CONNECT July 2014: What makes the difference in homelessness?

CONNECT THE MAGAZINE OF THE HOMELESSNESS SECTOR

WHAT MAKES THE DIFFERENCE IN HOMELESSNESS?

UNHEALTHY STATE

#THEDIFFERENCE 2015

PUTTING HOUSING FIRST

In our latest research on health, we ask

In the run up to next year’s general election, help us ask politicians to commit to ending homelessness.

We look at the planning, setup and progress of a Housing First pilot in Oxford.

whether the needs of the people you support are being met.

4-6 ISSN 2046-2921

7 CONNECT JULY 2014

8-11 |

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K A E R B T O N BEND ONFERENCE C L A N IO T A N on

Lond 014 Central 2 October 2

Find the tools and information you need This practical, solutions focused day will equip you to adapt to the changes in benefits provision.

This event is being organsied by Pavilion Publishing in association with Homeless Link.

BOOKINGS Find out more and book your place: homeless.org.uk/bend-not-break

ÂŁ145 PLACES FROM

Adapting to changes in benefits provision Services need to adapt, sometimes quite rapidly, in order successfully to respond to changes in policy, and in funding, and the changing needs of client groups.

As the impact of current changes in welfare benefits provision reveals itself, it is crucial that service commissioners, providers and managers across health, social care and housing focus efforts on supporting and empowering those who are directly affected. homeless.org.uk/bend-not-break

S T N E V E K IN L ELETHSESEXPERTISE OF THE SECTOR HOWM CASING S HO

TS | RG.UK/EVEN HOMELESS.O

40 INK | 020 78 @HOMELESSL

4461

JULY 2014

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IN CONNECT 4

7

THE UNHEALTHY STATE In 2010, Homeless Link first published national

The Chronically Excluded Adult (CEA) service in Cambridge - a Making Every Adult Matter

in England. Our latest research looks at how

pilot area - coordinates existing services for

health and the support available have

clients who typically have complex and

changed since then.

multiple needs, face exclusions from one or

#THEDIFFERENCE2015

more services, and have a history of rough

What should politicians prioritise in the run up to PUTTING HOUSING FIRST

sleeping or homelessness.

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adapted the Housing First model for their work in the city, and reviews their early progress.

FROM SLEEPING ROUGH TO ADVISING .GOV.UK David Ford looks back at the achievements of

REAL IMPACT Leah and Tommy, two people supported by the Chronically Excluded Adults team in

Lesley Dewhurst, Chief Executive of Oxford

Cambridge, told us how the service has made

Homeless Pathways, explains why they have

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LEARNING FROM CAMBRIDGE

data looking at the health of homeless people

next year’s general election?

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a difference.

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COVERED? Tim Wiltshire of Access Insurance introduces an exclusive 20% discount for Homeless Link members.

the Expert Advisory Panel and looks forward to a homelessness sector with lived experience at its heart.

www.homeless.org.uk/connect

Have you tried our new website?

We’ve completely redesigned it to be easier to find what you’re looking for on all of your devices.

But have we missed anything?

We’d love to hear your feedback - good or bad.

Email Martin Reed: editor@homelesslink.org.uk

www.homeless.org.uk

STORY TO SHARE? We’re always looking for stories about the work you do and the people you work with. Get in touch if you have something to share with readers of CONNECT magazine and blogs - editor@homelesslink.org.uk EDITOR: Martin Reed COVER IMAGE: Ron - member of Expert Advisory Panel - by Martin Reed

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THE UNHEALTHY

STATE

80%

reported some form of mental health issue, diagnosed or undiagnosed.

In 2010, Homeless Link first published national data looking at the health of homeless people in England. Our latest research looks at how health and the support available have changed since then.

Using information supplied by over 2,500 people, ‘The unhealthy state of homelessness’ highlights the extent to which people who are homeless experience some of the worst health problems in society.

The report uncovers the barriers many individuals face when it comes to getting treatment, as well as the impact of ill health on NHS A&E, hospital, mental health and substance misuse services.

Widespread ill health

In 2010, Homeless Link first published national data* looking at the health of homeless people. This new report makes clear that we are yet to see a real improvement in reducing the scale of health problems faced by those who have experienced homelessness.

Unhealthy lifestyles

Those with experience of homelessness are also more likely to have unhealthy lifestyles, which can cause long-term health problems or exacerbate existing issues.

Around

Almost

1/2

used drugs and/or alcohol to cope with mental health issues.

Analysis of the latest data found that 77% of homeless people smoke, 35% do not eat at least two meals a day and two-thirds consume more than the recommended amount of alcohol each time they drink.

