Category Archives: Homelessness

Alan Kilmister reports from Homelessness Health Event

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Alan Kilmister is a Peer Researcher and Expert by Experience with HSCWRU’s Homeless Hospital Discharge Project. The project, which is led by Senior Research Fellow at HSCWRU, Dr Michelle Cornes, is due to report shortly. The project researchers last month published an open access article in Wellcome Open Research—‘Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England’. (792 words)

Recent article from the HSCWRU study examining Hospital Discharge of homeless people

Recent article from the HSCWRU study examining Hospital Discharge of homeless people

Hi, it’s me Alan—yes, I know I am becoming a blogoholic. On Friday 8 March 2019 I attended the Queen’s Nursing Institute event, ‘Better Health for all Women especially those suffering homelessness’. It was held at Birmingham City University South Campus: it was a very good venue and we were well fed and watered, and all the speakers were women who introduced themselves with ‘nice to see you all’ on this International Women’s Day. Us poor menfolk were outnumbered by 20/1.

The four key themes of the meeting were: Improve quality of local health; and housing systems; improve access to healthcare; and, increasing knowledge and awareness. This was followed by six key recommendations: Accommodation, Collaborate, Together, Initiative and Intelligence, Ownership, and no Gaps in care. The main point out of these six to my mind was to foster collaborative working for homeless prevention and reduction and to ensure all health services understand their responsibilities regarding care and treatment of those that are homeless. Continue reading →

Oh, to be in Finland now that spring is here

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James Fuller reports on the ‘Housing First: Ending homelessness across Finland and the UK’ seminar at the Finnish Ambassador’s residence in London, 6 March 2019. The event was organised in co-operation with the Finnish Institute in London and Crisis UK. (1,070 words)

Kensington Palace Gardens, or Ambassadors Avenue as it might as well be called, is a private, heavily guarded boulevard nestled behind the sedate royal dwelling from which it takes its name that is packed with official residences. Not an obvious venue for a series of presentations, organised by the Finnish Institute, about how to house some of the most marginalised and multiply excluded members of society, even if the Finnish building is typically modest.

After a brief word from the Ambassador and the same from Jon Sparkes, Chief Executive of Crisis, we heard from Anita Birchall, Head of the Threshold Housing Project, a specialist housing first, five-year pilot project working with female homeless ex-offenders. As is generally the case for such pilots, Anita reeled off a succession of impressive outcomes for the fifty or so residents THP is helping, although she was clearly anxious about the renewal of her funding, as the end of term is fast approaching. She also revealed that whilst it had been possible to house people within about four weeks during the early stages of the pilot, at present it takes some 71 days on average. This is frustrating for her team, she said and is causing some distress to users of the service, who imagine an application will lead almost directly to accommodation. The idea that this is a ‘from the prison gate’ operation is way short of the mark. Continue reading →

Complexity, Homelessness and Addiction

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Alan Kilmister (Peer Researcher and Expert by Experience with the Policy Institute’s Homeless Hospital Discharge Project) describes proceedings at recent conference organised by the London Drug and Alcohol Forum. (534 words)

Michelle Cornes with Alan Kilmister

I had the pleasure of attending the ‘Addressing Complexity: Homelessness and Addiction’ conference on Friday 18 January 2019 at the Guildhall in London. I arrived at this beautiful venue a little tired after my early start. My first train was at 06:24. However, a few cups of coffee soon warmed me up. It was an excellent event with a wide range of subjects and very good speakers. I was most impressed by the talk by Kevin Dooley (Recovery Programme Consultant) who at one time had been an armed robber, alcoholic and heroin addict with extensive experience of the ‘criminal justice system’! He spoke very truthfully and emotionally about his time on the streets and how when he was in prison his son had died, he received little in the way of compassion and understanding from the system. Some of the other people at the conference with lived experience commented how they were able to fully connect with what Kevin was saying especially with regard to the shame and stigma that goes hand in hand with homelessness and addiction. Kevin made the point that coming to events like these and talking about ‘our’ experiences takes that shame away. I am a firm believer in involving people with lived experience (“nothing about us without us”) and Kevin made the point that we were are still too few in numbers at events like these. The keynote address by Professor Alex Stevens also made this point, highlighting how, a structurally advantaged social group can dominate the cultural, intellectual landscape, while the people most affected by drug deaths have little say (or in the jargon “corporate agency”). I asked the expert panel in the morning session about this topic and there was consensus about the importance of involvement and engagement, and us all doing more to enable this.

I found the talk by Dr Steve Sharman who presented case studies of people’s experiences of homelessness and gambling very interesting. It reminded me of my time in a Hostel in Wolverhampton. A few of the clients living there were addicted to gambling and just around the corner from the Hostel was a big Casino. This made me wonder if they were addicted to gambling before becoming homeless or took to gambling after becoming homeless.

I found the street drinking in East London talk by Dr Allan Tyler interesting too and wondered about boundaries – would the researchers have learned more had they participated in the actual drinking? There was also a very good talk by our very own Dr Michelle Cornes ably assisted by Darren O’Shea and Jo Coombes.

