CONNECT July 2014: What makes the difference in homelessness?

UNHEALTHY STATEIn our latest research on health, we ask

whether the needs of the people you

support are being met.

PUTTING HOUSING FIRSTWe look at the planning, setup and progress of a Housing First pilot in Oxford.

#THEDIFFERENCE 2015In the run up to next year’s general election, help us ask politicians to commit to ending homelessness.

WHAT MAKES THE DIFFERENCE

IN HOMELESSNESS?

CONNECT JULY 2014 | WWW.HOMELESS.ORG.UK

4-6 7 8-11

CONNECTTHE MAGAZINE OF THE HOMELESSNESS SECTOR

ISSN 2046-2921

HOMELESS LINK EVENTS

Adapting to changes in benefits provisionServices 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

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.

BOOKINGSFind out more and book your place:

homeless.org.uk/bend-not-break

SHOWCASING THE EXPERTISE OF THE SECTOR

BEND NOT BREAK2 October 2014 Central LondonNATIONAL CONFERENCE PLACES FROM £145

HOMELESS.ORG.UK/EVENTS | @HOMELESSLINK | 020 7840 4461

CONNECTJULY 2014

WWW.HOMELESS.ORG.UK 3

IN CONNECT

www.homeless.org.uk/connect

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 - [email protected]

EDITOR: Martin Reed COVER IMAGE: Ron - member of Expert Advisory Panel - by Martin Reed

4 THE UNHEALTHY STATE 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.

7 #THEDIFFERENCE2015 What should politicians prioritise in the run up to

next year’s general election?

8 PUTTING HOUSING FIRST 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.

12 FROM SLEEPING ROUGHTO ADVISING .GOV.UK David Ford looks back at the achievements of

the Expert Advisory Panel and looks forward to

a homelessness sector with lived experience at

its heart.

14 LEARNING FROM CAMBRIDGE The Chronically Excluded Adult (CEA) service

in Cambridge - a Making Every Adult Matter

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.

16 REAL IMPACT Leah and Tommy, two people supported

by the Chronically Excluded Adults team in

Cambridge, told us how the service has made

a difference.

18 COVERED? Tim Wiltshire of Access Insurance introduces

an exclusive 20% discount for Homeless Link

members.

Have you triedour 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: [email protected]

www.homeless.org.uk

CONNECT JULY 2014

4 WWW.HOMELESS.ORG.UK

THE UNHEALTHY

STATEIn 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.

Around

2/3 consume more than the recommended amount of alcohol

each time they drink.

80%reported some form

of mental health issue, diagnosed or

undiagnosed.

45% had been diagnosed with a mental health issue, compared to 25% of the general

population.

41% said this was a long-term

problem.

27% have or are

recovering from an alcohol problem.

Almost

1/2 used drugs and/or

alcohol to cope with mental health

issues.

39%said they take

drugs or are recovering from a drug problem.

73%reported physical health problems.

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 healthIn 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.

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 helpDespite 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.

CONNECTJULY 2014


35% had been to A&E in the past 6 months.

64% said they had somewhere suitable to go upon leaving hospital.

90% said they are registered with a GP.

26% had been admitted to hospital in the past 6 months.

Around

2/3 consume more than the recommended amount of alcohol

each time they drink.

80%reported some form

of mental health issue, diagnosed or

undiagnosed.

45% had been diagnosed with a mental health issue, compared to 25% of the general

population.

41% said this was a long-term

problem.

27% have or are

recovering from an alcohol problem.

Almost

1/2 used drugs and/or

alcohol to cope with mental health

issues.

39%said they take

drugs or are recovering from a drug problem.

73%reported physical health problems.

Impact on the NHSIndividuals 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 issueOur 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 progressThere has, however, been progress since 2010, especially when it comes to how the NHS deals with homeless patients admitted to hospital.

CONNECT JULY 2014


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.