Not enough help

Despite 90% of those surveyed reporting that they are registered with a GP, a significant number of homeless people report that they are not receiving help with their health problems.

Over 15% of respondents with physical health problems were not receiving support, while 17.5% of those with mental health issues and 16.5% with alcohol issues would like support but are not receiving it. Additionally, 7% of respondents had been refused access to a GP or dentist within the past 12 months.

Over a quarter of those receiving some form of support with their physical or mental health problems reported that they would benefit from more help.

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consume more than the recommended amount of alcohol each time they drink.

dru fro

JULY 2014

35%

90%

had been to A&E in the past 6 months.

said they are registered with a GP.

45%

had been diagnosed with a mental health issue, compared to 25% of the general population.

39%

said they take ugs or are recovering om a drug problem.

CONNECT

64%

said they had somewhere suitable to go upon leaving hospital.

26%

had been admitted to hospital in the past 6 months.

27%

have or are recovering from an alcohol problem.

Impact on the NHS

Individuals experiencing homelessness continue to be heavy users of acute health services, a situation that has significant cost implications for the NHS. The latest data indicates that the number of A&E visits and hospital admissions per homeless person is four times higher than for the general public. This matches the Department of Health’s own estimates, which puts homeless people’s use of health care at a minimum of £85m per year.

Housing – a health issue

73%

reported physical health problems.

41%

said this was a long-term problem.

Our data also reconfirms the strong links between health and somebody’s housing situation. Reported incidents of physical ill health, depression and substance misuse issues are far higher amongst individuals who are either sleeping rough or in living in precarious accommodation, like squats.

Signs of progress

There has, however, been progress since 2010, especially when it comes to how the NHS deals with homeless patients admitted to hospital.

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According to the latest data 36% of homeless people admitted to hospital report being discharged onto the streets with nowhere to go. In 2010, this issue was reported by 73% of respondents admitted to hospital.

As a result of campaigning by homelessness and health charities and new investment, our latest data suggests that while there is still a long way to go, progress is being made.

Recommendations

These findings underline the need for action across the health system. At the end of this report we make a number of recommendations to improve the commissioning and delivery of services that prevent and treat the poor health experienced by homeless people.

However, if we are to truly break the link between ill-health and homelessness, we will need to see a concerted effort by front-line NHS staff to help individuals manage and overcome their health problems.

Where there has been progress, we need to learn why it has been effective. We must ensure there is the political will and investment to maintain and develop this work.

Our findings emphasise the importance of recognising once and for all that homelessness and health cannot be tackled in isolation.

Although since our last report in 2010 addressing this issue has been made a priority by the Department of Health, we are yet to see this lead to significant health improvements for homeless people on the ground.

We need action across the health system; this means better commissioning of services which prevent and treat poor health experienced by homeless people. This also means concerted effort by front-line NHS staff to help individuals manage and overcome their health problems.

Where there has been progress, we need to learn why it has been effective. We must ensure there is the political will and investment to maintain and develop this work.

We are calling for:

Better care • All homelessness services to support clients to ensure that they are registered with GP, dental and optician services and receive an assessment.

• The NHS to offer a health check to any patient identified as homeless and a holistic care plan put in place to address any physical, mental health, substance misuse or wellbeing issues identified.

Better commissioning • Primary care services to be more targeted to the needs of homeless people: where clinical provision is integrated with the other services homeless patients require to regain and maintain their health, such as substance use services, welfare advice, adequate 6

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accommodation or hospital in-reach.

• A designated lead within local Health and Wellbeing Boards and Clinical Commissioning Groups (CCGs) to co-ordinate commissioning for homeless and vulnerable people, so that housing and health are joined up as part of the same pathway. They should review and report on progress to improve homeless people’s health and wellbeing as part of the commissioning cycle.

• Greater investment in the homelessness sector for approaches known to effectively help people engage with and co-ordinate their care in the health system, such as peer advocacy and health liaison schemes.

Better policy • NHS England and Public Health England to publish a clearer set of actions about their plans to reduce the heath inequalities of homeless people, as part of their commitment to improve ‘the health of the poorest, the fastest’. This should include a clearer set of standards and expectations for how local commissioners and Directors of Public Health should jointly meet the needs of this group.

• The Department of Health to continue co-ordinating the Inclusion Health work-stream at a national level.

This programme has helped to make lasting changes to how the NHS should address health inequalities and improve the health of the most vulnerable and we urge the Department of Health to renew this work-stream and maintain the progress which has been made.

Stronger inspection and accountability • Local Healthwatch and Healthwatch England to proactively reach out to homeless people to ensure their voices are heard and represented at a local level.

