Category Archives: Homelessness

Agency and choice in multiple exclusion homelessness

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Carolin Hess is a PhD student at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (583 words)

Carolin HessAs part of the NIHR Policy Research Unit in Health and Social Care Workforce Homelessness Series, Research Fellow at the Unit, Jess Harris, and Stan Burridge (public contributor) recently presented ‘lived experience’ perspectives from the emerging findings of an NIHR School for Social Care Research funded national study of homelessness, self-neglect, and safeguarding. The event, held on 25 April, was attended by over 180 people.

In light of a recent report that revealed that 1313 people died while homeless (including people sleeping rough, in emergency or other insecure settings) in the UK during 2022, an 85% increase on the number recorded in 2019, the research could not be more timely.

Bringing together the voices of multi-disciplinary practitioners and people with lived experience, the study findings highlight the complexities of safeguarding but also offer suggestions on how to strengthen safeguarding responses and more effectively support people who face multiple exclusion homelessness (MEH). Continue reading →

‘Opening the door’ to employment in healthcare: People with lived experience of homelessness

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Cover of a reportThe NIHR Policy Research Unit in Health and Social Care Workforce has published an evaluation of an access to employment programme in the NHS targeted at those with lived experience of homelessness. The pilot programme involved the homelessness charities Pathway and Groundswell and five NHS Trusts in England. Report author, Ian Kessler, here outlines the programme and the main findings of his evaluation.

Ian Kessler is Deputy Director of the NIHR Policy Research Unit in Health and Social Care Workforce. He is also Professor of Public Policy and Management at King’s Business School. (1,016 words)

Widening participation in the healthcare workforce has long been an important policy objective in the NHS. This has been reflected in an equalities, diversity, and inclusion agenda traditionally centring on gender and race, and more recently on young people with disabilities with the introduction of supported employment programmes by NHS Trusts, such as Project Search and Choice. However, the pursuit of widening participation is a rich policy space, connecting to an increasing range of workforce and broader service priorities.

Framed as ‘anchor institutions’, playing a key role as local employers, NHS Trusts have been encouraged to develop workforces which reflect, in socio-economic and demographic terms, the communities they serve. This role overlaps with moves to bring into the NHS workforce people with lived experience of various health conditions as a means of delivering patient-centred services and more effectively addressing health inequalities. Such moves have been especially evident in the introduction of the peer support worker role in mental health (which our Unit evaluated many years ago). More prosaically, but perhaps most pressing, the search for workforce diversity and inclusion addresses the recruitment and retention challenges faced by healthcare employers, with those at the margins of employment representing a new and reliable source of labour. Continue reading →

Social Care, Legal Literacy, Homelessness and the Care Act

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Helena Kitto is a third-year PhD student at Keele University. (1,097 words)

Homelessness and law

Homelessness is complicated to talk about from a legislative perspective. The Housing (Homeless Persons) Act 1977 is the first piece of English legislation that specifically pertains to homeless people, but other laws have been applied to people who are homeless, most infamously the Vagrancy Act 1824. Following the Housing (Homeless Persons) Act, there is now the Homelessness Act 2002, and later the Homelessness Reduction Act 2017. Another piece of legislation that does not specifically apply to homeless people, but nevertheless has significantly impacted them, is the Care Act 2014, primarily due to the changes the Act made to adult safeguarding in England.

These laws span a number of legal domains, from criminal concerns to property to social care. This is where the complications of discussing homelessness from a legislative perspective arise, because they require a degree of contextual understanding of several different areas of legal concern. Concepts like responsibility, entitlement and safeguarding can be hard to define.

One way to view homelessness legislation could be as in a state of evolution. A chronological analysis of laws that pertain to homeless people (including those that are not specifically about them) shows a gradual move away from viewing homelessness in a punitive fashion, or one that is exclusively a concern of housing and entitlement to housing support, to one that acknowledges homelessness as bringing in adult safeguarding and public health. Continue reading →

New Roles at the Health, Housing and Social Care Interface – The Homeless Health Team Leader

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The DHSC’s Out-of-Hospital Care Models Programme provided £16m of funding to 17 test sites across England to improve discharge arrangements for people experiencing homelessness. The programme affords opportunities to develop new services and workforce roles that aim to integrate health, housing and social care at key transition points. In this blog, Shevon Simon describes her work as a ‘Homeless Health Team Leader’ at the Princess Royal University Hospital in South East London. 

What is your job role?

In my new role as Homeless Health Team Leader, I am assigned to PRUH (Princess Royal University Hospital) in South East London to support the hospital with facilitating the discharge of homeless patients – primarily the discharge of single homeless people with complex needs. I am also responsible for developing discharge pathways and upskilling Discharge Teams to understand key homelessness legislation.

Can you tell us about why your role is needed?

My background is in local authority homelessness assessments and 14 years ago people rarely presented as homeless with more than one medical condition.