RecommendationsThese 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

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 STATEOF HOMELESSNESSDownload the full report on our Health Audit 2014

homeless.org.uk/health

CONNECTJULY 2014


As a sector, we have many concerns – the health of

clients, the quality and supply of accommodation, the

impact of welfare reform to name just a few.

But can we define one action which would make the

biggest difference in 2015?

#THEDIFFERENCE2015Between now and September we are consulting with

members and people with experience of homelessness

to pin down which policy changes will make the

biggest difference and are most important for the new

Government to support.

HAVE YOUR SAYThis summer, we need you to tell us the one action you

think Government should take that would make the

biggest difference to homelessness?

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.

WHERE DO WE NEED TO SEE ACTION?We are not starting from scratch. We already know

through our research what matters to homeless people

and the charities that support them.

Thanks to your input, our vision ‘A place to call your

home’, highlighted key areas where action is needed:

• Access to affordable, good quality accommodation

• Help to realise your potential

• Coordinated and personalised support for as long as

you need it

• An adequate income

So we know the challenges, but now we need a clear

consensus about the top actions a new government

should focus on first.

GET INVOLVEDThere are several ways you can take part.

• Local events: we’re running events for members in

every region. Visit our events section to find out more

- homeless.org.uk/events.

• 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.

We look forward to hearing your ideas. We’ll publish what

you tell us and urge all political parties to commit to the

campaign to end homelessness.

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?

CONNECT JULY 2014


PUTTING HOUSING

F I R S TLike many places in the UK, Oxford has a sizeable cohort

of people sleeping rough who do not cope in hostels and

have been entrenched in sleeping rough for years.

There are those who are fearful of hostels. They don’t

like being around other people, particularly those with

chaotic behaviour. They generally have mental health

or substance misuse problems themselves – often both

together.

And there are others who do periodically come in, but

they find the environment difficult and it exacerbates

poor behaviour. They are either excluded or they

abandon services of their own accord. Again, mental

health and substance misuse issues are often at the heart

of it.

Perhaps this sounds familiar. We knew the patterns

weren’t exclusive to Oxford, which is why we looked

beyond the city for possible solutions.

“I previously thought I would die on the streets and had accepted that would be the case.”

Our interest was grabbed by the Housing First model –

which originated in the USA but is slowly growing here in

the UK. As you know, most homelessness services in the

UK operate on a “treatment first” basis – with individuals

expected to progress through a homelessness pathway

which positions self-contained accommodation as the

holy grail at the end.

Housing First reverses that. The basic concept is that

an individual sleeping rough goes straight into a self

contained tenancy, without first tackling the issues that

have caused or are exacerbating their homelessness.

Support is coordinated on an individual basis, depending

on need.

We know that Housing First isn’t the best solution for

everyone, but we hoped it might well work in a small way

for us in Oxford.

FLAT HUNTINGOne of our first challenges was to identify suitable

properties. Renting in the city is particularly difficult

– after all, why should any landlord want to rent

accommodation at low cost to such potentially high risk

tenants when they can so easily find people willing to pay

high rents.

The timing couldn’t have been better when a wonderful

person left a substantial legacy – enough to fund the

purchase of four flats and giving us a real opportunity to

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

also wanted to make sure that the accommodation we

provided was good quality. We also felt that it would be

important not to buy flats that were too big – partly so as

not to encourage long-term unwanted visitors or partying,

and partly because these flats were never intended to be

permanent, otherwise the project would simply silt up.

We recognised that there would be different preferences

for location and type of flat, so looked for variety. We

deliberately aimed to ensure that the flats were not

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.

CONNECTJULY 2014


in close proximity and were not in areas with a high

proliferation of people who had been previously

homeless.

To date, we have purchased three flats and we are still

seeking a fourth. One is in a tower block, one is a studio

flat on the edge of a large housing estate and the third

is a first floor flat in a relatively non residential backwater.

We want the fourth to be on the ground floor with a

self-contained garden – something suitable for one of

the many entrenched rough sleepers who are fearful of

enclosed spaces and who often have a dog in tow.

