Agenda item
Supported Accommodation for Rough Sleepers & Single Homeless People with Complex Needs
Minutes:
4.1 The Chair opened the item by explaining that the Commission was keen to hear about the current provision and future need in Hackney for supported accommodation for rough sleepers and single homeless people with complex needs.
4.2 The Commission saw this discussion as timely given the increasing levels of homelessness in Hackney and increased levels of support required for those faced with homelessness since the Council changed its model of housing related support for adults with complex needs in 2016.
4.3 As part of the scrutiny process, Commission Members undertook site visits to supported accommodation schemes in Camden and also planned to visit schemes in Hackney in the new year. The findings of these visits would inform any scrutiny findings and/or recommendations.
4.4 Representing London Borough of Hackney
· Cllr Sade Etti, Deputy Cabinet Member for Homelessness & Housing Needs
· Rob Miller, Strategic Director Customer & Workplace
· Jennifer Wynter, Assistant Director of Benefits & Housing Needs
· Beverley Gachette, Strategic Commissioning Lead, Rough Sleeping and Homelessness
4.5 External Guests
· Dr Adi Cooper OBE, Independent Chair of City & Hackney Adult Safeguarding Board
· Anthony Simmons, Service Manager at St Mungos
· Andrew Horobin, Deputy Borough Director for City & Hackney at East London NHS Foundation Trust
· Catherine McElroy, Mental Health Community Service Manager & Social Work Lead for City & Hackney at East London NHS Foundation Trust
· Sally Caldwell, Strategy & Transformation Consultant
· Becky Rice, Research & Evaluation Consultant
4.6 The Chair then invited the Deputy Cabinet Member for Homelessness & Housing Needs, Council officers and external guests to give a verbal presentation. The main points are highlighted below.
4.7 Levels of homelessness in Hackney were increasing rapidly, and the levels of support required beyond that provided for people in general needs temporary accommodation was increasing. Many of the households approaching the Council had multiple and complex support needs.
4.8 The support needs of households approaching the Council varied, but were often characterised by mental health issues, drug and alcohol use, physical disability and mobility issues and experiences of trauma and neglect.
4.9 In order to help these people to recover, thrive and not deteriorate further, they needed specialist accommodation provided alongside support and supervision to help them live as independently as possible in the community.
4.10 The case study of a resident named ‘Gabriel’ was referenced. From 2012 to 2019 Gabriel was in supported accommodation where he was coping well and recovering. The accommodation was closed in 2019 and from that point onwards Gabriel had a number of hospital admissions and police arrests, and various temporary accommodation placements had broken down due to anti-social behaviour.
4.11 Not having Gabriel in supported accommodation led to increased costs to the public service system as a whole. There were increased costs to the Council, health and social care partners and the criminal justice system. Gabriel’s needs would also likely have become more acute, eventually reaching the threshold for costly adult social care interventions.
4.12 As of June 2023 there were 443 single adults placed with one or more support needs in temporary accommodation, and this was expected to grow rapidly over the next few years. Hackney had only 179 supported accommodation bed spaces - this was low when compared with other London Boroughs such as Camden, which had 743 bed spaces.
4.13 Camden’s approach was an example of good practice in this area. They had prioritised identifying and ring-fencing funding in supported accommodation units, as well as cohesive support pathways involving a number of different providers. They had also increased investment in this area to meet increasing demand where needed.
4.14 Modelling suggested that current supported accommodation capacity needed to increase by an additional 325 bed spaces to meet demand. Current provision directly funded by the Council comprised 125 with an additional 52 bed spaces funded through short term grants. Increased capacity would therefore need to deliver a total of around 250 bed spaces.
4.15 More capacity was needed to properly facilitate the recovery cycle of change. The current pathway was phased, built on personalised outcomes, trauma informed and focused on recovery. However, it was missing a stage with specialised interventions for people with high level, complex needs.
4.16 The National Housing Federation had recently commissioned research into how supported accommodation impacted homelessness, health and wellbeing. Applying this research to assessments of need in Hackney, an additional £7.6m per year of total costs to the local public service system were estimated were it not for the supported housing sector.
4.17 There were a number of risks associated with not increasing provision. These included needs becoming more acute with more people reaching the threshold for costly adult social care interventions, increased costs to the wider public service system, increased safeguarding incidents, anti-social behaviour incidents and health deterioration in temporary accommodation, early death, more rough sleeping and street-based anti-social behaviour, increased likelihood of recidivism and, ultimately, the current pathway becoming overwhelmed.
4.18 A small-scale rapid research project had recently been commissioned by the Council to understand the challenges in accessing the right support for single homeless people from the service user and staff perspective. It involved desk and data review, one-to-one interviews with 15 service users and 15 members of staff, and a service design workshop with 14 stakeholders from across the Council.
4.19 Participants described a pathway under real pressure, too few supported hostel places, low move on rates and a high number of people with support needs in unsupported temporary accommodation placements for long periods.
4.20 They also spoke to the challenges of providing a space for recovery, with some hostel buildings limiting opportunistic and quick interactions, ineffective use of communal spaces and temporary accommodation being a suitable environment. Smaller projects were seen to provide more contact and feel less institutional.