• Homelessness services to ensure homeless people understand their rights when it comes to accessing health services, utilising levers like the NHS Constitution.

• The Care Quality Commission to publicly report on its assessment of the quality of service offered to homeless people as part of its inspection of primary care with clear recommendations for improvement.

• Clinical Commissioning Groups to state how far they have improved access to services and health outcomes for homeless people as part of their annual reporting requirements against the new health inequalities legal duties.

THE UNHEALTHY STATE OF HOMELESSNESS Download the full report on our Health Audit 2014

homeless.org.uk/health

JULY 2014

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What should politicians prioritise in the run up to next year’s general election?

Next May we will elect a new Government but what should be at the top of their to-do list when it comes to homelessness?

As a sector, we have many concerns – the health of

Thanks to your input, our vision ‘A place to call your

clients, the quality and supply of accommodation, the

home’, highlighted key areas where action is needed:

impact of welfare reform to name just a few.

•

Access to affordable, good quality accommodation

But can we define one action which would make the

•

Help to realise your potential

biggest difference in 2015?

•

Coordinated and personalised support for as long as

#THEDIFFERENCE2015

•

you need it An adequate income

Between now and September we are consulting with members and people with experience of homelessness

So we know the challenges, but now we need a clear

to pin down which policy changes will make the

consensus about the top actions a new government

biggest difference and are most important for the new

should focus on first.

Government to support.

GET INVOLVED HAVE YOUR SAY

There are several ways you can take part.

This summer, we need you to tell us the one action you think Government should take that would make the biggest difference to homelessness?

• Local events: we’re running events for members in every region. Visit our events section to find out more - homeless.org.uk/events.

WHY IS THIS IMPORTANT? We need whoever comes to power to share our ambition to end homelessness and take action to help us achieve this.

• Our website: visit homeless.org.uk/td2015 and fill in the feedback form.

• Social media: if you can make your point in 130 characters tweet your idea to us using the hashtag #TheDifference2015.

WHERE DO WE NEED TO SEE ACTION? We are not starting from scratch. We already know

We look forward to hearing your ideas. We’ll publish what

through our research what matters to homeless people

you tell us and urge all political parties to commit to the

and the charities that support them.

campaign to end homelessness.

WWW.HOMELESS.ORG.UK

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PUTTING HOUSING

FIRST

Is there ever an ideal solution for people so entrenched in sleeping rough that they refuse all traditional offers of help? Lesley Dewhurst, Chief Executive of Oxford Homeless Pathways, explains why they have adapted the Housing First model for their work in the city, and reviews their early progress.

Like many places in the UK, Oxford has a sizeable cohort

contained tenancy, without first tackling the issues that

of people sleeping rough who do not cope in hostels and

have caused or are exacerbating their homelessness.

have been entrenched in sleeping rough for years.

Support is coordinated on an individual basis, depending on need.

There are those who are fearful of hostels. They don’t like being around other people, particularly those with

We know that Housing First isn’t the best solution for

chaotic behaviour. They generally have mental health

everyone, but we hoped it might well work in a small way

or substance misuse problems themselves – often both

for us in Oxford.

together.

FLAT HUNTING And there are others who do periodically come in, but

One of our first challenges was to identify suitable

they find the environment difficult and it exacerbates

properties. Renting in the city is particularly difficult

poor behaviour. They are either excluded or they

– after all, why should any landlord want to rent

abandon services of their own accord. Again, mental

accommodation at low cost to such potentially high risk

health and substance misuse issues are often at the heart

tenants when they can so easily find people willing to pay

of it.

high rents.

Perhaps this sounds familiar. We knew the patterns

The timing couldn’t have been better when a wonderful

weren’t exclusive to Oxford, which is why we looked

person left a substantial legacy – enough to fund the

beyond the city for possible solutions.

purchase of four flats and giving us a real opportunity to

“I previously thought I would die on the streets and had accepted that would be the case.”

get the project off the ground.

We decided to look for a range of flats to give us more scope to satisfy individual choice. We wanted to find places where our clients would not stick out, but we

Our interest was grabbed by the Housing First model –

also wanted to make sure that the accommodation we

which originated in the USA but is slowly growing here in

provided was good quality. We also felt that it would be

the UK. As you know, most homelessness services in the

important not to buy flats that were too big – partly so as

UK operate on a “treatment first” basis – with individuals

not to encourage long-term unwanted visitors or partying,

expected to progress through a homelessness pathway

and partly because these flats were never intended to be

which positions self-contained accommodation as the

permanent, otherwise the project would simply silt up.

holy grail at the end.