Today, many people have more than one condition – so they are multi-symptomatic and this in itself creates complexities around health management and means that they are sicker than in earlier times. In addition, chronic homelessness usually features at least three multiple long-term conditions – meaning people are more likely to suffer mental health problems, physical health problems and substance misuse and are not accessing the health services they need. COVID–19 and multiple lockdowns have not helped with healthcare accessibility, with many services not being as accessible as they were prior to the first lockdown in March 2020. Two years on and most local authority housing departments are still closed for face-to-face/office appointments, requiring patients to complete lengthy online forms or telephone assessments. As you can imagine, this is a huge barrier for someone who is homeless. Continue reading →

How Discharge to Assess (D2A) Can Work for Homeless Patients

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Senior Research Fellow, Dr Michelle Cornes, has been working with NHS England and Improvement on the new Discharge to Assess (D2A) practice guidance, identifying good practice examples that illustrate how this new hospital discharge policy can work effectively for patients who are homeless. Here she provides one example from Cornwall Council. (302 words)

Specialist D2A Reablement for People who are Homeless  

Hospital Discharge Service Case Study – KA (Harbour Housing)

Cornwall Council working in partnership with Harbour Housing and Stay at Home have redesigned their out of hospital care services to increase the number of options available to homeless patients leaving hospital on D2A Pathways. For those patients who do not have a home and require more than just a sign-posting service, Harbour Housing provides access to six self-contained units of accessible step-down accommodation. This comes with onsite practical support such as helping people to get to their hospital appointments, as well as holistic ‘enrichment support’ for improved health and wellbeing including counselling and a range of strengths-based activities. Where people have care and support needs including self-neglect and issues linked to drug and alcohol use, a specialist reablement service is provided for up to six weeks. The Stay at Home service provides CQC regulated activities into the step-down accommodation and into the community. Specialist reablement workers are trained in the use trauma informed approaches and can for example, deliver Naloxone to prevent drug related deaths from overdose. During the reablement period, permanent housing is arranged and where necessary a Care Act 2014 assessment is carried out to identify needs for any longer-term care and support. Before these specialist D2A services were in place homeless patients would usually have stayed in hospital for long periods (sometimes up to six weeks) while waiting for various care and housing assessments to be completed.

Hospital Discharge Service Case Study – KA (Harbour Housing)

Dr Michelle Cornes is Senior Research Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London.

Remembering Darren O’Shea (1977-2021), ‘Expert by Experience’ member of the HSCWRU Homeless Research Programme

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Darren O’Shea in London, February 2019

It is with great sadness that we share the news that Darren O’Shea passed away in hospital in London on 17 January 2021. Darren was a long-standing and much valued member of our Homeless Research Programme here at HSCWRU. He worked on the National Institute for Health Research (NIHR) study about improving hospital discharge arrangements for people who are homeless, sharing his lived experiences and giving presentations at many conferences and events. He was also a member of the Department of Health and Social Care’s Rough Sleeping Advisory Group, and advised the Healthy London Partnership based at City Hall. He was influential in campaigning for ‘step-down’ care so that people who are homeless have somewhere to stay when they leave hospital and it is now government policy that these services are developed across England. We are grateful for all Darren did to improve homeless health services and to contribute to our research at HSCWRU.

Stan Burridge, an Involvement specialist and another member of HSCWRU’s Homeless Research Programme, writes:

‘I was fortunate to work with Darren on many occasions over the past few years, and the value he brought to the work is almost beyond measure. We can forget that researching homelessness and social exclusion issues is dependent on capturing the harsh reality of people’s lives. Darren, who was often floating in and out of his own chaos, was a stark reminder that we were working to make a difference to real people with real lives and that our work goes beyond datasets. Darren had an incredibly valuable skill in that he was able to step out of his own difficult world and focus on the plight of others around him, and this brought a richness to the work we did together. His ability to talk openly, often when the rawness of his own journey was very evident, brought vividness to the research from a rich life, sadly now cut short. Darren’s death leaves a void and although we are saddened we are also enriched by the time he gave us. We will ensure his legacy lives on.’

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Darren O’Shea (1977-2021)

Three early papers on self-neglect

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At the NIHR Policy Research Unit in Health and Social Care Workforce we are undertaking two studies examining self-neglect, both funded by the NIHR School for Social Care Research. In an article published in The Journal of Adult Protection, for the project examining Adult Safeguarding Responses to Homelessness and Self-neglect, Stephen Martineau goes back to three pioneering research papers on self-neglect to consider what, if anything, they can feed into current debates. (787 words)

Patricia Shaw's contribution in the 1957 paper on ‘social breakdown in the elderly’

Patricia Shaw’s contribution in the 1957 paper on ‘social breakdown in the elderly’

While conducting a review of the self-neglect literature during this year, references to two early papers on the topic have come up repeatedly. The first, published in the British Medical Journal in 1966, by Macmillan and Shaw, is often described as the seminal academic paper in this field and drew on cases in Nottingham. The other is the Diogenes Syndrome article, by Clark, Mankikar and Gray, published in The Lancet in 1975; it derived from a study conducted in a Brighton hospital. Our new Journal of Adult Protection article examines these two articles plus a third, again by Shaw and Macmillan. This one dates from 1957 and, though it did not use the term self-neglect (rather, social breakdown in the elderly), it is the most vivid and interesting of the three.