LENGTH OF STAYUnlike the American Housing First model, where the

expectation is that the tenant can stay as long as they

like – or, if things aren’t working out in that particular flat,

they will be moved to another one) we decided that, for

practical reasons of enabling us to support all the people

we can, we would expect our clients to move on within a

couple of years.

We negotiated with Oxford City Council to allow our

Housing First clients access to the normal move-on route

if we could establish that they were able to pay rent and

keep up with bills, and that they were not likely to cause

anti-social behaviour.

There is acknowledgement among professionals that

the normal requirement of being drug free for a period

of time, or to have alcohol consumption within a certain

level, is not necessarily attainable nor necessary for this

client group. We are in the business of finding ways to

support our Housing First clients simply to maintain their

accommodation at a relatively basic level rather than

become model citizens.

STAFFINGWe did not want to underestimate the amount of

support these tenants would need, and we were also

keen to benefit from the expertise of someone who had

experienced homelessness themselves. Our decision to

appoint one full time support worker and one part time

peer support worker is broadly similar to the Housing First

scheme in Glasgow. These roles have been funded by

Oxford City Council for an initial two year period.

PARTNERSHIPIt is essential to get partner agencies on board from the

outset, so they have a commitment to the project and

Support worker Alison James with a Housing First tenant

CONNECT JULY 2014


understand the need to go “above and beyond” with

their interventions.

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

Centre, other support is brokered according to individual

need. We have also found the police and local Anti

Social Behaviour team to be helpful and supportive.

PRE-TENANCY WORKAs expected, the process of identifying likely candidates

and the subsequent process of engaging with them is a

lengthy one, with many false starts and dead ends. An

initial list was drawn up of potential candidates – some

of whom were simply not interested (though we haven’t

given up on them by any means) and others who we felt

were probably too high risk to cut our teeth on – perhaps

further down the line when we are more experienced!

Once we had identified potential candidates, the most

important thing to do initially was to gain the trust of the

individuals concerned. Most were suspicious at first and

dismissive of our offers. Alison, the Housing First support

worker, spent many hours either with the Outreach Team

or meeting up with potential clients in cafes or drop-

in centres. A lot of her work involved making it clear

what we were offering and how it was different from the

traditional approaches that had not worked for them in

the past.

“I have been able to make the flat family orientated and have my grandchildren to visit for the first time.”

PERSONAL BUDGETSIn addition to refurbishing the properties, we set aside a

budget of £1k for each Housing First client to spend on

furnishing the flat in whatever way he or she wanted.

They can take all of this with them when they leave and

the next person would have a similar budget to spend. It

has been important to give people as much choice as

possible – after all, the reason they are with us is because

it has not worked out for them in more traditional

homelessness services. It has been interesting how our

3 initial tenants have all spent this very differently. Jim

didn’t want a bed, he wanted a guitar stand. Gary only

wanted brand new kitchen equipment and was rather

unrealistic about what he could get for his money.

THE KEY TO THE DOORThe key to the whole project has been flexibility, good

working relationships with partner agencies and

maintaining the relationships with the clients. Only

with this balance has it been possible to engage with

“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.”

CONNECTJULY 2014


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 STORYGary 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 MOREABOUT OXFORD HOMELESS PATHWAYSOxHoP provides life-changing services for people experiencing homelessness in Oxfordshire.

oxhop.org.uk

CONNECT JULY 2014


FROM SLEEPING ROUGH TO ADVISING .GOV.UKBack in the autumn of 2009 Homeless Link invited a

number of people who had experienced homelessness

along to their offices to meet with Simon Cribbens from

the London Delivery Board. As a resident of a SLYMCA

hostel at the time I was invited to attend the meeting.

