Written evidence submitted by Thames Reach [HOL 122]
Thank you for the opportunity to contribute to the CLG Committee inquiry into homelessness. We greatly welcome the inquiry and believe that homelessness in this country in all its destructive forms can be eradicated.
Thames Reach works with a variety of people who have suffered from homelessness and the range of our services covers street outreach with rough sleepers, specialist accommodation for people with substance misuse and mental health issues, tenancy support, employment programmes and day services offering advice, group work and one-to-one assistance. We support over 7,000 people a year and operate primarily in London. We employ 300 staff, backed up in any single year by around 450 volunteers. 52 members of the salaried work-force are former homeless people.
Much of our work is with people who have high support needs and multiple problems. 39% of the people we support have alcohol issues and 38% suffer from poor mental health. Because of this focus we have chosen to give particular attention to those questions raised by the Committee that relate to:
In each section we have attempted to answer questions relating to the causes of homelessness in line with the request of the Committee before providing specific solutions that can lead to a reduction in homelessness. These are highlighted at the end of each section for ease of reference.
As the Committee will be well aware, different definitions of homelessness lead to confusion about who we mean by the homeless and responses to addressing homelessness will differ according to the cohort of homeless people under consideration. The UK continues to offer a strong statutory homelessness safety net in comparison with most other countries and in terms of statutory entitlement, families and dependent children are protected and make up the majority of those accepted as being statutorily homeless under the homelessness legislation. Thus, in the most recent quarterly figures (July –September 2015) 67% of those accepted for housing are households with dependent children. In contrast, just 9% of people accepted for housing are statutorily entitled to housing because of mental illness. This leads to a situation which can seem anomalous whereby somebody in accommodation, albeit unsatisfactory, is entitled to housing whereas a person with nowhere to live who is sleeping rough may have no statutory entitlement.
Overview of rough sleeping in London
Thames Reach works on the streets of London with rough sleepers every night of the year through its London Street Rescue service which is commissioned by the Greater London Authority (GLA). We have other specialist street teams including our TRIO team, funded by London Councils, which focuses on hotspots (congregations) of rough sleepers and we have teams in Tower Hamlets and Croydon which are commissioned by the local authority to provide a bespoke service in those boroughs.
Rough sleeping numbers have continued to rise over the past few years though, as the linked attachment shows, London’s figures remain some of the best in the world when measured in the context of city populations. http://www.thamesreach.org.uk/news-and-views/homelessness-facts-and-figures/rough-sleeper-counts-for-major-cities-across-the-world/
London has also sought to respond to rough sleeping by measuring its extent both in terms of numbers of people on the street and length of time spent on the street. In London the CHAIN reports provide a reliable source of data as street outreach teams working across London input data on a nightly basis and the cumulative figures offer a convincing picture of numbers, profile, outcomes etc. We believe that the cumulative collection of data provides a far more robust and comprehensive set of statistics than the annual national street count. A ‘point-in-time’ street count is inevitably going to be of limited value both in terms of the limited amount of detailed information it offers and as a means of assessing the scale of rough sleeping. The legitimacy of the national figure is also undermined by the street count including actual street counts alongside local authority estimates. We would urge other cities and towns with significant rough sleeping numbers to adopt an approach based on the ongoing collection of rough sleeper data of the kind developed in London.
http://data.london.gov.uk/dataset/chain-reports/resource/dd12fe65-0a44-465d-96e6-5339fc5c505d
The latest annual CHAIN statistics (2014-15) show that 7581 rough sleepers were seen across London with many rough sleepers suffering from poor mental health (45%), and tackling alcohol (41%) and drug (31%) problems. The number of rough sleepers has been rising consistently over the last five years, though there is some good news hidden amongst the high numbers. Firstly, over half of rough sleepers met in 2014-15 were met on only one occasion, many being assisted to escape rough sleeping through the No Second Night Out (NSNO) initiative. The numbers of rough sleepers who stay on the street night after night is remarkably low with just 183 (2%) of rough sleepers met across all four quarters of the year. Finally, there has not been a return, yet, to the significant levels of youth homelessness experienced in the 1980s and early 1990s. The CHAIN annual report shows that just nine rough sleepers under the age of 18 were met by outreach teams in the year.
