September 2021
Everyone In For Good
Homeless Link Submission to
Comprehensive Spending Review 2021
Homeless Link
2
1. Introduction
1.1. Homeless Link is the national membership organisation charity for frontline homelessness
services. Representing over 900 organisations, we work to improve services through research,
guidance and learning, and campaign for policy change that will ensure everyone has a place to call
home and the support they need to keep it. 
1.2. We are pleased to provide our submission to the 2021 Comprehensive Spending Review (SR21) as we
look to build on the momentum gained throughout the COVID-19 pandemic to reach this Government’s
goal of ending rough sleeping by the end of this parliament.
1.3. In line with the priorities of SR21, our proposals will deliver strong and innovative homelessness
services and ensure that the ‘levelling up’ agenda addresses some of the most acute inequalities in
socioeconomic, health and housing outcomes.
1.4. Homelessness services are so often the last line of defence for people in crisis and the pandemic has
highlighted the crucial role they play. Indeed, the last 18 months have demonstrated the extraordinary
commitment and drive across central government, local government, and the voluntary and community
sector (VCS) as they worked together to support those both currently, and at risk, of rough sleeping.
1.5. In March 2020, the Government took decisive action - through both the Everyone In initiative and wider
interventions such as the pause on evictions and the £20 a week Universal Credit uplift - that sought to
both accommodate people sleeping on the streets, and limit the flow of people pushed into rough
sleeping. These decisions and the funding made available to deliver on them have saved lives, and
supported tens of thousands of people into secure accommodation. The actions taken have shown us
without a doubt that with the right investment, commitment and support, ending rough sleeping is
possible.
1.6. However, these emergency measures were temporary by design. With the eviction pause already
lifted, Everyone In schemes coming to a close and interim welfare support set to be reversed, we are at
risk of seeing a significant new wave of rough sleeping. With an estimated half a million people facing
rent arrears, the true economic and social impact of the pandemic is still emerging and with it, many
people find themselves increasingly at risk of homelessness.
1
1.7. Homeless Link members are already reporting increases in rough sleeping across their local areas
(Appendix 1) and in particular, concerns are being raised about people experiencing homelessness for
the first time. The uncertainty and inefficiency generated by years of short-term funding cycles, coupled
with the intensity of work demanded throughout the pandemic, has left a fragile sector facing burnout
and financial instability. And yet, our research shows that this remains a hopeful sector who can see
that ending rough sleeping is possible.
1.8. Nobody wants to see this phenomenal progress and investment wasted. As we start to emerge from
crisis mode, the spending review is a vital opportunity to ensure that we follow through on investments
already made since March 2020. Looking ahead through the lifetime of the SR21 homelessness
providers have a vital role to play in building back better from the pandemic and supporting the
Government to deliver on the levelling up agenda.
1.9. To deliver on our shared goal of preventing and ending rough sleeping by the end of this parliament,
we ask Government to:
1
Citizens Advice. (2021) New year, same arrears: How the pandemic is leaving private renters with unmanageable debt Citizens
Advice
Homeless Link
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• Match enhanced investment in rough sleeping services during COVID-19 with a £132.5 million
annual boost to the Rough Sleeping Initiative through to 2024/25, compared to 2021/22 levels.
Deliver this through a simplified and long-term, guaranteed grant programme to local authorities.
• Commit £150.3 million annually for an initial three years for a national Housing First programme,
led by DLUHC but with cross-departmental investment and stewardship.
• Commit to a ten-year investment plan to realise the 90,000 social rent homes that England needs
per year.
• Unfreeze the Local Housing Allowance so that it continues to cover at least the 30th percentile of
local rents.
Homeless Link
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2. Build a homelessness funding system to end rough sleeping
2.1. Government has demonstrated a continued investment in homelessness and rough sleeping through a
60% in increase in revenue funding in 2021-22, compared to the 2020-21 spending review base
budget. Government has demonstrated a continued investment in homelessness and rough sleeping
through a 60% in increase in revenue funding in 2021-22, compared to the 2020-21 spending review
base budget.
2.2. Government’s renewed strategy to end rough sleeping and tackle homelessness, and the spending
commitments that back it, must provide a long-term, multi-year settlement to enable the development
of sustainable and effective services that people in need can rely upon. This call is unanimous across
the homelessness sector and is the priority concern of Homeless Link’s members.
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The funding must
be coordinated, streamlined and cross-departmental, to improve efficiency and reduce the burden on
local authorities and services.
2.3. In addition, in order to deliver the services needed to prevent and end rough sleeping as our economy
recovers, Government must sustain its move away from the funding cuts of the past decade, matching
enhanced investment in rough sleeping provision during COVID-19 and maintaining new funding to
help people to move on from homelessness for good.
2.4. Government investment in the homelessness response during COVID-19 has been crucial and
extremely valued, and has saved lives.
3
Government was responsive to sector needs – offering flexible
pots both to local authorities and directly to charity providers. However, reliance on short-term
funds also created massive uncertainty and anxiety among staff and clients.
2.5. Traditionally, and in the last decade in particular, the grant funding that fuels the homelessness
sector has been made up of numerous pots, many of them short-term and competitive. Our members
have told us how this creates a major administrative burden for local authorities and commissioned
providers. In addition, reliance on funding lasting a year or less undermines the stability and cost-
effectiveness of services, as well as skills development and retention of staff.
2.6. There is a compelling consensus across the homelessness and local government sectors on the
need to move towards long-term funding issued through streamlined multi-year settlements. In
addition, ending rough sleeping will require a joined-up strategy, with accountability
and aligned funding commitments shared across relevant government departments beyond
Department for Levelling Up, Housing and Communities (DLUHC).
2.7. Government already has the framework and tools at its disposal to make this work. With some key
improvements, the Rough Sleeping Initiative (RSI) and the Rough Sleeping Accommodation
Programme (RSAP), supported by the Homelessness Prevention Grant, provide a solid basis to deliver
a more efficient, effective and streamlined funding system to end rough sleeping.
Funding levels before Everyone In
2.8. Prior to the extraordinary demands and challenges of COVID-19, local authority spending on support
for single homeless people was already suffering from a decade of cuts. Research commissioned by
Homeless Link and St Mungo’s showed that the homelessness sector already faced an annual
2
See, for example: Homeless Link. (2021, forthcoming) Working together: the homelessness sector's path beyond COVID; NHF. (2020)
Comprehensive Spending Review 2020: National Housing Federation submission; The Kerslake Commission on Homelessness and Rough Sleeping
(2021) Interim report; Blood I et al. (2019) A Traumatised System’: Research into the commissioning of homelessness services in the last 10 years.
York: University of York
3
Lewer D et al. (2020) COVID-19 among people experiencing homelessness in England: a modelling study. The Lancet
Homeless Link
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spending shortfall of nearly £1 billion to support single homeless people. While the launch of the RSI
introduced a welcome boost in 2018/19, spending was still 40% down on 2008/09.
4
In roughly the
same period, rough sleeping in England more than doubled and temporary accommodation
placements increased by 91%.
5
2.9. In an attempt to fill this gap, local authorities were obliged to draw from general funds. Research from
the London School of Economics indicated that of the £919 million London’s authorities spent on
homelessness services in 2017/18, over one fifth (£201 million) was not covered by central government
grants or councils’ housing income.
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2.10. These figures are particularly stark when we consider that the ringfenced fund for accommodation-
related homelessness services prior to 2009 was found to be cost-effective. It delivered a net financial
benefit of £3.41bn per year overall, and £155.7m for homeless single adults and families alone.
7
2.11. Research with local authorities has also found that quality control was one of the first casualties of cuts
to local homelessness spend,
8
9
when local authorities felt they did not have the capacity to monitor
providers’ performance. It is likely that this is reflected in Government’s current difficulties in addressing
cases of poor quality and unsafe exempt accommodation across the country.