Michelle presented a case study called the Gutter Frame challenge which tells of the barriers people have to overcome if they want to access services following discharge to the street.  Finally, I must also offer my compliments on the superb buffet provided at lunch time, and of course the chance for some networking too. This is really important for us, and I was thrilled to be approached by a research manager from a leading charity who invited me to join a new advisory group being set up on peer research. All in all, a very worthwhile and enjoyable day.

Alan Kilmister is a Peer Researcher and Expert by Experience with the Policy Institute’s Homeless Hospital Discharge Project

Safeguarding Diogenes

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James Fuller is a Peer Researcher, Expert by Experience and a Support Worker at a Day Centre for people who are homeless in London. (1,200 words)

Brighton and Hove Safeguarding Adults Board recently published the key messages arising from a review. A Safeguarding Adults Review is held when an adult in the local authority areas dies as a result of abuse or neglect. In this case, the adult was sleeping rough and had been identified as ‘difficult to engage’. Chris Scanlon and John Adlam have written extensively about Diogenes, homelessness and what to do about people whose refusal to be included remains a problem for themselves and society as a whole. This review brought into sharp focus some of these same issues. Namely how can we safeguard Diogenes? According to the essayist Plutarch, the philosopher Diogenes the Cynic (412-323BC) lived in a barrel in Corinth and spent his time pouring vitriol on his fellow beings, who he roundly despised. One day, Alexander the Great invited Diogenes to a gathering, but the drum-dweller declined. Instead of having Diogenes executed, the usual outcome for disrespecting world conquerors, Alexander went down to see him.  Having greeted Diogenes, Alexander asked him if he wanted anything. Diogenes replied: “Yes, stand a little out of my sunshine” (Plutarch, Alexander, 14 Cf.). Continue reading →

Discharged home with no home to go to

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Peer research is a distinct type of service user involvement extending the expertise of lived experience into research. In peer research people with direct experience are involved in designing, delivering and shaping research (Revolving Doors, 2016).The Homelessness Research Programme at the Social Care Workforce Research Unit is currently running two research projects involving peer researchers. The first is looking at specialist primary care and the second at hospital discharge arrangements for homeless people. Both projects recently ran training and induction days for their peer researchers. In this blog James Fuller and Alan Kilmister (Peer Researchers on the Hospital Discharge Project) describe how they became involved in peer research, how their experience can make a difference and why striving for impact and change must be at the heart of this kind of participatory methodology. (1,372 words)

James: I am currently working as a support worker in a ‘day centre’ for homeless people in London. The main motive for throwing myself into the hospital discharge research project is a strong sense of righteous indignation at the way the people who use our service are routinely returned there by hospital staff who should know we have no accommodation – the clue is in our title!

One man has been delivered to our car park three times this year, on two occasions in a taxi, always clutching his transparent bag of medicines and still wearing his ward wristband. All we can do is get him to see our wonderful specialist nurse at the earliest opportunity (she can only fit us in one day a week) and use our best first-aiding to tend any wounds.

In the dark days I was myself discharged from hospital detox onto the street, which meant I couldn’t access even daytime rehabs, not having a secure address in what had been my local borough for more than five years. I was back in detox six months later. In the interim I was put out of the Emergency Investigation Unit of a well-known London hospital in pretty short order and with nowhere to go. Such experiences stick in the mind. Continue reading →

Providing formerly homeless people with the support that they need

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Maureen Crane, Louise Joly and Jill Manthorpe introduce the final report of the Rebuilding Lives study, published today. (678 words)

Full reportHomeless people clearly need homes but in order to keep them and to rebuild their lives they also need access to resettlement programmes that offer long-term support. A major new study by Unit researchers provides detailed evidence of what works in helping formerly homeless people to sustain a tenancy and avoid further homelessness.

We maintained contact with a group of 297 homeless people over five years after they were rehoused. We were fortunate enough to gain funding from the National Institute for Health Research (NIHR) School for Social Care Research to undertake this ground-breaking study. In the Rebuilding Lives study we investigated their experiences, the ‘ups and downs’ of settling down and building a more settled life. It is the largest and only UK study of its kind. One major finding is that just giving someone who has been homeless a tenancy is not the sole solution to homelessness, as many formerly homeless people are still vulnerable during the first few years after being rehoused. Many experience problems living independently, and require ongoing support from housing, health and social care services – help many do not receive. Continue reading →

Personal Budgets for adult social care and support: are homeless people eligible?

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With the Care Bill entering the report stage in the House of Commons shortly, Michelle Cornes urges us to take part in the debate over what constitutes eligible need in relation to adult social care and support. Dr Cornes is Senior Research Fellow at the Social Care Workforce Research Unit (SCWRU) at King’s College London and recently completed a major ESRC-funded project examining Multiple Exclusion Homelessness. Her work forms part of the Homelessness Research Programme at SCWRU.