Below we set out the factors that we believe have led to a rise in rough sleeping.
The most significant change in the profile of the rough sleeping population in London and indeed in the country overall has been the big increase in non-UK nationals sleeping rough on the street. In London, 57% of the rough sleeping population comprises non-UK nationals with 36% coming from the central and eastern countries that joined the European Union in 2004 and 2007. Sadly, a significant number of central and eastern European rough sleepers come onto the streets very quickly after entering the country. CHAIN data indicates that 38% of new central and eastern European rough sleepers begin sleeping rough within the first month of entering the country.
Thames Reach and other agencies have managed to successfully reconnect home destitute central and eastern European rough sleepers, indeed over 3,000 reconnections have now been achieved by Thames Reach. However, the flow onto the streets of migrant rough sleepers has been an enormous challenge and, of the most recent deaths of rough sleepers on the street that we have experienced including one as recently as December 24th, a disturbingly high percentage are central and eastern Europeans.
Some central and eastern Europeans are sleeping rough because they have no other options, being unable to access benefits to cover the costs of hostel accommodation. Others are sleeping rough and getting work in the informal economy where they are paid at below minimum wage levels, ‘off the cards’. For this group there is a reluctance to take up opportunities of accommodation because of the cost and the young men who make up the great majority of this group of working rough sleepers are resilient enough to sleep rough for a few months before returning home.
This situation is, of course, not acceptable because of the risks of exploitation of these men by unscrupulous employers and the impact that they have on communities when sleeping rough in parks and other public spaces. A way forward that we can explore with them is for a small group to move together into private rented accommodation where they can share costs and also receive in-work benefits to cover some of their housing costs. This option however is rarely taken up and, should entitlement to in-work benefits for migrants for the first four years be denied, a change the government is seeking through negotiation with European Union partners, then this route out will close up entirely.
Thames Reach is firmly of the view that, for people unable to fulfil treaty obligations to find work and who run the risk of destitution, the only reasonable option is a return to country of origin and Thames Reach and other organisations can provide a supported reconnection to family, friends and services in their homeland. The approach of street outreach teams should be to offer support alongside the possibility of enforcement if help to access services or to return home where that is the only practical solution is consistently turned down. However, for different reasons there is a reluctance to take up this voluntary reconnection and for some, inevitably, an Administrative Removal carried out by the Immigration Compliance and Enforcement (ICE) service becomes necessary. The flow of migrants coming to the UK to work who then sleep rough is the biggest single factor in the increase in rough sleeping in London.
Solutions
It is our view that the options that can reduce this flow are:
Continued funding of reconnections services for non-UK nationals who need a supported reconnection due to vulnerability.
Increased enforcement by ICE teams where EU treaty obligations or freedom of movement rights are being abused.
The introduction of basic, cheap shelter accommodation for those working migrants willing to legitimise their working situation (i.e. pay tax, make national insurance contributions and receive employment protection through working at minimum wage or above). Because the majority of this group do not have significant support needs, the staffing costs of this accommodation would be low.
Whilst the statistic that has changed most dramatically is that relating to nationality, the statistic that has remained resolutely unchanged is the shocking figure for the number of people on the street with severe and enduring mental health problems. Thames Reach is of the view that this is a national scandal and there is a complacency with which we accept the continued presence of this group of highly vulnerable people on our streets. In London we know from the CHAIN statistics that 45% (3,411) of rough sleepers in 2014-15 had a mental health issue. Not all of this group are long-term or entrenched rough sleepers. However, we also know that 21% of the rough sleeping population in London has been on the street for a minimum of two consecutive years. From this we can conclude that there is a group of at least 650 people with mental health issues who are entrenched rough sleepers.
The reasons why this number of long-term rough sleepers with mental health issues remain on the street is, in our view, because:
Solutions
Expectations on Community Mental Health Teams to undertake assessments in places and at times that are appropriate to entrenched rough sleepers should be made explicit and unwillingness to undertake assessments should be challengeable and made public. Best practice in this area should be disseminated and publicised.