10
2.12. The impact of these cuts is visible at the frontline of homelessness services in even more direct ways.
Homeless Link’s annual reviews of the sector from 2018-2020 show that between a quarter and a third
of accommodation services had to reduce staffing each year and almost one in four had cut back on
support provision in 2018, reducing slightly to 16% in 2020. Our members describe how support for the
people they work with is increasingly only available when clients reaches crisis point. Indeed, local
spend on activities aimed at enabling people to live independently dropped by three quarters in
2018/19, in contrast with a 60% increase in spending on short-term temporary accommodation since
2013/14. In 2020, there was a five percent decrease in bed spaces for homeless people in England
compared to the previous year.
Building back better after COVID-19 – the financial health of the sector
2.13. The mandate to protect people experiencing homelessness during the COVID-19 pandemic meant a
significant boost in funding from Government and in local authority spending on services, partnerships
and accommodation. In 2020/21, there was a 60% increase in the revenue funding for homelessness
and rough sleeping, when compared to the 2019/20 spending review. Indeed, on top of the RSI
allocation of £112 million and RSAP short-term fund of £91.5 million for 2020/21, the Kerslake
Commission on Rough Sleeping has estimated that an additional £223.5 million was spent by local
authorities on the emergency response to rough sleeping.
11
2.14. In total, 13 different government funding pots were allocated to rough sleeping during this period, most
of which were short-term.
12
This funding was needed to fill holes in expected income as a result of
voids and a halt in fundraising activity, as well as to cover increased spending on reconfiguring
services, agency staff, private transport, cleaning and PPE. Homeless Link research with the sector in
2021 found that, while grant funding had increased for most survey respondents over the previous
4
Oakley M et al. (2020) Local authority spending on homelessness 2020 Update. WPI Economic, St Mungo’s & Homeless Link
5
Fitzpatrick S et al. (2021) The Homelessness Monitor: England 2021. Crisis
6
London Councils. (2019) The Cost of Homelessness Services in London. London Councils
7
DCLG. (2009) Research into the financial benefits of the Supporting People programme. London: DCLG
8
Homeless Link. (2013) Who is Supporting People now? Experiences of local authority commissioning after Supporting People. London: Homeless Link
9
Raisbeck T. (2019) Exempt from Responsibility? Ending Social Injustice in the Exempt Accommodation Sector. Commonweal Housing
10
Imkaan and Women’s Aid. (2020) Concerns with Exempt Accommodation for Survivors of Domestic Abuse.
11
The Kerslake Commission on Homelessness and Rough Sleeping. (2021) Interim report. St Mungo’s
12
Ibid
Homeless Link
6
year, fundraising opportunities were more than twice as likely to decrease (43%) than to increase
(19%).
13
2.15. Our survey found that while most respondents described themselves as financially resilient coming out
of the pandemic (82%), only 45% believed local authority funding was sufficient to provide needed
support. This is supported by a June 2021 poll of members, which showed that, whilst 70% of
responding members were coming out of the pandemic financially resilient, 52% were concerned about
their financial health over the next two years (Appendix 1).
2.16. A common concern was that the increase in funding needed to meet the many challenges of the
pandemic, risked contributing to a decrease in future funding, despite continued need. As one
stakeholder said:
“[We had a] significant amount of unsolicited fundraising. We literally had people phoning us up and
giving us money. … It will be a difficult next couple of years, I think, once it all settles down. We can
see that already in the funding environment. … I think my biggest concern will probably be in two years’
time, when things settle down.” (North West, Housing Provider 2)
2.17. The RSI allocation for 2021/22 of £203 million does not mirror the increased spend on rough sleeping
services that was required during the previous year, leaving a shortfall of at least £132.5 million on
what best estimates indicate was needed to keep people in and tackle the continued flow of people
sleeping rough.
14
The challenge of current funding streams
2.18. Our survey of the sector confirmed that one of the greatest preoccupations of services and local
authorities continues to be the precarious nature of short-term funding opportunities.
15
While the
aforementioned short-term and short-notice grants issued during COVID-19 were justified by the
demands of an unprecedented crisis, fragmented funding has been a challenge for the sector for a long
time. A report by the Local Government Association found that homelessness
services were issued with 12 short-term funding grants between 2015-2020 and half of these
were allocated through a competitive process.
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2.19. Homeless Link members’ concerns about short-term funding cycles are especially visible in relation to
the RSI contracts upon which so many of their services depend. Linked to the Rough Sleeping Strategy
(2018), a major advantage of the RSI is its reliability as a guaranteed national funding pot across four
years. However, the benefits of this Government’s long-term commitment to ending and preventing
rough sleeping have not necessarily translated through to services it funds: each area is
allocated funding for one year only and is required to pass through an annual competitive process,
destabilising contracts and partnerships.
2.20. A common theme in our survey responses was the challenge of trying to obtain and maintain high-
quality staff when reliant upon precarious funding opportunities. Three quarters of Homeless Link
members polled stated that short-term funding impacts negatively on staff retention in their
organisation (Appendix 1). Interviewees described difficulties in hiring experienced staff and negative
impacts on staff well-being of related to short-term contracts. Organisations commonly described the
heavy toll on staff working incredibly hard over the pandemic without certainty of future employment:
13
Grassian. T & Boobis S. (2021) Working together: the homelessness sector's path beyond COVID. Homeless Link
14
The Kerslake Commission on Homelessness and Rough Sleeping. (2021) Interim report. St Mungo’s
15
Grassian. T & Boobis S. (2021) Working together: the homelessness sector's path beyond COVID. Homeless Link
16
LGA. (2020) Fragmented funding - the complex local authority funding landscape.
Homeless Link
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“I had a lot of sleepless nights at the time about, oh, how are we gonna fund these posts? And it was
kind of like, well, how about we take a bit out of this pot and put it there and that would do for maybe
two months and then we’d see what happens. … We need all our staff, so how do we keep them all?
You know, how do we pay the bills at the end of the month?” (North West, Housing Provider 1)
2.21. Unsurprisingly, this funding and staffing instability has a direct effect on the quality of services, too. The
recent poll of Homeless Link members showed that 75% of responding members find short-term
funding negatively impacts on the quality of the service they provide and a further 83% stated that it
leads to inconsistent support for people experiencing homelessness (Appendix 1).
2.22. On the other hand, organisations and local authorities emphasised the value of long-term funding
opportunities when they were available:
“The MHCLG grant that we got … was fantastic and that really helped us grow our services, … but I
guess what would then help more is if that was three-year funding or five-year funding to then sustain
that growth rather than just being a one-off. … Going back to these projects like ours where we’ve
grown our services using that funding and actually saying, … we want to sustain that and sustain the
positive outcomes for years to come. That’d be great.” (North East, RC)
2.23. The RSAP was an example of just such a long-term investment in the sector - offering revenue funds
over a four-year period - and was widely welcomed for this reason. It complements the RSI, by offering
both capital and revenue funding to councils for move-on homes and support to people who have been
rough sleeping.
2.24. While this longer-term funding was widely welcomed, when RSAP launched in 2020 during the first
wave of COVID-19, local homelessness systems were required to develop plans to acquire new
accommodation units within five weeks and then to deliver these units (3,300 nationwide) within five
months. The non-alignment of the capital funding with the long-term revenue funds meant that capital
funding was not rolled over for local authorities who were unable to deliver units on-time and local
systems lost funds that had already been committed.