We recognised that there would be different preferences Housing First reverses that. The basic concept is that

for location and type of flat, so looked for variety. We

an individual sleeping rough goes straight into a self

deliberately aimed to ensure that the flats were not

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Support worker Alison James with a Housing First tenant

in close proximity and were not in areas with a high

keep up with bills, and that they were not likely to cause

proliferation of people who had been previously

anti-social behaviour.

homeless.

There is acknowledgement among professionals that To date, we have purchased three flats and we are still

the normal requirement of being drug free for a period

seeking a fourth. One is in a tower block, one is a studio

of time, or to have alcohol consumption within a certain

flat on the edge of a large housing estate and the third

level, is not necessarily attainable nor necessary for this

is a first floor flat in a relatively non residential backwater.

client group. We are in the business of finding ways to

We want the fourth to be on the ground floor with a

support our Housing First clients simply to maintain their

self-contained garden – something suitable for one of

accommodation at a relatively basic level rather than

the many entrenched rough sleepers who are fearful of

become model citizens.

enclosed spaces and who often have a dog in tow.

STAFFING LENGTH OF STAY

We did not want to underestimate the amount of

Unlike the American Housing First model, where the

support these tenants would need, and we were also

expectation is that the tenant can stay as long as they

keen to benefit from the expertise of someone who had

like – or, if things aren’t working out in that particular flat,

experienced homelessness themselves. Our decision to

they will be moved to another one) we decided that, for

appoint one full time support worker and one part time

practical reasons of enabling us to support all the people

peer support worker is broadly similar to the Housing First

we can, we would expect our clients to move on within a

scheme in Glasgow. These roles have been funded by

couple of years.

Oxford City Council for an initial two year period.

We negotiated with Oxford City Council to allow our

PARTNERSHIP

Housing First clients access to the normal move-on route

It is essential to get partner agencies on board from the

if we could establish that they were able to pay rent and

outset, so they have a commitment to the project and WWW.HOMELESS.ORG.UK

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“Only with this balance has it been possible to engage with this group of people and to ensure that moving into independent accommodation is the first step on a long journey, not the end of the journey itself.”

understand the need to go “above and beyond” with

what we were offering and how it was different from the

their interventions.

traditional approaches that had not worked for them in the past.

The Oxford City Outreach team (managed by St Mungo’s Broadway) is a key partner. They have the most significant contact with the rough sleeping population, so we work closely with them. Along with primary care from mental health practitioners at Luther Street Medical

“I have been able to make the flat family orientated and have my grandchildren to visit for the first time.”

Centre, other support is brokered according to individual need. We have also found the police and local Anti

PERSONAL BUDGETS

Social Behaviour team to be helpful and supportive.

In addition to refurbishing the properties, we set aside a budget of £1k for each Housing First client to spend on

PRE-TENANCY WORK

furnishing the flat in whatever way he or she wanted.

As expected, the process of identifying likely candidates

They can take all of this with them when they leave and

and the subsequent process of engaging with them is a

the next person would have a similar budget to spend. It

lengthy one, with many false starts and dead ends. An

has been important to give people as much choice as

initial list was drawn up of potential candidates – some

possible – after all, the reason they are with us is because

of whom were simply not interested (though we haven’t

it has not worked out for them in more traditional

given up on them by any means) and others who we felt

homelessness services. It has been interesting how our

were probably too high risk to cut our teeth on – perhaps

3 initial tenants have all spent this very differently. Jim

further down the line when we are more experienced!

didn’t want a bed, he wanted a guitar stand. Gary only wanted brand new kitchen equipment and was rather

Once we had identified potential candidates, the most

unrealistic about what he could get for his money.

important thing to do initially was to gain the trust of the individuals concerned. Most were suspicious at first and

THE KEY TO THE DOOR

dismissive of our offers. Alison, the Housing First support

The key to the whole project has been flexibility, good

worker, spent many hours either with the Outreach Team

working relationships with partner agencies and

or meeting up with potential clients in cafes or drop-

maintaining the relationships with the clients. Only

in centres. A lot of her work involved making it clear

with this balance has it been possible to engage with

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this group of people, and to ensure that moving into independent accommodation is the first step on a long journey, not the end of the journey itself.

GARY’S STORY Gary was initially resistant to even looking at any of the flats. One of the first we had bought was on the 10th floor of a tower block and this seemed to be the least likely place that he would agree to live. He had already made it clear that he was terrified of being trapped and, after 8 years of sleeping rough in a rural environment, this would seem to be too enclosed and different.

“Housing First gave me an opportunity and I have been able to demonstrate what I can do, all my skills have come into play to make the place look comfortable.”