4.21 Service users felt that the people most poorly served by the current pathway were those with severe and enduring mental health problems, those reducing drug and alcohol use, those wanting to work and those that were frail and/or vulnerable to exploitation.
4.22 In terms of providing the right support, it was felt that homelessness services were acting as mental health, health, offending and substance use services with increasing complexity being seen across the board. Some clients were experiencing barriers to accessing social care and mental health support.
4.23 Participants spoke about the role of positive activities in aiding recovery, with feedback around boredom and a lack of positive ways to spend time leading to some cases of depression and drug use. Staff felt that they would like to be able to do more activities but were restricted by staffing, space and budget. It was generally not considered feasible to work within hostels or temporary accommodation.
4.24 It was felt that there was an overall lack of move-on with all routes limited. Silting up impacted on the ability to rapidly house people in appropriate accommodation with support, and long stays resulted in higher support needs for some. Clients often felt there was no plan for them, and even those with potential move on options felt unsure, and poorly informed about their situation.
4.25 Speaking more generally, the national and local picture was changing with more recognition of ‘multiple exclusion homelessness’. This term refers to people who had been homeless and had also experienced one or more domains of deep social exclusion, such as institutional care, substance misuse or street culture activities.
4.26 Historically homelessness had been seen as a housing issue, however increasingly opportunities for interdisciplinary social care interventions are being explored particularly for those who may be on a ‘cliff-edge’ and not qualify for statutory support despite multiple and complex vulnerabilities and needs.
4.27 One of the issues faced in this regard was encouraging vulnerable people to engage with services, which in many cases was logical when considering their life experiences. Solutions therefore need to be built on personalised outcomes, trauma informed and focused on recovery.
4.28 Recent research in relation to Safeguarding Adult Reviews where homelessness was a factor had recognised that agencies may have missed opportunities to protect adults at risk. Locally, this had led to a positive shift in culture and practice in terms of the interface between the various needs of vulnerable adults and the risks they faced.
4.29 It was therefore important the local system worked collaboratively to prevent the needs of vulnerable adults and the risks they faced from escalating. Ultimately, this approach needed significant funding commitments but the impact on system-wide costs further down the line, as well as on mortality needed to be recognised.
4.30 On mental health, Hackney had the highest number of people with severe mental illnesses in North East London but the lowest proportion of commissioned support in the region. This gave mental health services very little flexibility to offer supported accommodation to anyone other than those with the highest levels of needs, and with demand rapidly increasing, even this cohort had to be put in costly out of borough placements.
4.31 Currently mental health staff were reporting that the biggest challenge in delivering care was people presenting to services with complex needs and the lack of appropriate accommodation available to meet those needs. Generally, there was a positive interaction between housing, mental health services and adult social care but this was being limited by a lack of suitable accommodation.
4.32 Hackney had the highest number of people presenting to A&E in mental health crisis across North East London, and these presentations were often complicated by health and social care issues. There was a significant bed crisis locally and a lack of suitable accommodation was impacting on safe discharge.
4.33 There were also a range of challenges facing supported housing providers locally. One of the biggest challenges facing providers was the reduction in funding over time, in the context of wider cuts across the public sector resulting in social care resources being concentrated on the highest need individuals.
4.34 The complexity of need of those living in supported housing had also continued to increase locally, within a wider context of reduced availability of statutory services. Meeting these needs was challenging because of the complexity of people’s circumstances and histories, and it had become difficult to appropriately manage or support clients.
4.35 Clients were spending increasing amounts of time with supported accommodation providers because there was a lack of suitable move-on options, limited by a lack of affordable housing, barriers faced in securing private housing and complexity of need and access to external services.
4.36 Providers were also facing staff recruitment and retention challenges, finding it difficult to pay staff adequately despite asking them to manage increasing levels of risk and complexity.
4.37 In terms of next steps, there was a need locally to enhance the preventative approach by introducing diversity in terms of support and support providers, and develop a whole system approach working in partnership with health and other anchor institutions.
4.38 There was also a need to prioritise and identify funding for much needed provision with partners in health and across the wider public service system, and for a programme of accommodation to be included in the Housing Strategy with delivery plans for minimum number of units per annum.
Questions, Answers and Discussion
4.39 A Commission Member asked what some of the barriers had been in developing effective local partnerships to develop supported accommodation provision in Hackney.
4.40 The Assistant Director of Benefits and Housing Needs explained that, historically, health partners had often been less involved in homelessness prevention work. Since the pandemic, the link between health outcomes and homelessness had become more apparent and was now more universally understood across the local partnership.
4.41 There were now quarterly Homelessness and Health Forum meetings which brought together a number of health agencies across City & Hackney. The Council also met with North East London Integrated Care Partnership on a monthly basis through the Housing Directors Forum.
4.42 The strategic focus across the partnership had moved on from those who were currently rough sleeping, as it was felt that the response in this area was now robust. More focus now needed to be given to those that move between services, such as health, offending and substance use services, and supporting their needs.
4.43 A Commission Member asked what some of the challenges in commissioning supported accommodation and housing-related support were, and for more information on the supported accommodation pathway model in Camden.