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Future funding: align, simplify and stabilise levels before Everyone In
2.25. Partnership working has been one of the great successes and anticipated legacies of the ways of
working that developed during the pandemic. Collaboration not just between local authority housing
services and the voluntary, community and faith sector, but also with other relevant public bodies -
including health and social care services - have transformed approaches to working in local areas. As
one local authority said:
“It does feel hugely different. I think what I’ve noticed is a lot of barriers coming down where originally
providers were quite happy working in their silos, whereas [what] I’m seeing is a lot more genuine
partnership working between organisations…It feels like we’re a lot more focused on achieving positive
outcomes and, actually, since the pandemic we’ve been part of jointly commissioning a lot of really
exciting new ventures.” (South West, LA)
2.26. Partnership working helps to bring people together, creates more efficient pathways and services and
drives innovation. Effective and efficient partnership working means that barriers between services are
broken down and people experiencing homelessness are better enabled to reach the right support at
the right time and exit/recover from homelessness.
18
As one organisation stated:
17
The Kerslake Commission on Homelessness and Rough Sleeping. (2021) Interim report. London: St Mungo’s
18
Grassian T & Boobis S. (2021) Homeless Provision for the Future: Best Practice from the homelessness sector during the pandemic. Homeless Link
Homeless Link
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“When new people come on to the city’s radar, they can be directed to the organisation that has the
best fit and the greatest chance of getting them to achieve their stated outcomes. Because we’re not
working against each other, we’re not worried about who’s doing what. We are doing it all together for
the benefit of the individual.”
2.27. Building effective partnerships takes time and Homeless Link members have highlighted how the
current short-term and competitive funding mechanisms can put at risk the future growth and
sustainability of partnership working. With concerns that good partnerships require time and resource
to embed that isn’t always made possible due to funding constraints.
“The unpredictability of funding is the biggest challenge. Short timescales to do the bid. All our cold
weather bids will be big partnership bids. We want to work together but this takes time. Need funding
streams for more than 6 months or a year” (CEO, North West based service provider)
“Our partnerships died, you must fund it. It is hard work, and you need it to fund it on purpose.” (CEO,
North East based service provider)
2.28. Rough sleeping response and prevention in England are currently largely funded through three key
programmes: the Rough Sleeping Initiative (RSI); Rough Sleeping Accommodation Programme
(RSAP) and the Homelessness Prevention Grant. Core funding streams are typically complemented by
additional major investments from various government departments, usually targeting specific areas
and groups. In 2020/21, these have included £23 million for people sleeping rough with drug and
alcohol dependency, £70 million for accommodation and support for prison leavers and £64 million
for the Changing Futures programme 2021-24.
2.29. This cross-departmental investment reflects the complex interconnecting needs that people facing
homelessness often have across mental health, drug and alcohol and physical health services, among
others. It also reflects the savings that integrated services deliver across health, welfare and criminal
justice, to mention a few.
2.30. Interim findings from the Kerslake Commission have emphasised the opportunities presented by an
enhanced RSI and RSAP to tackle rough sleeping as we approach 2024.
19
With some key
improvements and reconfigurations, we agree that these core funding streams provide an excellent
basis to fund the homelessness system to achieve our shared goal of ending rough sleeping. In order
to do so, these funding opportunities must be adjusted to offer increased and multi-year funding
settlements to local authorities to increase stability, predictability and quality for services, clients and
the workforce.
2.31. In addition, within and beyond core programmes, greater cross-departmental coordination is
required to align strategy, improve local partnerships and minimise administrative burdens related to
multiple funding pots. The new Cabinet sub-committee on rough sleeping and plans to renew the
Rough Sleeping Strategy offer opportunities to deliver these improvements that must be capitalised
on to deliver on our shared commitments to end rough sleeping by 2024.
2.32. In order to deliver this we ask Government to:
• Match enhanced investment in rough sleeping services during COVID-19 with a £132.5 million annual
boost to the Rough Sleeping Initiative through to 2024/25, compared to 2021/22 levels.
• Develop and implement a simplified funding stream for local areas bringing together capital and
revenue streams allowing for local areas to respond flexibly and innovatively to local need.
19
The Kerslake Commission on Homelessness and Rough Sleeping. (2021) Interim report. St Mungo’s
Homeless Link
9
• Allocate funding for a three-year period, allowing for multi-year contracts.
• Coordinate all funding streams to under a clear, accountable, cross-departmental plan to end rough
sleeping.
• Embed the development of strong, strategic partnerships within funding providing the resource to
ensure development and growth of collaborative working.
• Extend the Rough Sleeping Accommodation Programme funding to 2024 at least and allow for roll-over
of capital funding.
• Continue to invest in statutory prevention services by maintaining the Homelessness Prevention Grant
as a ‘visible lines’ allocation.
3. Invest in Housing First to maintain progress and widen its
reach
3.1. In 2017, Government made a ground-breaking £28 million investment to establish three regional
Housing First Pilots in Liverpool City Region, West Midlands and Greater Manchester. The pilots, and
wider 2019 manifesto commitments to further roll out Housing First, form a crucial and high-profile part
of Government’s plans to end rough sleeping by 2024.
3.2. We are calling on Government to ensure that Housing First is made available to everyone who needs it
over the next three years through the delivery of a national, cross-departmental Housing First funding
programme and to maintain the pilots’ excellent progress by allocating the additional funding needed to
secure their survival in the immediate-term.
The case for a dedicated, national programme for Housing First
3.3. Housing First is crucial to plans to end rough sleeping as it provides an effective solution for people
facing the most complex support needs. Encompassing a housing-led approach with intensive,
unconditional support and no fixed end point, it catalyses the system flex that people facing the most
acute multiple disadvantage require.
20
3.4. Growing evidence from England and elsewhere shows that Housing First residents are able to stabilise
and improve outcomes in a number of areas, often when nothing else has worked. It has been proven
to end homelessness for 80% of people with high support needs, reduce anti-social behaviour, stabilise
or reduce substance misuse and reduce use of emergency and criminal justice services.
21
22
Significantly, the then MHCLG’s second evaluation report of the Government regional pilots shows a
remarkable 87% tenancy sustainment rate for the 534 people housed so far.
23
3.5. Along with the Centre for Social Justice (CSJ) and stakeholders across the homelessness sector, we
are calling for a long-term, cross-departmental funding programme that is designed to deliver high-
fidelity Housing First in more areas where it is needed across England.
24
The programme should build
20
Homeless Link. (2021) About Housing First. London: Homeless Link
21
Pleace N & Bretherton J. (2013) The Case for Housing First in the European Union: A Critical Evaluation of Concerns about Effectiveness. European
Journal of Homelessness
22
Bretherton J & Pleace N. (2015) Housing First in England An Evaluation of Nine Services. York: Centre for Housing Policy
23
MHCLG. (2021) Evaluation of the Housing First Pilots Second Process Evaluation Report. London: MHCLG
24
Centre for Social Justice. (2021) Close to Home: delivering a national Housing First programme in England. London: Centre for Social Justice
Homeless Link
10
on learning from the existing regional pilots, as well as on the wealth of knowledge from the existing
small-scale Housing First projects across the country. Valuable research by Crisis has outlined in detail
how the programme might be delivered.
25
3.6. Research commissioned by Homeless Link and Crisis estimated that at least 16,450 Housing First
places are needed by people with the most complex needs in England.
26
As the approach continues to
attract the support of commissioners and providers, the number of Housing First projects has grown
remarkably in recent years, from 32 in 2017 to 105 today. However, with the majority of them small,
locally-funded projects they have a total capacity to support only 1,995 people.
27
3.7. We are calling for the national programme to fill this shortfall in places by providing funding and
leadership needed to deliver Housing First locally - with client choice, control and no end-point - where
it is needed. To do this, we support the proposals of the CSJ for an annual investment of £150.3 million
for at least three years, with an expectation that the programme should, if needed, continue beyond
then. We expect this investment to support a phased roll-out of Housing First to additional regions at
first, based on an assessment of need in the homelessness and rough sleeping populations.