However, he agreed to go and at least have a look at the area which reminded him of somewhere he had lived as a child. He had good memories of this and agreed to look at the flat. Though he had been initially put off by the position of the flat in the middle of a high rise, he was pleased to find that there were two routes in and out – giving him the feeling he could escape if he needed to.

The views are magnificent, and the flat is bright and airy which he liked.

However, even having agreed to move in, it was a huge effort to get him there. Gary was very anxious about committing to the tenancy and there were many false starts. In the end, Alison gave him the keys to the flat without signing the tenancy agreement, suggesting he at least tried staying for one night. This worked and, 10 months later, he is still there.

There have been many ups and downs and numerous interventions by Alison, Ben and others, and Gary may yet decide to leave, but there is no doubt that his life is now significantly different than it was before.

FIND OUT MORE ABOUT OXFORD HOMELESS PATHWAYS OxHoP provides life-changing services for people experiencing homelessness in Oxfordshire.

oxhop.org.uk WWW.HOMELESS.ORG.UK

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FROM SLEEPING ROUGH TO

ADVISING .GOV.UK David Ford is former Chair of Homeless Link’s Expert Advisory Panel, a group of people with direct experience of homelessness who advise us on policy and practice. Here he looks back at the Panel’s achievements and looks forward to a homelessness sector with lived experience at its heart.

Back in the autumn of 2009 Homeless Link invited a

take this opportunity to welcome those new faces and to

number of people who had experienced homelessness

share some of our achievements over the past few years.

along to their offices to meet with Simon Cribbens from the London Delivery Board. As a resident of a SLYMCA

DCLG

hostel at the time I was invited to attend the meeting.

One of the first milestones of the Panel was a meeting with Roger Wilshaw, the then head of homelessness at

That kick started the formation of Homeless Link’s Expert

DCLG, and his team.I took two members of the Panel,

Advisory Panel. We have been formally in existence

Tonny and Gerry, to meet them and discuss the effects

for almost three years now, set up with the purpose of

of ongoing cuts to funding and the impact it would have

advising Homeless Links Policy team and the CEO. I had

on people experiencing homelessness. Roger was so

the privilege of being the Chair of the Panel for two years,

impressed that he asked Tonny to join DCLG’s working

until earlier this year. Thanks to the promotion of the Panel

group on personalisation.

by Homeless Link, and the efforts of Panel members, we became a popular source for advice in a lot of the areas

INTER-MINISTERIAL GROUP ON HOMELESSNESS

of work within the organisation, as well as for Central

We were invited to feed in to the first two papers

Government Departments and the GLA.

published by the Inter-ministerial Group on Homelessness.

Old hands like me have passed on the mantle to new

We were consulted on an early draft of those papers and

panel members over the past few months. I wanted to

the final versions include a series of quotes from us.

This photograph: members of the Expert Advisory Panel at a recent meeting.

Top right and cover: current Panel member, Ray.

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WELFARE REFORM DEBATE

THE BOARD

It should surprise no one that we have been involved

The second ask, and arguably the most important, was

passionately in a lot of the debates and discussions

to have lived experience of homelessness represented at

around welfare reform. A crucial time was our

Board level, with a link to the Panel. This was something

involvement in the campaign to prevent benefits being

that we all felt passionately about.

reduced by 10% annually. We can’t claim to have made the Government reverse its decision on those reductions

Of course there were many questions both for the Panel

- we were part of a wider campaign - but I’d like to

and the Board. What would it mean for both parties? How

think that maybe our input was the straw that broke the

would it work? How would it effect existing structures?

camel’s back. We’ll probably never know, but I’m going

How would we choose a candidate? And more.

to hang on to that thought anyway.

We need to be clear on our own structure and how we HIGH COST TO PAY CAMPAIGN

fitted into Homeless Link, and the Board needed to look

I am sure that most of you reading this are aware of

their existing structure how it would work for them. There

Homeless Links investigation into the impact of benefit

were numerous meetings and discussions between

sanctions on people experiencing homelessness. We fed

the Panel, Homeless Link’s SMT and Board members,

into it in depth, and the resulting report, A High Cost to

including Board members attending our annual Panel

Pay, has caused the DWP to actively look at its sanctions

away-day.

regime in relation to homelessness.

I was involved in the recruitment process – working with DWP CUSTOMER INSIGHT TEAM

Cath Gulliver (SIFA Fireside CEO and Homeless Link Board

We met with a member of DWP’s Customer Insight Team

member) on the difficult task of working through some

to discuss the best approaches for Jobcentre Plus staff

fantastic applications, shortlisting the best for interviews,

to engage people experiencing homelessness. This is

then interviewing and selecting two new Board members.

an ongoing campaign for Homeless Link and one that is

Ross Watkins and Natalie Atkins have been active on the

making positive inroads.

