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 |
WWW.HOMELESS.ORG.UK
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
CONNECT
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.
16
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
12
LEARNING FROM CAMBRIDGE
data looking at the health of homeless people
next year’s general election?
8
14
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
CONNECT
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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JULY 2014
“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... WWW.HOMELESS.ORG.UK
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JULY 2014
“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.” WWW.HOMELESS.ORG.UK
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CONNECT
JULY 2014
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
CONNECT
JULY 2014
homeless.org.uk/connect
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