That kick started the formation of Homeless Link’s Expert

Advisory Panel. We have been formally in existence

for almost three years now, set up with the purpose of

advising Homeless Links Policy team and the CEO. I had

the privilege of being the Chair of the Panel for two years,

until earlier this year. Thanks to the promotion of the Panel

by Homeless Link, and the efforts of Panel members, we

became a popular source for advice in a lot of the areas

of work within the organisation, as well as for Central

Government Departments and the GLA.

Old hands like me have passed on the mantle to new

panel members over the past few months. I wanted to

take this opportunity to welcome those new faces and to

share some of our achievements over the past few years.

DCLGOne of the first milestones of the Panel was a meeting

with Roger Wilshaw, the then head of homelessness at

DCLG, and his team.I took two members of the Panel,

Tonny and Gerry, to meet them and discuss the effects

of ongoing cuts to funding and the impact it would have

on people experiencing homelessness. Roger was so

impressed that he asked Tonny to join DCLG’s working

group on personalisation.

INTER-MINISTERIAL GROUP ON HOMELESSNESSWe were invited to feed in to the first two papers

published by the Inter-ministerial Group on Homelessness.

We were consulted on an early draft of those papers and

the final versions include a series of quotes from us.

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.

This photograph: members of the Expert Advisory Panel at a recent meeting.Top right and cover: current Panel member, Ray.

CONNECTJULY 2014


WELFARE REFORM DEBATEIt should surprise no one that we have been involved

passionately in a lot of the debates and discussions

around welfare reform. A crucial time was our

involvement in the campaign to prevent benefits being

reduced by 10% annually. We can’t claim to have made

the Government reverse its decision on those reductions

- we were part of a wider campaign - but I’d like to

think that maybe our input was the straw that broke the

camel’s back. We’ll probably never know, but I’m going

to hang on to that thought anyway.

HIGH COST TO PAY CAMPAIGNI am sure that most of you reading this are aware of

Homeless Links investigation into the impact of benefit

sanctions on people experiencing homelessness. We fed

into it in depth, and the resulting report, A High Cost to

Pay, has caused the DWP to actively look at its sanctions

regime in relation to homelessness.

DWP CUSTOMER INSIGHT TEAMWe met with a member of DWP’s Customer Insight Team

to discuss the best approaches for Jobcentre Plus staff

to engage people experiencing homelessness. This is

an ongoing campaign for Homeless Link and one that is

making positive inroads.

CHAMPIONSWhen I first became Chair of the Panel, I met with the

Policy team to discuss a way forward for the Panel

and a vision for the future. I had two specific asks of

Homeless Link. Firstly it was apparent that we were too

London-centric and that the Panel should represent

Homeless Link’s national presence. This posed numerous

challenges. How do we bring people together? How

should we fund it? The Panel worked with Homeless Link’s

Policy team to look at ways in which this could work.

Today the policy team is working hard at building up a

data base of national champions around the country

keeping them informed from a local perspective. This is

a massive step forward in getting the national voices of

people experiencing homelessness heard.

THE BOARDThe second ask, and arguably the most important, was

to have lived experience of homelessness represented at

Board level, with a link to the Panel. This was something

that we all felt passionately about.

Of course there were many questions both for the Panel

and the Board. What would it mean for both parties? How

would it work? How would it effect existing structures?

How would we choose a candidate? And more.

We need to be clear on our own structure and how we

fitted into Homeless Link, and the Board needed to look

their existing structure how it would work for them. There

were numerous meetings and discussions between

the Panel, Homeless Link’s SMT and Board members,

including Board members attending our annual Panel

away-day.

I was involved in the recruitment process – working with

Cath Gulliver (SIFA Fireside CEO and Homeless Link Board

member) on the difficult task of working through some

fantastic applications, shortlisting the best for interviews,

then interviewing and selecting two new Board members.

Ross Watkins and Natalie Atkins have been active on the

Board since the beginning of this year – and I think that

between them they’ll demonstrate just how crucial it is

that lived experience is represented at all levels.

I’m extremely proud of what the Panel has achieved, and

what their involvement in Homeless Link’s work has meant

to homelessness sector as a whole.