Why a dedicated, long-term national programme is needed
3.8. A dedicated multi-year Housing First programme is required because traditional homelessness funding
and commissioning often undermines the unique principles that make Housing First work. Short-term
funding pots with traditional expectations in terms of staffing, caseload, outcomes and throughput fail to
take into account the open-ended and unconditional support offer of Housing First, the importance of
choice and control, and the patience and intensity of support that people who have experienced
extreme complex trauma require.
3.9. The Principles of Housing First is an evidenced-based guide for what makes Housing First work for
people with the most complex needs.
28
For example, the offer of housing must be non-conditional so
that it can provide a stable base for recovery to begin;
29
30
31
caseloads must be small to allow for
intensive support; clients must receive a permanent offer of support that they can trust in. While there
is evidence that in some cases the intensity of support can reduce over time and some clients may
move on from Housing First entirely, the open-ended support principle - and other key principles - are
recognised as crucial to the overall impact of Housing First.
32
33
25
Crisis. (2021) Home for All: The case for scaling up Housing First in England. London: Crisis
26
Blood I et al. (2018) Implementing Housing First across England, Scotland and Wales. London: Crisis
27
Homeless Link. (2020) The picture of Housing First in England 2020. London: Homeless Link
28
Homeless Link. (2021) The Principles of Housing First. London: Homeless Link.
29
Mackie P et al. (2017) Ending rough sleeping: what works? An international evidence review. Hariot-Watt University
30
Groundswell (2017) An End to Street Homelessness? A Peer-led Research Project for the Hammersmith & Fulham Commission on Rough Sleeping.
Hammersmith & Fulham Council
31
Pleace N. (2018) Using Housing First in Integrated Homelessness Strategies: A Review of the Evidence. York: Centre for Housing Policy
32
Bretherton J & Pleace N. (2015) Housing First in England An Evaluation of Nine Services.
York: Centre for Housing Policy
33
Centre for Social Justice. (2021) Close to Home: delivering a national Housing First programme in England. London: Centre for Social Justice
Homeless Link
11
3.10. Homeless Link analysis shows that the most common funding stream for Housing First is the Rough
Sleeping Initiative (RSI), which provides funds to 43% of the 105 Housing First services in England.
34
Of those, more than half were relying on funds for one year or less and three years as a maximum. The
next most common types of funding are local authority homelessness grants and grant-making
charities.
3.11. These funding sources tend to be short term and therefore unpredictable, so it is unsurprising that
funding is the second most cited challenge by Housing First services after finding suitable
accommodation.
35
3.12. Increasing numbers of Housing First providers have raised how inappropriate targets around
throughput, constraints and expectations linked to these funding sources frequently undermine fidelity
to the principles of Housing First. In some cases, this has led to demonstratively successful services
being decommissioned.
3.13. In addition, short-term contracts make it more difficult to engage landlords, to retain the specialist
workforce Housing First needs and, crucially, to build the trust of clients.
3.14. The RSI and RSAP are the primary programmes through which Government have endeavoured to
fund Housing First beyond the pilots in recent years. However, intelligence from our members
demonstrates some of the difficulties this has created, when funding structures do not facilitate fidelity
to the unique principles of Housing First. Continuing the current approach risks undermining the model,
diluting its original purpose and diverting it to client groups for whom different approaches would be
better suited. The following service vignettes provide some examples of where we believe this has
occurred.
34
Homeless Link. (2020) The picture of Housing First in England 2020. London: Homeless Link
35
Ibid
Homeless Link
12
A cross-departmental programme: collaboration and investment from health and
justice
3.15. Housing First relies on the engagement of health and social care and, importantly, delivers measurable
benefits and savings across sectors. This means a cross-departmental programme - with particular
emphasis on the involvement of the Department of Health and Social Care (DHSC) and the Ministry of
Justice (MOJ) - is required. The CSJ estimates that every £1 spent by Government on such a
programme would save £1.56 across health, criminal justice and the homelessness system.
36
3.16. The insecure funding landscape for Housing First - in England - is perhaps compounded by the fact
that it is generally viewed and commissioned as a homelessness intervention, rather than the health
and social care intervention it is seen as elsewhere. Just as the role of the health, social care and
criminal justice systems in delivering Housing First is crucial, the benefits and savings delivered by
Housing First to the NHS, public health budgets and prisons and probation are clear.
3.17. There is growing international and English evidence that Housing First improves criminal justice
outcomes, and, in some cases, significantly reduces criminal activity.
37
For example, the proportion of
59 service users arrested in the year before joining Housing First compared when they became
Housing First tenants, dropped from 53% to 36%; begging reduced from 71% to 51%; anti-social
36
Centre for Social Justice. (2021) Close to Home: delivering a national Housing First programme in England. London: Centre for Social Justice
37
Bretherton, J. and Pleace, N. (2015) Housing First in England An Evaluation of Nine Services. York: University of York; Quilgars, D. and Pleace, N.
(2017) The Threshold Housing First Pilot for Women with an Offending History: The First Two Years Report of the University of York Evaluation. York:
University of York; Pleace, N. and Quilgars, D. (2017) The Inspiring Change Manchester Housing First Pilot: Interim Report. York: University of York;
Jones, K., Gibbons, A. and Brown, P. (2019) Assessing the impact of Housing First in Brighton and Westminster. University of Salford and St Mungo’s.
Homeless Link
13
behaviour from 78% to 53%.
38
The CSJ estimates a saving to the criminal justice system of -£1,658 to
criminal justice per person in Housing First per year.
39
3.18. As noted, a broad evidence base indicates improved mental and physical health for Housing First
tenants, including stabilisation and reduction in drug and alcohol dependency and better engagement
with routine health services.
40
While the greatest savings inevitably accrue to homelessness services at
£8,650 per person per year, the CSJ estimates savings of £4,350 per person per year to the NHS;
£250 to drug and alcohol per person per year and £165 to mental health per person per year.
41
3.19. High fidelity Housing First cannot operate optimally without engaged commitment from each of these
systems. Nor will those systems gain from the savings Housing First delivers. Unfortunately, very few
Housing First projects currently receive funding via adult social care (9%) or public health (6%) budgets
and barriers to accessing health services are often cited as a key challenge for Housing First
services.
42
Hightown Housing Association Housing First – Drug and Alcohol worker
Hightown Housing Association have been delivering Housing First since October 2019, joint funded
through Dacorum Borough Council and St Albans City Council RSI.
In the first year of delivery, Hightown found that 90% of the people being supported had drug and
alcohol issues, but only 15% were engaged with the addictions service, Change Grow Live
(CGL). In July 2020, Hightown began a partnership with CGL to embed a Housing First Recovery
worker into the service and since this time, engagement with the addictions service has increased
to 69%.
This peripatetic and flexible drug treatment support has had a significant impact for residents. One
person is heroin-free and on a stable Physeptone prescription, which has reduced risks and
allowed engagement with mental health services. Another resident has benefitted from the
relationships-based approach from the Housing First Recovery worker and has now significantly
reduced their cannabis and alcohol use, which has in turn reduced their chaotic behaviour and
contact with the police.
3.20. Improving outcomes - including housing outcomes - for people with multiple disadvantage who are
frequent users of their services is an explicit strategic priority of the DHSC.
43
44
The national programme
of Housing First should receive investment and leadership from DHSC and the Ministry of Justice,
along with the DLUHC, in order to deliver more integrated provision at the local level and maximise the
potential for Housing First to deliver person-centred care for those with the most complex needs.
DHSC investment should secure additional health professional roles in Housing First services, as in
Hightown’s project, in addition to supporting joint commissioning and accountability at the local and
national level to support improved integration with NHS services and better outcomes for residents.
Securing the progress made by the Housing First regional pilots
“We still have a commitment to ending homelessness and we can't do that without Housing First”.