Board since the beginning of this year – and I think that between them they’ll demonstrate just how crucial it is

CHAMPIONS

that lived experience is represented at all levels.

When I first became Chair of the Panel, I met with the Policy team to discuss a way forward for the Panel

I’m extremely proud of what the Panel has achieved, and

and a vision for the future. I had two specific asks of

what their involvement in Homeless Link’s work has meant

Homeless Link. Firstly it was apparent that we were too

to homelessness sector as a whole.

London-centric and that the Panel should represent Homeless Link’s national presence. This posed numerous

I don’t underestimate the opportunity that Homeless Link

challenges. How do we bring people together? How

has offered us, by giving us a voice that is heard at the

should we fund it? The Panel worked with Homeless Link’s

highest level. But similarly we mustn’t underestimate the

Policy team to look at ways in which this could work.

value to services that the voice of experience brings. That might be a voice heard nationally through the Panel,

Today the policy team is working hard at building up a

heard locally through champions and peer groups, or a

data base of national champions around the country

single voice listened to in a single service. That voice of

keeping them informed from a local perspective. This is

experience, I believe, is so often the one that can make a

a massive step forward in getting the national voices of

difference.

people experiencing homelessness heard.

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LEARNING FROM

CAMBRIDGE The Chronically Excluded Adult (CEA) service in Cambridge - a Making Every Adult Matter (MEAM.org.uk) pilot area - coordinates existing services for clients who typically have complex and multiple needs, face exclusions from one or more services, and have a history of rough sleeping or homelessness.

The CEA approach is assertive and flexible based on

the team’s Project and Development Manager, “and

the needs and wishes of people it supports. Crucially, it

working together means we avoid many of the barriers

supports local services to adopt the same approach with

that people can face.”

this group, which is small in number but high in social and service expense.

IDENTIFICATION, REFERRAL AND CASELOADS Clients are referred to the service using the New

THE RIGHT PEOPLE AT THE TABLE

Directions Team Assessment, a simple tool to assess

Governed by a broad spread of local agencies,

behaviours, which is completed by the referring agency

including the County Council, Cambridge Cyrenians and

and validated by CEA.

Emmaus (local homelessness services), as well as local health, mental health and drug and alcohol services, its

Each referral is prioritised by the multi-agency operational

management reflects the broad needs of its target client

group, which reviews the client’s previous journey through

group.

services and their level of engagement before assigning a CEA service coordinator.

The governing partnership originally came together to consider the escalating problems of one individual

Most CEA coordinators manage a caseload of 12-15

in Cambridge City. Joint working led to a solution that

clients – although given the flexibility of the service this

made a significant different to this person’s life, including

is measured on a time needs basis. Each client is taken

their physical health, mental health, housing, ASB and

on with the understanding that they will be supported

other issues. Ongoing discussions at the time around the

until that help is no longer needed, whether that means

Joint Strategic Needs Assessment led to a commitment

working with them for months or years.

from the county council to explore coordinated approaches for clients with complex needs – and for the

FRONTLINE FLEXIBILITY

City and County Councils, along with the Police and NHS

Workers have no remit other than to the client and have

each to contribute a relatively small amount to fund a

the authority to explore innovative approaches on their

manager to bring this work together.

behalf. They work to the client’s wishes using a truly person centred approach that is not constrained by

“The structure of this project has given us access to

service limits, but never promising anything they cannot

people who can make a real difference,” says Tom Tallon,

deliver. This is not only crucial to getting things done – it is also a large part of earning the client’s trust.

Coordinators are able to follow the client’s journey irrespective of where it takes them.

“Traditionally, someone might be supported by a long line of workers, at different stages,” explains Tom Tallon, “from outreach to hostel to tier two accommodation and beyond. Each worker would support a client with a specific set of issues before passing them along to the next worker in line. But now we can stick with each client,

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staying in constant contact, putting us in a far better

“It’s great being able to work and deliver to what the

position to have a longstanding impact on their journey.”

client needs and what they can deal with themselves at any given moment,” says Tom. “It’s the opposite of a

FLEXIBLE RESPONSES FROM SERVICES

prescriptive one-size-fits-all formula.”

Flexibility from services is vital for the work of the coordinators – and this has made senior level strategic

WHAT DOES SUCCESS LOOK LIKE?

buy-in vital from the outset, with sufficiently senior

The CEA service has used several evaluation tools, with

commissioners on the Governance Group meaning that

the support of MEAM. They look at the economic impact,

flexibility can be demanded when necessary.

measuring changes in costs associated with Housing, Health, Substance Misuse and Criminal Justice. Figures

Everyone involved wants the best outcome for each

from the first two years show a shift away from big costs

client and having a coordinator with a direct link

associated with Criminal Justice, towards higher costs for

between client and commissioner can be a powerful

other support services as clients get the help they need.

way to drive positive outcomes.

