed in several different areas over the course of their childhood and can struggle to prove local connections. Accommodation sourced for care leavers long term is more likely to be successful where the individual feels comfortable. Government can introduce a stronger safety net against care leaver homelessness by removing the local area connection test, ending intentionally homelessness practice, providing a rent guarantor scheme and increasing the leaving care grant to £2,438 for care experienced people
It is crucial that all departments play a positive and collaborative role in the prevention of homelessness and rough sleeping, and that it is not just perceived as the responsibility of DLUHC and local housing authorities. Collaboration to achieve prevention requires joint ambition, but it also needs common approaches to information, protocols, partnership, case management, training, monitoring, reviews and commissioning; maximising the value from collective investments. We therefore make a number of recommendations for requiring all departments to consider their role in preventing homelessness and rough sleeping, to set out what action they will take, and to monitor the success of this action. All Government departments should:
- commit to ending homelessness and rough sleeping by developing a joint statement which details the set of departmental actions to take, this could include a commitment that no-one becomes homeless directly from leaving their services
- review, the need to strengthen the legislative ‘duty to refer’ on public authorities into a ‘duty to cooperate’ in the prevention of homelessness and rough sleeping, and extending it to a wider group of public authorities
- explicitly acknowledge the Departmental responsibilities in delivering the Homelessness Reduction Act, by developing and publishing a Departmental Implementation Plan that establishes a ‘commitment to cooperate’ in the prevention of homelessness, beyond the ‘duty to refer’
- determine definition of preventing homelessness and rough sleeping for each Department. Identify and define key success factors, put in place data collection and usage through which to monitor the impact of actions, report annually on progress towards ending homelessness and rough sleeping and produce action plans to continue this progress
- lead culture change within the Department and its agencies, by providing clear and detailed guidance and training for all service managers, commissioners and staff in delivering the implementation plan through effective multi-agency working locally.
- adopt default commitment to route all additional funding targeted at supporting homelessness and rough sleeping prevention through Local Homelessness Strategies, either directly or as part of co-commissioning models. A case would have to be made for when adopting a different approach
- engage with mechanisms that enable those with lived experience to contribute to co-design services.
Asks for local government
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.
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.
- 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.
- 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.
Ask for the third sector
The third workshop of the morning focused on what good voluntary and community sector involvement looks like. Voluntary and Community Sector includes a wide variety of third sector organisations, national, regional, local, faith based, accommodation-based services and support/outreach services as well as a range of commissioned and non-commissioned services. All of them play a different, important, and valuable role in tackling rough sleeping as well as valuable insight and knowledge of local areas and the people they serve, however interaction and integration with local authority and local homelessness and Rough Sleeper strategy varies significantly.
What does success look like?
- Co-production of homelessness/rough sleeping strategies and action plans at local level with local authorities working jointly with services and also with lived experience.
- Communication through local boards and forums eg homelessness partnership boards, rough sleeping steering groups.
- Importance of joint working locally - gaining insight from front line services and recognising the value of non-commissioned faith and community sector and avoiding duplication.
- Strategic leadership.
- Flexibility and ability to respond quickly.
- A focus on better outcomes eg no terms and conditions for support, minimum or maximum length stays as a performance indicator.
- Inclusion of specialist services eg supporting Non-UK Nationals.
- Good relationships and a person-centred approach that can do what statutory services can’t to act as a safety net.
What are the barriers and challenges?
- Different cultures.
- A dynamic and rapidly changing sector.
- Unwillingness to work together/fractured relationships.
- Lack of communication/collaboration.
- No spaces to work together/learn from one another.
- Power dynamics inhibit ability for true coproduction, support from independent party.
- Commissioned services have better relationships with local authorities than non-commissioned including faith and community groups.
- Recognising which organisations to work with.
What changes are needed?
- More stable funding periods.
- Salaries that recognise the complex work required.
- Lack of inflationary uplifts in contract funding.
- Contract management focused more on outcomes as opposed to outputs.
- Building in good practice and innovation.
Councils also placed input onto a digital whiteboard which elaborates on some of the main points above and was centred around four main areas – co-production, local strategy, communication, joint working. The following points were highlighted.
- Engaging people with lived experience.
- A range of channels to facilitate homelessness prevention.
- Involving residents of temporary accommodation to find out what would have worked better as part of a customer satisfaction process.
- Training together eg trauma informed approach.
- Co-production of services and strategies fosters joint accountability.
Inspiring Change Manchester
Four core projects used co-production to help change services from the inside out.
Core Group: Core Group consisted of people with first-hand experience of multiple disadvantages, either through their own lived experience or as a carer for someone else in their lives. They played a part in all decision made that affected how things work.
Women's Voices: A group run by women for women, the Women’s Voices movement is about uniting women to improve communities and services in order to create equal opportunities.
Its members had all experienced homelessness, addiction or abuse. They ran events and campaigns geared towards changing problematic preconceptions and inequality.
The Mental Health Action Group: The Mental Health Action Group (MHAG) was a part of the Manchester Homelessness Partnership (MHP), a collective of people from a range of backgrounds: people who have experienced homelessness themselves, people who work on the front line of homelessness and people of all levels working in services that come into contact with homeless people, including commissioners and businesses.
Getting Real Opportunities of Work (GROW): GROW traineeships are paid placements giving people who have experienced multiple disadvantages the chance to secure work and develop experience within the workplace. The programme was designed to help break down barriers into work, with the aim of supporting trainees to secure further paid employment.
2. Local Strategy
a. Develop a shared understanding of what can and can’t be delivered.
b. Create a core group of multi-agency governance of local strategy.
c. Develop critical friend relationships who can review activities and policies.
d. Bring in third sector expertise at all stages of strategy development.
a. Third sector leaders leading local homelessness partnerships works well in local areas.
4. Joint working
a. Developing joint strategies and working together keeps everyone focused on a common goal and provides customers with additional routes for support, engagement and trust building outside of statutory services.
b. Creating shared workspaces lends itself to a multi-agency approach.