- Amanda Bloxsome, Housing First Best Practice and Partnerships Lead, Liverpool City Region Combined
Authority
38
Bretherton, J. and Pleace, N. (2015) Housing First in England An Evaluation of Nine Services. York: University of York
39
Centre for Social Justice. (2021) Close to Home: delivering a national Housing First programme in England. London: Centre for Social Justice
40
Bretherton, J. and Pleace, N. (2015) Housing First in England An Evaluation of Nine Services. York: University of York; Mackie, 2017; Baxter, A. J.,
Tweed, E. J., Katikireddi, S. V., & Thomson, H. (2019). Effects of Housing First approaches on health and well-being of adults who are homeless or at
risk of homelessness: systematic review and meta-analysis of randomised controlled trials. J Epidemiol Community Health, 73(5), 379–387
41
Centre for Social Justice. (2021) Close to Home: delivering a national Housing First programme in England. London: Centre for Social Justice
42
Homeless Link. (2020) The picture of Housing First in England 2020. London: Homeless Link.
43
HMPPS. (2020) A response to: An inspection of accommodation and support for adult offenders in the community and on release from prison.
London: HMPPS.
44
NHS England. (2019) The NHS Long Term Plan. London: NHS England
Homeless Link
14
3.21. Evidence from the pilots suggests they are replicating the success of Housing First seen elsewhere.
The then MHCLG’s second evaluation report of the pilots shows a remarkable 87% tenancy
sustainment rate for the 534 people housed so far, outperforming the international evidence.
45
The
pilots also report impressive non-housing outcomes, including maintaining substitute prescribing and
reducing illicit drug-use, improved health and engagement with GP care and re-establishing
connections with children. Wider system benefits noted include improved joint-working and embedding
person-centred approaches across local housing and health services.
3.22. However, all that the government pilots have achieved is being placed at risk by an approaching
funding cliff-edge, with Greater Manchester and Liverpool City pilots coming to an end in March and
August 2022, respectively and the West Midlands following in 2023.
3.23. These services are still working intensively with hundreds of residents who continue to need Housing
First support, including 148 people have been in their tenancies for a year or less and 295 people who
were recruited, but have yet to be placed in housing. Commissioners have reported that the anxiety
and uncertainty created by the approaching end points is having an impact on residents and has led to
loss of staff already.
3.24. The first Interim Process Evaluation Report (2020) of the pilots highlighted the need for action from
Government to secure the sustainability of the pilots. A three-year extension will provide the stability
the cohort requires and enable a smooth transition around Government’s planned decision on its long-
term strategy for Housing First flowing from the pilots’ impact evaluation in 2023.
3.25. In order to sustain the progress achieved by the regional pilots and to roll out Housing First to
where it is needed, we ask Government to:
• Provide £150.3 million annually for an initial three years for a national Housing First
programme, led by DLUHC but with cross-departmental investment and stewardship.
• Through investment in one-bed homes for social rent, ensure the programme is accompanied
by a supply of truly affordable housing to meet the scale of need for Housing First.
• While we await a longer-term decision on funding, we ask that Government commit to extend
funding for all three of the pilots by three years, at a level that enables continued support and
accommodation for the existing cohort of clients, at least.
4. Supporting the needs of specific populations
4.1. People experiencing homelessness are not homogenous, and the services available must be able to
reflect both the range of support needs and the diversity of the wider population. Those with multiple
and complex needs require a different approach to support than those with few additional needs.
Widespread gender-based provision is needed to ensure women experiencing homelessness are
supported in the most effective means possible. Young people need dedicated provision to help make
sure services are able to reach them and support them to effectively move quickly out of
homelessness. Non-UK nationals with immigration-based restrictions require a unique approach to
support entirely. No strategy to end rough sleeping will be successful without addressing the full range
of need and support required for all those experiencing homelessness.
45
MHCLG. (2021) Evaluation of the Housing First Pilots Second Process Evaluation Report. London: MHCLG
Homeless Link
15
4.2. In order to address the specific support needs of people experiencing homelessness there is a real
need to understand and appreciate the specific trauma faced by many of those within the population.
Trauma that may predate homelessness, such as adverse childhood experiences including experience
of the care system, domestic abuse, and the impact of sustained mental ill health, alongside the trauma
of homelessness itself.
4.3. An inability to appreciate and understand the impact that trauma has on an individual’s ability to
engage effectively in support, or on the way they interact with their environment, can prevent services
from helping to move people from the streets to safe and secure accommodation.
4.4. Trauma informed care (TIC) is an approach that creates an environment where someone who has
faced trauma feels safe and that they can establish trust with those supporting them. TIC provides for a
more compassionate and ultimately more effective means by which providers deliver their services.
4.5. The value of TIC is already established across the NHS with the NHS Long Term Plan committing to
developing TIC in relation to a community offer for people with severe mental health problems, but also
a service for vulnerable young people in contact with the youth justice system. Additionally, an
expectation of TIC approaches in mental health services accessed by people sleeping rough is
included in the NHS mental health implementation plan. The homelessness sector has also long-
valued the need for TIC approaches, and this is reflected in uptake of Homeless Link’s training and
guidance on the topic for the last number of years.
46
Scottish Government has gone further still,
establishing a National Trauma Training Programme (NTTP) in 2016 that support trauma informed and
trauma responsive workforce and services across Scotland, providing £2million funding until 2023 to
deliver the rollout of training and associated toolkits.
47
4.6. In order to deliver this, we ask Government to:
• Invest in the delivery and rollout of a national trauma training programme in England mandated for local
authorities and providers of commissioned services
Women and homelessness
4.7. Women’s routes into and experience of homelessness are different to that of men. According to the
annual street count, 14% of people sleeping rough in England on a single night in autumn 2020 were
women (377 people).
48
Just a fifth (21%) of those using St Mungo’s housing related support services
are women. But rather than this speaking to a lower rate of homelessness amongst women, it speaks
to unidentified need.
4.8. Women are often hidden whilst homeless or rough sleeping: finding secluded sleep sites or using tents,
staying with friends or family, sleeping on buses, or with strangers who expect sex in return for shelter,
or wearing baggy clothes to hide their sex.
49
“Homeless women will engage in many things to avoid street sleeping, this can include engaging in sex for rent,
getting back with abusive ex partners or for sex workers, staying with clients. However, as you can imagine, we
are not going to ring up Housing Options at the council and disclose any of this. Often, the people we opt to stay
with turn abusive, rape us or outright exploit us. When the time comes to try and leave, we will be told we are
46
Homeless Link trauma-informed training offer: www.homeless.org.uk/trauma-informed
47
NHS Education for Scotland trauma-informed training offer: www.transformingpsychologicaltrauma.scot/
48
Ministry for Housing, Communities and Local Government. (2020) Rough sleeping snapshot in England: Autumn 2020. London MHCLG
49
Bretherton J & Pleace N. (2018) Women and Rough Sleeping: A Critical Review of Current Research and Methodology. University of York, Centre for
Housing Policy
Homeless Link
16
intentionally homeless. This is because we likely told the housing team that we are staying with a friend or family
member, so it looks as though we are making ourselves homeless. By doing this, you won’t get housed because
they argue it’s your choice.” Woman with experience of homelessness
50
4.9. Hiding from harm means that women are hidden from help, missing from homelessness services and
rendered statistically invisible. Further still, not all women accommodated in refuges will be counted as
homeless despite experiencing homelessness. This undercounting means the true extent of women’s
homelessness is underestimated. Local authorities need to be provided with the means to redress this.
4.10. Many people’s homelessness is rooted in trauma, underpinned by common early experiences of
neglect, poverty, family breakdown and disrupted education, compounded by their experiences as
adults.
51
However, the experiences and needs of women differ from men’s.
4.11. The trauma experienced by women experiencing homelessness is often rooted in sex-based sexual
and domestic abuse, which can happen before, during, and after their experience of homelessness.
Indeed, research suggests that the “…experience of domestic violence and abuse is near-universal
among women who become homeless.”