Meanwhile, the progress of individual clients is made FILLING THE GAPS

using the Homelessness Outcomes Star and New

Tom explains the menu of expertise and services on hand:

Directions Team Assessment.

“If one day we need something that isn’t on the menu, we now have an approach that offers enough flexibility

As early as the end of the first year, these measures

that we can ask the chef to add it.”

demonstrated significant positive change.

The CEA service plays a consultative role in the tendering

FROM PILOT TO SUSTAINABILITY

process for services in Cambridgeshire, identifying where

After three years of operation, the CEA service is exploring

gaps exist so that better provision can be made.

ways of sustaining the level of coordination and flexibility from local services. They are looking at the possibility of

There have also been discussions around making service

mainstreaming within one service, while continuing to

flexibility a part of future commissioning processes.

seek smaller contributions from other services, to reinforce

The CEA service has also involved clients in service

the strategic significance of the work.

development and re-design, which has helped to identify a number of gaps.

As for the sustainability of the service for clients, Tom says: “Our job is to work systems for them, getting services to

Bringing the process full circle, they have made a point

work for clients’ needs – taking the strain for them if you

of helping clients who have successfully made changes

like. All they need to do is trust our way of working and to

in their lives to feed back to services and commissioners,

buy into a level of support that works.”

about what worked this time, after years of falling through the gaps.

Overleaf - meet two people supported by CEA...

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“I get angry and upset, but they know how to take me ... first time I’ve had that.”

- Tommy -

REAL

Leah and Tommy, two people supported by the

knew support was there, waiting in the wings for the right

Chronically Excluded Adults team in Cambridge, told

moment, enabled her to make the decision to leave

us how the service has made a difference.

when she felt ready. This has enabled her to stay away and try to rebuild her life.”

LEAH “If I looked back to twelve months ago, there’s no way I’d

Today, Leah is about to move into a new home and is

have thought I’d be here now,” says Leah.

thinking about the future. She has a very clear view of the role that CEA support has had: “I’ve had Gail and Tom

Six months ago, she was living in a violent relationship,

and people that I can rant and rave to along that time.

just one of many episodes, including drug dependency,

If I hadn’t had that, I probably wouldn’t have got as far.

physical abuse, mental ill health and more, in a

If it wasn’t for the fact that I had that support, I would not

complicated life she describes as “too much bad luck for

have left him in the first place.”

just one person.”

“Leah has grown in confidence and self-esteem over the When she walked out of that relationship she had already

last few weeks and is now talking positively about the

been on the caseload of the CEA team in Cambridge for

future,” says Gail. “We take it one step at a time and she

18 months, referred because she was not engaging with

has overcome many hurdles. This is because she has led

agencies and there were concerns around her safety

the support - we are working to her timeframe and she

and wellbeing.

owns her own journey.”

She had originally accepted support offered by CEA in

Leah now has the space and support to think about

the hope that it would help her stabilise her relationship.

where her life is headed. She is philosophical about her

The flexibility of the team and the services it coordinated

past and she is well aware that she still has some way to

during that 18 months helped Leah build confidence

go. In particular, she has a strong idea of what she still

in the support she would get to help her change her

needs to achieve before she re-enters her son’s life, who

situation when the time came.

lives with his father. But she knows things are changing for the better. She has confidence in the flexible nature of the

Leah’s support worker, Gail, explains: “The fact that she

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support she gets from the CEA service. She understands

JULY 2014

CONNECT

“If it wasn’t for the fact that I had that support, I would not have left him.”

- Leah -

IMPACT how that support is taking the strain for her, making sure

angry and upset, but they know how to take me. They

her move is organised and that appointments are kept.

know I don’t mean it; it’s just how I am. 20 years of being

It’s giving her an opportunity to grow and she sees herself

homeless and it’s the first time I’ve had that.”

one day working in a role where she can help people dealing with issues like her own.

The CEA team’s approach has been based around maintaining constant contact with Tommy and enabling

“All I’ve ever really wanted,” she says, “is to have my son,

him to access independent local authority housing

have my own family, just normal things, Christmases and

without going through the hostel route, which Tommy has

birthdays. I never would have thought that would be

entered and fallen out of on numerous occasions. He

possible, but now it looks like it will be. I’m not going to say

now has a flat, with a garden for his dog, and a support

a timeframe. I don’t need to. I know it’s going to happen.”

network around him to help him to keep it.