I don’t underestimate the opportunity that Homeless Link

has offered us, by giving us a voice that is heard at the

highest level. But similarly we mustn’t underestimate the

value to services that the voice of experience brings. That

might be a voice heard nationally through the Panel,

heard locally through champions and peer groups, or a

single voice listened to in a single service. That voice of

experience, I believe, is so often the one that can make a

difference.

CONNECT JULY 2014


LEARNING FROM CAMBRIDGEThe CEA approach is assertive and flexible based on

the needs and wishes of people it supports. Crucially, it

supports local services to adopt the same approach with

this group, which is small in number but high in social and

service expense.

THE RIGHT PEOPLE AT THE TABLEGoverned by a broad spread of local agencies,

including the County Council, Cambridge Cyrenians and

Emmaus (local homelessness services), as well as local

health, mental health and drug and alcohol services, its

management reflects the broad needs of its target client

group.

The governing partnership originally came together

to consider the escalating problems of one individual

in Cambridge City. Joint working led to a solution that

made a significant different to this person’s life, including

their physical health, mental health, housing, ASB and

other issues. Ongoing discussions at the time around the

Joint Strategic Needs Assessment led to a commitment

from the county council to explore coordinated

approaches for clients with complex needs – and for the

City and County Councils, along with the Police and NHS

each to contribute a relatively small amount to fund a

manager to bring this work together.

“The structure of this project has given us access to

people who can make a real difference,” says Tom Tallon,

the team’s Project and Development Manager, “and

working together means we avoid many of the barriers

that people can face.”

IDENTIFICATION, REFERRAL AND CASELOADSClients are referred to the service using the New

Directions Team Assessment, a simple tool to assess

behaviours, which is completed by the referring agency

and validated by CEA.

Each referral is prioritised by the multi-agency operational

group, which reviews the client’s previous journey through

services and their level of engagement before assigning

a CEA service coordinator.

Most CEA coordinators manage a caseload of 12-15

clients – although given the flexibility of the service this

is measured on a time needs basis. Each client is taken

on with the understanding that they will be supported

until that help is no longer needed, whether that means

working with them for months or years.

FRONTLINE FLEXIBILITYWorkers have no remit other than to the client and have

the authority to explore innovative approaches on their

behalf. They work to the client’s wishes using a truly

person centred approach that is not constrained by

service limits, but never promising anything they cannot

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,

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.

CONNECTJULY 2014


staying in constant contact, putting us in a far better

position to have a longstanding impact on their journey.”

FLEXIBLE RESPONSES FROM SERVICESFlexibility from services is vital for the work of the

coordinators – and this has made senior level strategic

buy-in vital from the outset, with sufficiently senior

commissioners on the Governance Group meaning that

flexibility can be demanded when necessary.

Everyone involved wants the best outcome for each

client and having a coordinator with a direct link

between client and commissioner can be a powerful

way to drive positive outcomes.

FILLING THE GAPSTom explains the menu of expertise and services on hand:

“If one day we need something that isn’t on the menu,

we now have an approach that offers enough flexibility

that we can ask the chef to add it.”

The CEA service plays a consultative role in the tendering

process for services in Cambridgeshire, identifying where

gaps exist so that better provision can be made.

There have also been discussions around making service

flexibility a part of future commissioning processes.

The CEA service has also involved clients in service

development and re-design, which has helped to identify

a number of gaps.

Bringing the process full circle, they have made a point

of helping clients who have successfully made changes

in their lives to feed back to services and commissioners,

about what worked this time, after years of falling through

the gaps.

“It’s great being able to work and deliver to what the

client needs and what they can deal with themselves

at any given moment,” says Tom. “It’s the opposite of a

prescriptive one-size-fits-all formula.”

WHAT DOES SUCCESS LOOK LIKE?The CEA service has used several evaluation tools, with

the support of MEAM. They look at the economic impact,

measuring changes in costs associated with Housing,

Health, Substance Misuse and Criminal Justice. Figures

from the first two years show a shift away from big costs

associated with Criminal Justice, towards higher costs for

other support services as clients get the help they need.