52
This connection between violence, abuse and women’s
homelessness is reinforced by international evidence.
53
Need for female-only provision
4.12. Women traumatized by abuse will often experience an understandable fear of trusting others, their trust
having been profoundly and repeatedly betrayed by those who abused them. Distrust of men in
particular is common. Many women who have experienced male
54
violence will actively avoid
traditional mixed sex homelessness provision from fear of (or lived experience of) exposure to further
violence and exploitation.
55
4.13. Despite this, women-specific and sex-informed homelessness services are absent across many areas
of England and Wales. In 2019, only a tenth of accommodation services in England provide female-
only accommodation - a one per cent drop from the previous year.
56
Almost two thirds (61%) of all local
authorities in England, and most of Wales, were reported to have no homelessness services
specifically for women.
57
Evidence also suggests that the broader range of services working with
people experiencing multiple disadvantage - for example, housing, mental health, drug and alcohol
services or employment services - are not always well-versed on the impact of male violence and
abuse.
58
This can significantly affect women’s attitudes towards, and experiences of, support services
and health services, aggravating their problems further and trapping them in a cycle of homelessness
and chronically compromised health, amenable to intervention.
4.14. In addition to increased likelihood of adverse childhood experiences (ACE) amongst people with lived
experience of homelessness, women often face an additional burden of sex-based sexual and
50
https://street-hooker.com/2021/07/18/why-homeless-women-are-being-failed-by-services/
51
Fulfilling Lives (2020) NPC and Fulfilling Lives Lambeth Southwark and Lewisham
52
Bretherton J & Pleace N. (2018) Women and Rough Sleeping: A Critical Review of Current Research and Methodology. University of York, Centre for
Housing Policy
53
Ibid
54
Hester M (2013) Who does what to whom? Gender and domestic violence perpetrators in English police records European Journal of Criminology
55
Bretherton J and Pleace N (2018) Women and Rough Sleeping; A Critical Review of Current Research and Methodology University of York, Centre
for Housing Policy
56
Homeless Link. (2020) Support for People Experiencing Single Homelessness in England; annual review 2019.
57
Young L & Horvat T (2018) Promising Practice from the Frontline: exploring gendered approaches to supporting women experiencing homelessness
and multiple disadvantage. Homeless Link
58
Sharpen J (2018) Jumping through hoops: How are coordinated responses to multiple disadvantage meeting the needs of women? AVA, MEAM,
Agenda and St Mungo’s
Homeless Link
17
domestic abuse. About one in every 20 women in England has experienced extensive physical and
sexual violence and abuse, compared to one in every 100 men.
59
4.15. The overwhelming majority (84%) of those who suffer extensive physical and sexual abuse as both
children and adults are women.
60
The prevalence of abuse is even higher amongst women who have
experienced homelessness.
61
This experience of multiple trauma is linked to profoundly compromised
physical and/or mental health outcomes, substance dependency and a higher risk of further violence
and abuse. This is compounded by social disadvantage.
62
Delivering a homelessness system that works for women
4.16. We very much welcome Government’s widening of the criteria that determine who is in priority need for
housing to include people who have been made homelessness as a result of domestic abuse.
63
For too
long those fleeing domestic abuse have had to not only show they are homeless as a result of being
subject to domestic abuse, but also, separately, show that they were rendered ‘vulnerable’ as a
consequence of that domestic abuse. We are pleased that Government has recognised that, by
definition, people fleeing domestic abuse are vulnerable. This means that now, at the highly stressful
and dangerous time
64
of leaving an abusive partner, survivors of domestic abuse will now be
guaranteed secure housing under the main housing duty of the Housing Act 1996 (HA96).
4.17. A further recognition of the need for respite takes the form of Government’s Respite Room pilots,
providing safe accommodation with - critically - specialist support in single gender spaces, for women
at risk of rough sleeping who are experiencing domestic abuse and multiple disadvantage.
4.18. However, the funding for specialist support for those who have survived domestic abuse is inadequate.
Following the removal of the Supporting People ring-fence in 2009 and its absorption into shrinking
local authority budgets in 2011, funding for specialist support for domestic abuse survivors has reduced
significantly. Indeed, at time of their report in 2019, Women’s Aid found that nearly one in ten refuge
providers now operate with no local authority funding at all.
65
Despite repeated tranches of emergency
government funding between 2014-2020,
66
specialist services continue to operate on short-term and
insecure resources.
4.19. In order for local authorities to be able to support all those entitled to main duty support under HA96,
they need to have sufficient resource to provide adequate appropriate accommodation options
including refuge beds, as well as the specialist support need to effectively engage with those
experiencing the high trauma that comes from being made homeless through fleeing domestic abuse.
There is a real need for sufficient and secure funding that will mean these changes make a real and
lasting difference to the life chances of all those fleeing violence and abuse.
4.20. If Government is committed to ending women’s homelessness, it will need to commit to designated
funding for local authorities to commission female-only support and accommodation, including
expanded provision of Respite Rooms. This must include adequate funding for local authorities to fulfil
59
Scott and McManus (2016) Hidden Hurt: Violence, abuse and disadvantage in the lives of women
60
McNeish D & Scott S. (2014) Women and girls at risk: Evidence across the life course. Lankelly Chase
61
Bretherton J & Pleace N. (2018) Women and Rough Sleeping: A Critical Review of Current Research and Methodology. University of York, Centre for
Housing Policy
62
McNeish D & Scott S. (2014) Women and girls at risk: Evidence across the life course. Lankelly Chase
63
Section 189 of Housing Act 1996, as extended by statutory instrument
64
Long J et al. (2020) UK Femicides 2009-2018. Femicide Census
65
Women’s Aid. (2019) The Domestic Abuse Report 2019: the Annual Audit. Women’s Aid
66
Davidge S. (2019) Funding Specialist Support for Domestic Abuse Survivors. Women’s Aid
Homeless Link
18
their duty to provide accommodation-based and non-accommodation-based domestic abuse support
for all victims or their children, as required by the Housing Act 1996 (as amended).
4.21. In order to deliver this, we ask Government to:
• Fund local authorities to provide sufficient female-specific and gender-informed homelessness services
• Invest in the delivery and rollout of a national trauma training programme in England mandated for local
authorities and providers of commissioned services (see 4.6)
Youth homelessness
4.22. The past year has thrown the vulnerabilities in many young people’s lives - and in the services they rely
on – into sharp relief. Youth homelessness and rough sleeping spiked during the pandemic, as young
people lived through the fall-out of widespread job losses, the breakdown of informal living
arrangements and family breakdown. The Centrepoint helpline reported a huge surge in demand in
April 2020, with calls up 61% from 2019, and demand continued to rise as the year went on.
67
4.23. Worryingly, reports indicate that Everyone In did not serve young people as well as it might have.
Services reported that many local authorities frequently struggled to respond effectively to young
people newly arriving on the streets, failing to recognise their homelessness and/or to provide age-
appropriate emergency accommodation.
68
4.24. Indeed, evidence suggests that young people were driven to the most acute forms of homelessness
during the pandemic. Centrepoint reported that the proportion of young people sleeping rough when
they called in 2020-21 slightly increased.
69
CHAIN data for the 2020/21 showed that a historically high
one in ten people sleeping rough in London were young people (n=1093).
70
While numbers have been
generally decreasing since their peak in April-June 2020, they have been doing so at a slower rate than
for other age groups.
Long-term accommodation and move-on
4.25. Now and in the longer-term, distinct responses are needed to address the major repercussions of
COVID-19 on young people experiencing, or at risk of, homelessness. Over a number of years,
Homeless Link’s Young and Homeless research has highlighted how a shortage of suitable emergency
and longer-term supported accommodation, and support, has been a crucial barrier to young people
getting the help they need. Our 2021 survey of youth providers found that lack of access to affordable
housing was by far the most widely reported barrier preventing young people from moving on from
homelessness services when they are ready. Lack of social housing (85%, 45); lack of accommodation
available at the Local Housing Allowance rate (77%, 41) and inability to afford upfront costs like rent
and deposit (74%, 39) were the top three barriers that kept young people stuck.