TOMMY

The CEA team has also ensured access to treatment

Following a family breakdown in his teens and a long

services to medicate Tommy’s opiate dependency and

history of drug and alcohol dependency, 38 year old

for ongoing alcohol treatment.

Tommy has been homeless and sleeping rough for most of his adult life.

An essential part of the approach has been for the team to work with relevant professionals on Tommy’s behalf,

He was first referred to the CEA team by local street

negotiating greater flexibility from services and only

outreach in September 2012. He would have had no

asking him to participate when necessary.

knowledge of this – in fact referral to CEA requires no client consent, since that would only add an unnecessary

Tommy acknowledges that this flexible, assertive

barrier. The first he knew was when he was contacted by

approach works for him: “If it weren’t for the help of these

the team and asked what he wanted.

people, I tell you, I’d still be on the streets. I’d be a fucking mess, you know what I mean. Tom’s been so good to

He has trouble explaining why the CEA approach has

me. I swear at him, I tell him off, I ignore the phone and

succeeded with him where others haven’t been able to,

everything, and all he does is he won’t leave me alone

but on one thing is clear: “I can be an awkward. I get

until I talk to him.”

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Tim Wiltshire of Access Insurance introduces an exclusive 20% discount for Homeless Link members.

In our long history of working with the sector, we have

within that ‘care’ bracket. However, after carefully

seen first-hand the issues that you face as you support

reviewing the insurance requirements of each individual

people out of homelessness.

organisation we are usually able to offer premium savings that can be significant, especially after applying the 20%

With increasing pressure to make your money go further,

discount for Homeless Link members.

it’s more of a challenge than ever to maximise what you spend for charitable purposes. That’s why we have

SOCIAL ENTERPRISE

arranged a 20% discount for Homeless Link members.

Charities are getting creative to find new revenue streams. We arrange cover for a number of charities who

We understand the risks that charities face and advise on

have trading subsidiaries undertaking more commercial

risk management and insurance programmes to suit your

activities. As your organisation evolves, we’ll stay in touch

needs. These are some of the issues some of my clients

to make sure your cover adapts with you.

have faced and where we have been able to help: GETTING ADVICE FROM A SPECIALIST SOURCING COVER FOR PROVIDING A SERVICE TO

As well as being a Homeless Link member, we work with

ANYONE WITH ARSON OR SEX OFFENCE HISTORY

the Charity Finance Group and know many charities are

Most insurers prefer to avoid the potential risk presented

dissatisfied with levels of service and do not feel they are

by people with certain backgrounds – and when they

entirely understood by their broker.

take it on it is usually expensive.

When we review their policies we often find gaps in cover We worked closely with our panel of specialist insurers

and areas where money can be saved straight away.

to find a solution. Some have agreed parameters within which you are able to support these people without

We only work with the voluntary sector, working with

flagging it with them, dramatically reducing the time,

more than 5500 clients of all shapes and sizes. With the

effort and cost on your part. Insurers will only require full

experience, knowledge, products and contacts we have

details before making a decision over the cover if an

developed we are well placed to provide the highest

individual falls outside certain set criteria.

level of service based around your needs. We also have a dedicated support team that is easily accessible to

In any event, we constantly push hard to find cover that

Homeless Link members.

will allow you to deliver the services that are desperately needed.

GET IN TOUCH FOR A FULL REVIEW OF YOUR COVER

ABOVE INFLATION PREMIUM INCREASES

Tim Wiltshire - 0208 651 7420 tim.wiltshire@accessinsurance. co.uk

Many insurers are increasing their rates due to losses they have made in the care sector. Some have included charities working with vulnerable people on the frontline

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www.accessinsurance.co.uk

A E R A YOUR

SUMMER E H T T U O H ERS THROUG B M E M R O F AL SUMMITS N IO G E R E E R F

As a Homeless Link member you will: •

Learn more about our latest research looking at the state of homeless support and services in your area

•

Discuss and debate best practice, local concerns and the future of the sector

•

Get the opportunity to network with fellow members

•

And, with the next election on the horizon, you will also get a chance to tell us the top priorities you think the next government should focus on to end homelessness.

OPPORTUNITIES THROUGHOUT ENGLAND Network, share knowledge and ideas, and learn more about the latest developments in the homelessness sector and how they affect your area.

Contribute to our #TheDifference2015 consultation as we approach next year’s General Election. www.homeless.org.uk/free-events

S T N E V E K IN L ELETHSESEXPERTISE OF THE SECTOR HOWM CASING S HO

TS | RG.UK/EVEN HOMELESS.O

40 INK | 020 78 @HOMELESSL

4461

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JULY 2014

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