There is a good deal of research interest in self-neglect at present. Following consultation with, and a survey of, practitioners, carers and service users (suggested by our Unit), the James Lind Alliance (2018) Priority Setting Research Partnership on Adult Social Work recommended that the topic should be a research priority. As well as the Unit’s two studies (details below), the NIHR has a call out for a study of self-neglect in the community (closing 28 January 2021). The need for such research is reinforced by Michael Preston-Shoot and colleagues’ new national study of Safeguarding Adults Reviews that were conducted between April 2017 – March 2019. SARs are commissioned where questions are raised about the way agencies involved in safeguarding have worked together in individual cases: among the 231 reviews the authors analysed, self-neglect constituted the most common type of abuse/neglect (featuring in 45% of the reviews). Continue reading →

Keeping “Everybody in” – the need to move from hotels to Housing First

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Stan Burridge is an ex-rough sleeper and an HSCWRU Peer-researcher. He is Director of Expert Focus, a user-led organisation that supports the involvement of people with lived experience in homelessness research and policy. (1,029 words)

Over the past few weeks, I have been thinking about all the people who have been swept from the streets and into hotels because of the COVID-19 pandemic. The old mantra that it was impossible to house all those sleeping rough has been scotched. This event signifies how, with the right amount political will and financial investment, radical change can happen at scale and pace.

Thinking about the next steps for Everybody in (the policy of offering people sleeping rough a hotel room for duration of the lockdown) I would like to urge policymakers to continue to pursue radical change (i.e. doing the right thing). Looking for a real solution to homelessness means taking note of the ‘overwhelming evidence that highlights the effectiveness of Housing First.’[i]

Housing First affords people a permanent home (their own front door) with no requirements beyond accepting the help of a trusted worker to maintain their tenancy. There is no requirement to ‘move on’ with other areas such as addiction and mental health issues, and even if someone were to lose their home, the trusted worker will continue to work with them. Continue reading →

The Challenge of Self-Isolating in Houses in Multiple Occupation (HMOs)

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Emily HillIn this blog, Emily Hill from Harbour Housing, a homeless charity in Cornwall, describes how their service has supported people living in temporary accommodation to leave hospital safely during the pandemic. She highlights some of the challenges in making sure everyone has the opportunity to self-isolate when living in a House in Multiple Occupation (HMO) (903 words)

Harbour Housing provides supported accommodation across Cornwall for people with multiple and complex needs, including those who have recent experience of homelessness. The accommodation is provided in what are called Houses in Multiple Occupation (HMOs). Residents have their own rooms but share communal areas such as bathrooms and kitchens.

Clinical advice and guidance on reducing the risk of infection and severe illness among the homeless population as a result of coronavirus (COVID-19) is clear that HMO’s could pose risks. In order to reduce these risks, the guidance suggests that individuals should be provided with their own room and bathroom facilities wherever possible. Where this is not possible, providers should make best use of provision and should undertake regular cleaning of shared facilities.

Hygiene zoneThe first step in Harbour Housing’s response to keeping residents safe from COVID-19 was to provide everyone with an information briefing, ensuring staff had time to talk through any concerns. Video screens in the properties also relayed NHS advice about hygiene and hand washing. Washing facilities and hand dryers were installed in the entrance lobby at each building. This meant that everyone had the opportunity to wash their hands before entering the property. In addition, thermal imaging CCTV cameras were installed to read the temperature of every person entering the building. This was to ensure that symptoms could be caught early. Continue reading →

Embracing New Technology and Social Media to Prevent Homelessness: How COVID-19 is impacting on support workers in the criminal justice system

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In this post, Stan Burridge, Director of Expert Focus (a user-led consultancy), reports on how COVID-19 is impacting on workers who support people leaving prison to find accommodation and resettle in the community. He speaks to two workers from the Cumbria Offender Service run by Humankind, a medium-sized voluntary sector organisation based in the north of England. (1,388 words)

Thinking about your job before the lockdown, what is your normal role like?

There are a number of different roles I play supporting offenders who have either been released after serving a prison sentence or as part of a community-based sentence involving probation. All of my work fits into the wider picture of helping them to find a stable platform (securing accommodation and claiming benefits is part of that process) so they can engage with other services as part of their sentencing commitments but also as a way of moving forward and hopefully away from committing crime.

What are the difficulties in finding accommodation for people leaving prison, especially as housing is at a premium?

There is a real difficulty in getting people housed and in an ideal world everyone who was released from prison would have somewhere to go, but that is not the case. Often when accommodation is found it is in areas where there is a lot of crime and drug use, so it seems as though we are often perpetuating people’s problems. Options to place people in less deprived areas are limited and the harsh reality is if I couldn’t get someone housed in those sorts of areas, I probably wouldn’t be able to get them housed anywhere, so they would be homeless. Continue reading →