Meanwhile, the progress of individual clients is made

using the Homelessness Outcomes Star and New

Directions Team Assessment.

As early as the end of the first year, these measures

demonstrated significant positive change.

FROM PILOT TO SUSTAINABILITYAfter three years of operation, the CEA service is exploring

ways of sustaining the level of coordination and flexibility

from local services. They are looking at the possibility of

mainstreaming within one service, while continuing to

seek smaller contributions from other services, to reinforce

the strategic significance of the work.

As for the sustainability of the service for clients, Tom says:

“Our job is to work systems for them, getting services to

work for clients’ needs – taking the strain for them if you

like. All they need to do is trust our way of working and to

buy into a level of support that works.”

Overleaf - meet two people supported by CEA...

CONNECT JULY 2014


Leah and Tommy, two people supported by the Chronically Excluded Adults team in Cambridge, told us how the service has made a difference.

LEAH“If I looked back to twelve months ago, there’s no way I’d

have thought I’d be here now,” says Leah.

Six months ago, she was living in a violent relationship,

just one of many episodes, including drug dependency,

physical abuse, mental ill health and more, in a

complicated life she describes as “too much bad luck for

just one person.”

When she walked out of that relationship she had already

been on the caseload of the CEA team in Cambridge for

18 months, referred because she was not engaging with

agencies and there were concerns around her safety

and wellbeing.

She had originally accepted support offered by CEA in

the hope that it would help her stabilise her relationship.

The flexibility of the team and the services it coordinated

during that 18 months helped Leah build confidence

in the support she would get to help her change her

situation when the time came.

Leah’s support worker, Gail, explains: “The fact that she

knew support was there, waiting in the wings for the right

moment, enabled her to make the decision to leave

when she felt ready. This has enabled her to stay away

and try to rebuild her life.”

Today, Leah is about to move into a new home and is

thinking about the future. She has a very clear view of the

role that CEA support has had: “I’ve had Gail and Tom

and people that I can rant and rave to along that time.

If I hadn’t had that, I probably wouldn’t have got as far.

If it wasn’t for the fact that I had that support, I would not

have left him in the first place.”

“Leah has grown in confidence and self-esteem over the

last few weeks and is now talking positively about the

future,” says Gail. “We take it one step at a time and she

has overcome many hurdles. This is because she has led

the support - we are working to her timeframe and she

owns her own journey.”

Leah now has the space and support to think about

where her life is headed. She is philosophical about her

past and she is well aware that she still has some way to

go. In particular, she has a strong idea of what she still

needs to achieve before she re-enters her son’s life, who

lives with his father. But she knows things are changing for

the better. She has confidence in the flexible nature of the

support she gets from the CEA service. She understands

REAL IMPACT

“I get angry and upset, but they

know how to take me ... first time I’ve had that.”

- Tommy -

CONNECTJULY 2014


how that support is taking the strain for her, making sure

her move is organised and that appointments are kept.

It’s giving her an opportunity to grow and she sees herself

one day working in a role where she can help people

dealing with issues like her own.

“All I’ve ever really wanted,” she says, “is to have my son,

have my own family, just normal things, Christmases and

birthdays. I never would have thought that would be

possible, but now it looks like it will be. I’m not going to say

a timeframe. I don’t need to. I know it’s going to happen.”

TOMMYFollowing a family breakdown in his teens and a long

history of drug and alcohol dependency, 38 year old

Tommy has been homeless and sleeping rough for most

of his adult life.

He was first referred to the CEA team by local street

outreach in September 2012. He would have had no

knowledge of this – in fact referral to CEA requires no

client consent, since that would only add an unnecessary

barrier. The first he knew was when he was contacted by

the team and asked what he wanted.