71
A welfare safety net that enables young people to live and to thrive
4.26. While unemployment has risen across all age groups during the pandemic, young people have felt the
worst of the economic fall-out of COVID-19. Already three times more likely to be insecurely employed,
one third of 18-24 year-olds lost jobs or been furloughed during the pandemic, compared to one-in-six
67
Centrepoint. (2021) A year like no other: Youth homelessness during the COVID pandemic.
68
Homeless Link. (2020) Preventing youth homelessness after COVID-19: lessons and opportunities from the crisis.
69
Centrepoint. (2021) A year like no other: Youth homelessness during the COVID pandemic.
70
GLA. (2021). Rough sleeping in London (CHAIN reports). London: GLA.
71
Homeless Link. (2021, forthcoming). Young and Homeless.
Homeless Link
19
adults aged 25 and over.
72
582,000 young people aged 16-24 were unemployed in November 2020-
January 2021, an increase of 76,000 (or 15%) from the same period the year before.
73
4.27. Unsurprisingly, this has led to a sharp rise in the number of young people claiming benefits. Between
February 2020 and 2021, the youth claimant count in England more than doubled.
74
4.28. Research from Homeless Link with 45 young people with experience of homelessness identified the
inadequacy of welfare support, specifically Universal Credit, as a key challenge for young people trying
to move on from homelessness and pursue their goals. Young people felt that the system was not
responsive to their circumstances and their Universal Credit allowance – paid at a lower rate than for
those aged 25 and over - meant they were often unable to afford basic needs. They also felt blocked
from training or work because the impact it would have on their benefits would mean they could no
longer afford to live in supported accommodation
.
75
4.29. In order to deliver this, we ask Government to:
• Invest in truly affordable supply of long-term accommodation, with support, which enables young
people to live, work, earn and learn, as well as youth-only emergency accommodation.
• Raise the Universal Credit standard allowance for all under-25s living independently to match the
amount over-25s receive, while maintaining the COVID-19 uplift.
• Remove barriers to employment for young people in supported accommodation, by raising the amount
within Housing Benefit or extending work allowances to vulnerable young people through Universal
Credit.
5. Support the homelessness sector to tackle non-UK national
homelessness
5.1. The ongoing impact of the COVID-19 pandemic has demonstrated more clearly than ever how
immigration status-based restrictions on eligibility for welfare and other public funds act as a major
barrier to effective homelessness responses. These policies, as well as confusion around the positive
solutions that can be offered, have created an unsustainable financial burden on local authorities. And,
without an offer of support, many people in these circumstances are forced into destitution and driven
into exploitative working and living situations, putting them at risk of modern-day slavery.
5.2. Everyone In created a unique opportunity to extend an accommodation offer to this group and, with
targeted immigration advice and employment support, many local authorities reported promising
progress in helping people to regularise their immigration status, start work and move on from
homelessness for good.
76
Homeless Link is actively working with our members and local authorities to
improve the local offer to non-UK nationals, and to mainstream the specialist support that they need.
5.3. However, local systems are struggling and the disjuncture between Government priorities around
rough sleeping and immigration control are undermining their tireless efforts. We need sustainable
72
Gustafsson, M. (2020). Young workers in the coronavirus crisis: Findings from the Resolution Foundation’s coronavirus survey. London: Resolution
Foundation.
73
Office of National Statistics. (2021). Unemployment statistics.
74
Centrepoint. (2021) A year like no other: Youth homelessness during the COVID pandemic.
75
Homeless Link. (2020) We Have A Voice, Follow Our Lead: Young and Homeless 2020.
76
Grassian T & Boobis S (2021) Working together: the homelessness sector's path beyond COVID. London: Homeless Link
Homeless Link
20
solutions and clarity of direction, to support homelessness services and local authorities to achieve
positive outcomes for non-UK nationals and all of our diverse communities, in turn.
5.4. The urgency of the need for Government action has been highlighted across the homelessness and
local government sectors, as well as across political party divides.
77
Indeed, the need for reform to
resolve the inconsistencies in no recourse to public funds (NRPF) policy and commitments to end
rough sleeping was highlighted by HCLG Select Committee.
78
5.5. We call on Government to tackle this conflict by committing to fund increased capacity in the
independent immigration advice sector and reforming immigration-based restrictions on homelessness
assistance to give local authorities the tools they need to end rough sleeping.
Support homelessness services to tackle non-UK national rough sleeping,
sustainably
Non-UK national homelessness
People currently living in England without a social safety net because of their immigration status are at
much greater risk of homelessness. Most of those affected can be divided into the following groups:
1. People with leave to remain who have a no recourse to public funds (NRPF) condition attached.
2. People who have outstanding applications for leave to remain
3. EEA nationals with pre-settled status who are not working.
4. People with no current regularised status, often because of prohibitive application fees, barriers to
accessing advice, and the complexity of the immigration system.
Rough sleeping figures
Data on rough sleeping populations also gives us some indication of the nationalities of people sleeping
rough. Of course, while this can be a helpful illustration, it is not a reliable indicator of immigration status.
The 2020 national rough sleeping count found that almost a quarter of people found sleeping rough on a
single night in Autumn were non-UK nationals.
79
472 people (18% of the total) were EU nationals and 128
people (5% of the total) were from outside the EU and the UK. This is down both in term of numbers and
proportions from preceding years, when almost a third of people counted were non-UK nationals (1,201 in
2018 and 1,088 in 2019).
The scale of the issue is particularly acute in London. The latest CHAIN figures show that approximately
half of people found sleeping rough in London are non-UK nationals and this is consistent across quarters
(to June 2021) and the previous year.
80
5.6. During Everyone In and beyond, local authorities utilised their full range of powers to accommodate
people with eligibility restrictions, including NRPF.
81
82
5.7. Uncertain about their ability to legally continue to accommodate and the affordability of doing so, many
local authorities began denying support to people with NRPF in summer 2020. Others continue to
77
Local Government Lawyer (2020) Councils call for suspension of No Recourse to Public Funds condition. NHF. (2020) We are
joining calls for a suspension of No Recourse to Public Funds (NRPF) conditions.
78
https://committees.parliament.uk/work/271/impact-of-covid19-coronavirus-on-homelessness-and-the-private-rented-
sector/publications/
79
https://www.gov.uk/government/statistics/rough-sleeping-snapshot-in-england-autumn-2020/rough-sleeping-snapshot-in-england-
autumn-2020
80
https://data.london.gov.uk/dataset/chain-reports
81
From here onward, we use the term ‘NRPF’ to refer to all groups described in Box 1.
82
Boobis S & Albanese F (2020) The impact of COVID-19 on people facing homelessness and service provision across Great
Britain. Crisis; Whitehead C (2021) Homelessness and rough sleeping in the time of COVID-19. LSE
Homeless Link
21
provide accommodation and support under the duty held in Ncube v Brighton and Hove without any
assurances from Government of funding to enable this to continue.
83
84
While the national suspension
of the EU derogation in June 2020 was welcomed as a short-term fix for EU nationals, many local
authorities reported that 12 weeks was simply not long enough to support individuals to get into work
and into sustainable accommodation.
85
Unprecedented progress with a neglected group
5.8. Despite this confusion, our members report that significant proportions of those housed in hotel
accommodation had NRPF, ranging from 25% to 70% in some areas.
86
Indeed, the National Audit
Office estimated that people with NRPF accounted for about half (about 2,000 people) of the total
number of people accommodated under Everyone In in emergency accommodation in London in
September 2020.
87
5.9. Research by Homeless Link found that this ability to lift restrictions during Everyone In was key to its
success and homelessness organisations welcomed being able to support this group of people for the
first time, in many cases.