We also believe that to comprehensively tackle the issue of entrenched rough sleepers with severe and enduring mental health issues a specific, high profile initiative is required. The government has committed itself to developing the social investment market to address homelessness issues and Thames Reach enthusiastically supports this prioritisation. We propose a Social Impact Bond initiative focusing on this group of around 650 named people. Our experience of delivering a very successful Social Impact Bond for 416 entrenched rough sleepers has led to some very productive links with social investors and we are convinced that social investors will be interested in tackling this issue. Additionally, assisting this group of rough sleepers with mental health issues for whom there is considerable sympathy is likely to receive public support, far more so than, for example, an initiative focusing on street drinkers.
It is our experience that the response received by people presenting to local authority Housing Options teams who are homeless or at risk of homelessness is extremely variable. With stretched services and limited accommodation options we fully understand how providing housing advice is challenging. However, we have examples of people sleeping rough who before going onto the street visited Housing Options and were given out-of-date lists of hostels and bed and breakfast accommodation - an unacceptably poor form of preventative advice and support.
Figures provided through the No Second Night Out initiative of which Thames Reach is part show that a disturbingly high percentage of people who enter the NSNO assessment hubs after sleeping rough for the first time had approached their local authority before ending up on the street.
On the other hand, some Housing Options teams are evidencing good practice and some exciting developments are improving local preventative services. In the London Borough of Hackney, colleagues from Housing Options are now operating out of a facility managed jointly by Thames Reach and health partners NHS East London and the City called the Greenhouse Centre. The Provision of homelessness advice from this community setting has enabled the local authority to deliver a much more holistic service that can address housing concerns and also linked areas associated with homelessness such as health-related issues, financial problems and family and neighbour disputes. We believe that this is the way local authorities should be seeking to address homelessness in the 21st century based on the premise that, particularly with respect to rough sleeping, the issues leading to homelessness are rarely about lack of housing alone.
Solutions
Local authorities should be challenged and incentivised to develop holistic approaches to assessing and responding to homelessness presentations along the lines of the model being developed at the Greenhouse Centre in Hackney. The role of the voluntary sector in supporting the delivery of preventative services is key. Stronger mandatory requirements around the delivering of preventative services are required and the development of new approaches should be stimulated by the provision of funding with a focus on evidencing the cost benefits that can be achieved by recalibrating the system towards a robust preventative response.
We believe this offers a more effective step forward than attempting to extend the priority need groups through legislation. In the past, extending the priority need groups to include a category of people becoming homeless after leaving custody, care or the armed services had minimal impact on the numbers being accepted as homeless because of the need to prove vulnerability to achieve a statutory acceptance. This is illustrated by the most recent statutory homelessness figures (October-December 2015) which show that just 4% of acceptances were people from this category.
Homelessness can only be reduced and ended if there is an iron determination to find out what works and to replicate it. Too many services for the homeless are able to escape unchallenged without being required to prove that the support and interventions they offer help people to move away from homelessness in a sustainable way. For example, many of the well-publicised, familiar front-line responses to rough sleeping such as soup runs and some shelters are not able to evidence that what they offer is helping people take steps to move from the street and to recover their health and self-esteem.
In fact, some services are not even able to show that they know who they are providing a service to. There is compelling evidence from a number of reliable sources including street outreach teams which suggests that the majority of people using soup runs and other street hand-outs dispensing, for example, clothes and sleeping bags are not sleeping rough. Instead people are returning to the street to access services and some, having returned, then decide to stay which, given the dangers inherent in sleeping rough, can be a calamitous decision.
Hostels for the homeless in the UK are of a standard that is much higher than the rudimentary dormitory-style shelters common in North America. In this country single rooms are the norm and a range of other services addressing areas such as health and employment are standard. However, outcomes achieved by hostels are not particularly impressive which is especially concerning given that a move to a hostel remains the most likely first step away from street homelessness. In 2014-15 the CHAIN statistics show that only 39% of people using hostels for rough sleepers in London were able to move on into mid to long term accommodation. For 29% the outcome was abandonment and eviction and a further 27% transferred to another hostel; that is, made a sideways move. We know through being part of a benchmarking group with other comparable homelessness organisations managing hostels that performance across the hostel system is very variable. We believe that an evaluation of hostels would be beneficial with a view to promoting best practice and increasing positive move on from hostels.