He has trouble explaining why the CEA approach has

succeeded with him where others haven’t been able to,

but on one thing is clear: “I can be an awkward. I get

angry and upset, but they know how to take me. They

know I don’t mean it; it’s just how I am. 20 years of being

homeless and it’s the first time I’ve had that.”

The CEA team’s approach has been based around

maintaining constant contact with Tommy and enabling

him to access independent local authority housing

without going through the hostel route, which Tommy has

entered and fallen out of on numerous occasions. He

now has a flat, with a garden for his dog, and a support

network around him to help him to keep it.

The CEA team has also ensured access to treatment

services to medicate Tommy’s opiate dependency and

for ongoing alcohol treatment.

An essential part of the approach has been for the team

to work with relevant professionals on Tommy’s behalf,

negotiating greater flexibility from services and only

asking him to participate when necessary.

Tommy acknowledges that this flexible, assertive

approach works for him: “If it weren’t for the help of these

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

me. I swear at him, I tell him off, I ignore the phone and

everything, and all he does is he won’t leave me alone

until I talk to him.”

REAL IMPACT

“If it wasn’t for the fact that I had that support, I would not have left him.”- Leah -

CONNECT JULY 2014


In our long history of working with the sector, we have seen first-hand the issues that you face as you support people out of homelessness.

With increasing pressure to make your money go further,

it’s more of a challenge than ever to maximise what

you spend for charitable purposes. That’s why we have

arranged a 20% discount for Homeless Link members.

We understand the risks that charities face and advise on

risk management and insurance programmes to suit your

needs. These are some of the issues some of my clients

have faced and where we have been able to help:

SOURCING COVER FOR PROVIDING A SERVICE TO ANYONE WITH ARSON OR SEX OFFENCE HISTORYMost insurers prefer to avoid the potential risk presented

by people with certain backgrounds – and when they

take it on it is usually expensive.

We worked closely with our panel of specialist insurers

to find a solution. Some have agreed parameters within

which you are able to support these people without

flagging it with them, dramatically reducing the time,

effort and cost on your part. Insurers will only require full

details before making a decision over the cover if an

individual falls outside certain set criteria.

In any event, we constantly push hard to find cover that

will allow you to deliver the services that are desperately

needed.

ABOVE INFLATION PREMIUM INCREASESMany 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

within that ‘care’ bracket. However, after carefully

reviewing the insurance requirements of each individual

organisation we are usually able to offer premium savings

that can be significant, especially after applying the 20%

discount for Homeless Link members.

SOCIAL ENTERPRISECharities are getting creative to find new revenue

streams. We arrange cover for a number of charities who

have trading subsidiaries undertaking more commercial

activities. As your organisation evolves, we’ll stay in touch

to make sure your cover adapts with you.

GETTING ADVICE FROM A SPECIALISTAs well as being a Homeless Link member, we work with

the Charity Finance Group and know many charities are

dissatisfied with levels of service and do not feel they are

entirely understood by their broker.

When we review their policies we often find gaps in cover

and areas where money can be saved straight away.

We only work with the voluntary sector, working with

more than 5500 clients of all shapes and sizes. With the

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level of service based around your needs. We also have

a dedicated support team that is easily accessible to

Homeless Link members.

Tim Wiltshire of Access Insurance

introduces an exclusive 20%

discount for Homeless Link

members.

GET IN TOUCH FOR A FULL REVIEW OF YOUR COVERTim Wiltshire - 0208 651 7420 [email protected]

HOMELESS LINK EVENTS

OPPORTUNITIES THROUGHOUT ENGLANDNetwork, 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

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.

SHOWCASING THE EXPERTISE OF THE SECTOR

YOUR AREAFREE REGIONAL SUMMITS FOR MEMBERS THROUGHOUT THE SUMMER

HOMELESS.ORG.UK/EVENTS | @HOMELESSLINK | 020 7840 4461


CONNECT JULY 2014

homeless.org.uk/connect

CONNECT July 2014: What makes the difference in homelessness?

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