A group of local authority housing leads gathered in a room in Hampshire recently to talk about their experiences with the health and social care system. The word that came up most frequently was ‘battle'. A battle to get referrals under the Homelessness Reduction Act in a reasonable timeframe, a battle to share information, a battle to secure mental health support for clients in Temporary Accommodation. And the list went on, despite some pockets of good practice and good relationships with some health services.
This will be familiar to local authorities across the country. Poor health is both a cause and a consequence of homelessness, yet too often health services, under their own pressures, are not at the table, leaving local authorities feeling alone in managing the fallout from England's housing crisis.
In Pathway, we see the difference that good care makes to homelessness every day. We work with NHS hospitals to set up and run multi-disciplinary teams to support homeless patients during a hospital admission and into better accommodation on discharge.
But hope is on the horizon. The Government's new National Plan for Ending Homelessness puts to rest the idea that homelessness is simply about housing and makes clear that local authorities are not in this alone. With contributions across Government, the strategy sets out clearly the role of NHS services in reducing homelessness. The commitment to end discharges from hospital to the street, underpinned by a cross-Government target, is a major advance, with the potential to prevent homelessness at significant scale. The commitment to embed housing officers in hospital discharge teams is an important first step towards improving the quality of NHS referrals under the Duty to Refer. Finally, the proposed ‘duty to collaborate' between public services should mean that public services collectively take shared responsibility for resolving people's homelessness.
These commitments are informed by strong evidence about what works in reducing homelessness, recently summarised in NICE guideline 214. It identifies implementable, cost-effective, proven approaches such multi-disciplinary team working and specialist step-down care from hospital.
In Pathway, we see the difference that good care makes to homelessness every day. We work with NHS hospitals to set up and run multi-disciplinary teams to support homeless patients during a hospital admission and into better accommodation on discharge. Last year, our teams helped 4,700 people, and reduced returns to rough sleeping by 62%. A number of things contribute to this success. A hospital admission can be a window of opportunity, when people may be more open to the right kind of support. The teams work hard to build relationships of trust with patients, matched with energetic advocacy on their behalf, inside the hospital and out. And their multi-disciplinary way of working means that patients' overlapping needs are met more thoroughly, setting them up for success when they leave hospital.
Local authorities already fund housing officers in several of the teams in our networks and embedding housing expertise in the hospital leads to greater integration and direct benefits for local authorities. They resolve local connection questions sooner, prevent homelessness at source through identification of people at risk in hospital.
The ambitious health commitments in the Government's plan are an opportunity to build on these and other examples of health and homelessness service integration. There are three things local authorities can do to get the most out the health commitments in the plan. The first is to make sure you have a seat at the table as local planning for ‘neighbourhood health' gets going. Neighbourhood health is central to the NHS's drive to move ‘care closer to home' and focused on people with multiple conditions at risk of hospital admission; this describes a lot of people facing homelessness. There is a real opportunity here to create services that help vulnerable people in a more preventative way.
Second, share as much data as possible with NHS partners, to help to make people facing homelessness visible to them, so that their needs are properly considered by NHS commissioners. And finally, invest in Housing First, a secure base from which people can get the healthcare they need, setting up a virtuous circle of recovery from homelessness and poor health.
The new homelessness action plan has not fixed everything. Local Housing Allowance still urgently needs to be restored so that more people can afford their rent and relieve the pressures on TA and local authority finances. But with a greater recognition of the links between housing and health, we see reasons for bounded optimism, and perhaps at least the beginning of the end of the battle.
Dee O'Connell, Director of Policy, Pathway