In contrast, one particular area of service provision where the evidence base is considerable is Housing First. A Housing First approach focuses on moving people with a high level of need, including those who are street homeless, into self-contained accommodation without the requirement for the individual to first undertake a programme to address issues such as substance misuse. Once in the accommodation, services appropriate to the needs of the person are put in place so that the accommodation can be sustained. This model of delivery was developed in North America and adapting the model to ensure its effectiveness within a UK context is necessary. Yet, this caveat aside, there can be little doubt that the Housing First model has consistently delivered effective results in terms of housing sustainment, particularly for people with mental health issues, and these have been evidenced in the United States through randomised control trials run over a number of years. The cost effectiveness of Housing First has also been demonstrated.
In the UK a report on a number of small scale Housing First pilots including a successful initiative managed by Thames Reach also concluded that Housing First as a model in the UK has produced impressive outcomes.
Solutions
We propose that there should be a robust review of the hostel system in the UK with a view to establishing how the hostel pathway as a route away from homelessness can be improved.
Evaluations of the Housing First model have provided considerable evidence of the effectiveness of the model as a way of sustaining people with complex needs in accommodation and its financial value has also been proven. Government should now set in place a tendering process through which Housing First initiatives can be established. We believe that some effective partnerships will develop and there is an opportunity for Registered Providers to work collaboratively with homelessness organisations in delivering Housing First solutions. A Payment by Results (PbR) element to the commissioning would be appropriate.
Much of Thames Reach’s work focuses on a relatively small number of people with multiple needs. These individuals consistently lose out because of the sheer complexity of the issues they are seeking to address which span a range of professional disciplines and services including mental health teams, drug and alcohol teams and offender services. The ground-breaking research Hard Edges undertaken by Heriot Watt University and funded by Lankelly Chase which interrogated substance misuse, homelessness and criminal justice datasets showed that there was very considerable overlap with 58,000 multiply disadvantaged individuals appearing in all three.
http://lankellychase.org.uk/multiple-disadvantage/publications/hard-edges/
Initiatives targeting the most disadvantaged and entrenched rough sleepers have been extremely successful including in London:
Initiatives of this kind which are required to demonstrate outcomes against agreed targets must continue to be supported based on addressing the situation of named individuals whose length of time on the street and level of need can be evidenced. These people are high cost in terms of the amount of time and resources they use up and moving them to a sustainable place away from the street has immense benefits in terms of financial savings. This is also the group most likely to die on the street so the moral imperative to address their situation is also strong.
There are other projects either under-way or imminent that impact on this group and it is important that any new initiatives are informed by these. For example:
This group of multiply disadvantaged people is well known to a variety of services. Our collective response should therefore be based on a multi-agency approach with a commitment to providing accommodation and support at a local level that reflects the requirements of the 2014 Care Act to provide a comprehensive assessment of vulnerability and improved access to support. Integrated commissioning and pooled funding should bring benefits to this multiply-excluded group if the intentions of the Care Act are to be met, though our experience is that with this group aspirations and reality have rarely coalesced.
However, there are some encouraging examples of emerging best practice offering a more holistic response. In the London Borough of Lambeth Thames Reach is part of a formal partnership which is providing interventions to people at an early point when they are experiencing poor mental health and the span of assistance is much wider than has traditionally been the case. Practical help around housing, finances and social networks is offered as well as clinical interventions and assistance linking with primary care support. The message is that it is no longer necessary for you to become very unwell before support becomes available and that the best place to receive help is to you in your home, rather than in an institution. Integrated commissioning by Clinical Commissioning Groups (CCGs) and social care should increase the possibility of this kind of approach becoming mainstream.
Solutions
Our view is that to address the needs of a small group of multiply disadvantaged homeless individuals who disproportionately use up resources and are particularly vulnerable the focus should be on:
Learning from existing initiatives that are already focusing on this group, ensuring that any new projects build on evidence of what works.
Local approaches, ensuring that multi-agency interventions avoid the sadly familiar experience of people with multiple needs falling between services. Integrated commissioning between CCGs and social care and pooled local authority budgets spanning, for example, social care, public health and housing should also hasten the introduction of more holistic interventions with the 2014 Care Act providing a structure for assessing vulnerability and allocating resources.
The extension of hospital discharge programmes to include a reconnection service helping vulnerable non-UK nationals who do not have recourse to public funds return to their country of origin.