As funding for Supporting People services continues to shrink (see Patrick Butler’s article in The Guardian, 12 February 2014) it is timely to revisit the question as to whether homeless people are eligible for publicly funded social care support (e.g. personal budgets secured through adult social care) or personal health budgets. The Care Bill currently going through Parliament heralds some positive changes that may serve to open the door to this funding stream which has, de facto, mainly been closed to homeless people. As the law currently stands ‘homeless people’ are not eligible for support (though ‘homeless people’ with mental health, physical health, and drug and alcohol problems may be). The Care Bill will remove ‘eligible’ and ‘ineligible’ groups so that any adult with any level of need will have a right to an assessment (Department of Health 2013: 1.9).

Under the existing guidance, the purpose of a community care assessment is to assess need in the round. The guidance is clear that needs relating to social inclusion and participation should be seen as just as important as needs relating to personal care (Department of Health 2010: 61). It is perhaps worth noting that housing related support can be purchased using a personal budget from adult social care. In Scotland, 11% of direct payments and self-directed support packages in 2012 encompassed this element (Rosengard et al. 2011).

Once a community care assessment has been carried out, a decision must then be taken by the local authority (on a case-by-case basis) about whether the needs identified are eligible needs. The eligibility framework is graded into four bands which describe the seriousness of the risk to independence or well-being (Department of Health 2010: 54). This considers issues such as the ability to carry out personal care or domestic routines, whether vital involvement in work, education or learning can be sustained and if vital family and other social roles and responsibilities can be undertaken. Risks are banded as low, moderate, substantial and critical with many councils only meeting those needs identified as substantial or above.

Making decisions about which banding to apply and ultimately, who is eligible for a ‘personal budget’ is open to professional interpretation. With increasing austerity, the regulator has taken issue with those local authorities identified as being too restrictive. For example, Michael Mandelstam highlighted a recent case in which a local authority visited a woman at home, assessed her as managing her own personal care and closed the case—having first recorded that she was unkempt, her knickers were around her knees, there was evidence of faeces on the floor and she was not taking her medication (2013: 123).

Evidence from the Multiple Exclusion Homelessness Research Programme (Cornes et al. 2011) and other studies suggests that people who are homeless fare particularly badly in getting their needs banded correctly, often struggling to access an assessment at all. There is evidence that homelessness is written off as ‘lifestyle choice’ or as a housing responsibility, with the ‘substantial’ and ‘critical’ risks posed to well-being ignored or overlooked. The notion that homelessness poses mostly low to moderate risks to well-being is most clearly challenged by the startling statistic that the average age of death of a homeless person is 47 (43 for a homeless woman) as compared to 77 for the general population. The Care Bill (page 2) makes explicit the need to challenge discriminatory practices so that decisions about the individual are made having regard to all the individual’s circumstances and are not based only on the individual’s age or appearance or aspect of the individual’s behaviour which might lead others to make unjustified assumptions.

The problems with the way eligibility criteria are being applied are acknowledged by the Coalition Government. The Care Bill will introduce a national minimum threshold for adult care and support and there are plans to replace the current ‘Fair Access to Care’ (FACS) eligibility criteria in 2015. A new description of what is eligible need will be put forward for consultation in 2014 and a discussion document is already in the public domain (Department of Health 2013). I would urge all those working in the homelessness sector and those interested in challenging social exclusion to respond to this consultation. Without doing so there is the danger that homeless people will continue to be denied the support they are entitled to and, given what we know is happening to Supporting People services, possibly robbed of the little support many already have.

Dr Michelle Cornes is Senior Research Fellow at the Social Care Workforce Research Unit. She recently completed a major study on Multiple Exclusion Homelessness funded by the ESRC. For work on homelessness at the Social Care Workforce Research Unit at King’s see our Homelessness Research Programme pages.

The Social Care Workforce Research Unit is part of the King’s Policy Institute (KPI) at King’s College London. The Institute is involved in the translation of academic research at King’s to the benefit of policy and practice.

References

Butler, P. (2014) ‘If supported housing is cut, we will see more rough sleeping and more crime’. The Guardian, 12 February 2014.

Cornes, M., Joly, L, Manthorpe, J., O’Halloran, S., and Smythe, R. (2011) ‘Working together to address Multiple Exclusion Homelessness’, Social Policy and Society, 10(4): 513-522.

Department of Health (2010) ‘Prioritising need in the context of Putting People First: a whole system approach to eligibility for social care – guidance on eligibility criteria for adult social care, England 2010’, London: Department of Health.

Department of Health (2013) ‘Draft national minimum eligibility threshold for adult care and support. A discussion document’, London: Department of Health

Mandelstam, M. (2013) Safeguarding Adults and the Law. London: Jessica Kingsley.

Rosengard, A., Ridley, J. & Manthorpe, J. (2013) ‘Housing support and personalisation: observations from the Scottish Self-Directed Support test sites’, Housing, Care and Support, 16(3/4): 136-144.