4.44 The Assistant Director of Benefits and Housing Needs explained that there were a few key reasons why the Camden pathway had been successful. The first was that there were a number of providers in Camden, one of the largest being the Council itself. This gave rise to improved quality and partnership working, and the Council itself setting a high standard for providers to follow.
4.45 Another was that the pathway was consistent across all providers. This meant that the journey was the same for all people that go through the pathway, and monitoring and reporting across the pathways were the same allowing for joined-up partnership working. Ultimately this led to consistency in outcomes for service users.
4.46 The Supported Housing (Regulatory Oversight) Act had now been introduced which affected supported housing providers by introducing changes to how the supported housing sector was regulated. This had been introduced to improve the quality of the accommodation, care and support, but there were also concerns that this may drive up costs for providers and some may exit the market as a result.
4.47 The Strategic Commissioning Lead, Rough Sleeping and Homelessness added that the supported accommodation pathway in Camden was well funded, and that much of the funding had been ring fenced to support its continued delivery.
4.48 The supported accommodation market generally was facing financial pressures, especially in light of funding cuts and more recently the cost of living crisis, which made the variety of providers across the pathway and the Council Itself providing its own accommodation even more important.
4.49 A Commission Member asked how immediate progress could be made in this area, and what it may realistically look like.
4.50 The Assistant Director of Benefits and Housing Needs explained that the Council had a role to play in influencing partner agencies to recognise the challenges that exist in the supported accommodation market, and the risks associated with not increasing provision.
4.51 It was important that health partners began to more widely understand the health costs associated with not increasing provision, and ultimately the increased likelihood of early death for homeless people if these interventions were not available. Other partner agencies, such as those across the criminal justice system, needed to understand the increased costs associated with not taking action too.
4.52 One of the key takeaways from the research project recently commissioned by the Council with providers and service users was the need for increased collaboration between agencies. One suggestion was that the Council had a convening role in this regard, and that thought should be given to increasing or diverting resources to allow for this to happen.
4.53 The Council had meetings arranged with North East London Integrated Care Board on this issue, and would be exploring some of the associated challenges and funding opportunities at the City & Hackney Neighbourhood Health and Care Board in 2024. It would also be taken to the Adult Safeguarding Board in the near future.
4.44 The Deputy Borough Director for City & Hackney at East London NHS Foundation Trust added that there was a significant bed crisis locally and a lack of suitable accommodation was impacting not only on safe discharge, but also on preventing people from needing psychiatric beds.
4.45 The Assistant Director of Benefits and Housing Needs went on to explain that further exploratory work was needed to look at delivery options as part of the new Housing Strategy, and engagement with providers of social housing to understand any opportunities for developing provision within their existing stock.
4.46 A Commission Member asked what role community safety partners might play in unlocking funding opportunities to develop supported accommodation provision locally.
4.47 The Assistant Director of Benefits and Housing Needs explained that conversations were ongoing with the Community Safety Partnership to explore funding opportunities, but at present this had been limited to interventions for those experiencing domestic abuse and sex workers.
4.48 It was noted that not increasing provision would likely lead to increased costs across the Community Safety Partnership in terms of anti-social behaviour and crime, as well as the criminal justice system.
4.49 A Commission Member asked how the Council could engage directly with the borough’s registered social housing providers to explore the opportunities for developing supported accommodation provision within their existing stock.
4.50 The Assistant Director of Benefits and Housing Needs explained that conversations were being had with specific registered social housing providers where development opportunities had been identified. This was specifically around bringing empty sites back into use, and involved adult social colleagues and health partners.
4.51 The Assistant Director Strategy, Assurance and Private Sector Housing explained that the Better Housing Partnership was the forum through which the Council and registered social housing providers met to discuss key issues and was split into two sub groups, namely development and management. This would be reviewed in 2024 to ensure it was focused and well attended.
4.52 The Hackney Registered Provider Compact was recently introduced and outlined shared priorities and commitments, however it was not enforceable and relied on good working relationships.
4.53 A Commission Member asked about the particular needs of the Orthodox Jewish community in regard to supported accommodation, and what discussions had taken place with community leaders to address them.
4.54 The Assistant Director of Benefits and Housing Needs explained that the level of need within the Orthodox Jewish community was low, and that it was rare for a member of that community to present as homeless with complex needs.
4.55 Having said this, there was a need to explore demographically and culturally informed interventions more widely going forward. For example, there was a clear need for gender specific accommodation for women who were unsuitably housed, and for Black and Global Majority residents who were more likely to be affected by homelessness and health issues.
Summing Up
4.56 The Chair thanked Commission Members for their questions and all witnesses for their responses and engagement with the scrutiny process.
4.57 It was explained that, after the meeting, the Commission would reflect on the evidence heard and may invite colleagues from across Housing Delivery & Regeneration and health and social care partners to an additional meeting to explore the issues raised further.
Supporting documents:
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Item 4. Cover Sheet, item 4.
PDF 89 KB -
Item 4a. Presentation from Benefits & Housing Needs on Supported Accommodation for Rough Sleepers & Single Homeless People, item 4.
PDF 462 KB