88
It offered an unprecedented opportunity to work with individuals from a
stable base of accommodation, develop links with immigration advisors and build trust with people who
had never had access to advice and support. In particular, Homeless Link members reported success
with helping many EU nationals to enter into employment, repatriate or regularise their immigration
status via applications to the EU Settlement Scheme (EUSS).
89
In turn this meant many were able to
move on from homelessness.
5.10. Everyone In was also especially important given that people with NRPF faced some of the worst
consequences of the pandemic and were particularly at risk of losing employment, being evicted from
their housing and being unable to afford to self-isolate or shield. Citizens Advice reported a 91% year-
on-year increase in NRPF issues in the first nine months of the pandemic.
90
Additionally, a survey of
310 non-UK nationals in the winter of 2020-21 found that 44% of surveyed hospitality and cleaning
workers lost their jobs, all of whom were subject to NRPF.
91
Research from The Children’s Society has
also highlighted the particular risks to the health and wellbeing of children and families subject to the
NRPF condition, both during COVID-19 and prior.
92
5.11. Our research with people working in the homelessness sector found that while the lifting of eligibility
restrictions was one of the most positive measures, the removal of these measures was also one of the
greatest areas of concern moving forward, particularly given the variety in local authority approaches
over the course of Everyone In.
93
Support local authorities to deliver a basic safety net from homelessness
83
Homeless Link intelligence; Whitehead C. (2021) Homelessness and rough sleeping in the time of COVID-19. LSE;
The Kerslake Commission on Homelessness and Rough Sleeping. 2021. When We Work Together – learning the lessons. Interim Report.
https://usercontent.one/wp/www.commissiononroughsleeping.org/wp-content/uploads/2021/07/KRSC_Interim_Report_0721.pdf; Boobis, S. and
Albanese, F. (2020) The impact of COVID-19 on people facing homelessness and service provision across Great Britain. London: Crisis
84
University of Portsmouth. (2021) submission to Kerslake Commission; Local Government Committee (2021) Protecting rough sleepers and renters
https://publications.parliament.uk/pa/cm5801/cmselect/cmcomloc/1329/132903.htm#_ idTextAnchor000
85
Boobis S & Albanese F (2020) The impact of COVID-19 on people facing homelessness and service provision across Great Britain. Crisis
86
Homeless Link (2020) Member Survey. Data available on request.
87
NAO. (2021) Investigation into the Housing of Rough Sleepers during the COVID-19 Pandemic. NAO
88
Grassian T & Boobis S (2021) Homeless Provision for the Future: Best Practice from the homelessness sector during the pandemic. Homeless Link;
89
Grassian T & Boobis S (2021) Working together: the homelessness sector's path beyond COVID. London: Homeless Link
90
Citizens Advice. (2020) No Recourse to Public Funds: data and developments.
91
Gardner Z. (2021) Migrants with No Recourse to Public Funds’ Experiences During the COVID-19 Pandemic. JCWI
92
Pinter I et al. (2020) A Lifeline for All Children and Families with No Recourse to Public Funds. London: The Children’s Society.
93
Grassian T & Boobis S (2021) Working together: the homelessness sector's path beyond COVID. London: Homeless Link
Homeless Link
22
5.12. With Everyone In, individuals who would have otherwise remained hidden, in vulnerable and
exploitative situations have received the support they are entitled to as survivors of modern day
slavery, the healthcare they are entitled to, the support they desired to return to their country of origin
or the quality advice they needed to regularise their immigration status. All of this was made possible
by the provision of basic emergency accommodation, alongside appropriate advice and support.
5.13. Estimates from the LSE put the cost to London boroughs and the GLA of providing COVID-19
accommodation and move-on support to people sleeping rough with NRPF at £33.1 million, out of a
total £98.8 million spent overall in 2021/21.
94
This reflects an unsustainable burden on local authority
budgets, as well as a much more accurate picture of homelessness need than we have ever had.
5.14. There is convincing and emerging evidence from Everyone In and pre-existing initiatives such as A
Bed Every Night (ABEN) in Greater Manchester, that investment in a minimum standard of NRPF-
neutral emergency accommodation that is embedded with local support services, is an effective means
of reducing rough sleeping and generating savings for local budgets.
94
Whitehead C. (2021) Homelessness and rough sleeping in the time of COVID-19. London: LSE
95
Watts B. et al. (2021) Greater Manchester’s A Bed Every Night programme: An independent evaluation. Edinburgh: Heriot Watt University.
Homeless Link
23
5.15. However, this cannot be achieved on the scale required without a clear Government commitment,
accompanied by funding and necessary reforms. If no action is taken now to address the needs of non-
UK nationals with restricted entitlements, much of the remarkable work jointly done under Everyone In,
and investment made, will be undermined. We saw an impressive drop in the national rough sleeping
count in 2020 as a result of Everyone In, but the consequence of inaction now may result in thousands
of people returning to sleeping rough on the streets of England in the coming months.
5.16. We ask Government to support homelessness services to tackle non-UK national rough
sleeping by:
• Immediately issuing clear guidance to local authorities that they should use their legal powers under
the Local Government Act 1972 and NHS Act 2006 to accommodate people otherwise ineligible for
support during the ongoing pandemic and ensure that they are funded to do so.
• Extending eligibility for benefits to all EEA nationals with pre-settled status.
• No longer applying NRPF conditions to individuals granted leave to remain on family or private life
grounds when the person has a dependent child, or is unable to work due to an illness, disability or
caring responsibilities.
• Reviewing all immigration-based restrictions on public funds to ensure that local authorities have
powers to provide emergency accommodation in order to prevent destitution.
Improve access to immigration advice
5.17. Independent immigration advice is a crucial part of every local multi-agency homelessness response.
Unfortunately, a lack of capacity and funding for specialist advice and the absence of guidance for
homelessness commissioners on embedding it in their offer, means that many people are left stuck in
homelessness or emergency accommodation without the support that could help them to regularise
their status and move on.
5.18. Immigration advice services are underfunded and overstretched, and this is compounded by the
passing of the EUSS deadline, which is likely to lead to an increase in EU nationals with restricted
entitlements, and therefore at serious risk of homelessness.
97
Indeed, research in London estimates
96
Bromley R & Briggs C. (2019) Greater Manchester Joint Commissioning Board Report: Investment in Homeless Healthcare and ‘A Bed Every Night’.
Greater Manchester Health and Social Care Partnership
97
NRPF Network. (2021) Supporting European Economic Area (EEA) nationals with care needs ADASS; Public Interest Law Centre. (2021) Still Here:
Defending the rights of homeless EU citizens after Brexit and Covid-19.
Homeless Link
24
the total capacity for casework in London at no more than 4,000-4,500 pieces per year, compared with
demand in the hundreds of thousands.
98
It highlights the particular need for longer-term casework
capacity, rather than one-off advice sessions.
5.19. Investing in quality immigration advice is an effective homelessness intervention. It can produce
savings for local and national government by enabling people to enter employment and reducing
dependence on local funds. Service data and costings from a Lewisham Law Centre partnership with
Lewisham Council to deliver independent immigration advice identified significant savings to the local
authority as people given specialist advice moved onto public funds following a successful application.
Following investment of approximately £60,000 to contract a solicitor and a paralegal, work done with
68 referrals from the Lewisham NRPF team between May 2019 and February 2020 resulted in
potential savings to the council of £32,060.19 per month or £384,722.28 per year.
99
5.20. There is also some evidence of savings for other public services. An evaluation of Southwark Law
Centre’s Homeless Patients Legal Advocacy Service with Guy’s and St Thomas’ Homeless Team
suggests a significant reduction in inpatient admissions and bed days in a small sample of patients,
comparing six months prior to support through the project and six months after.
100
5.21. In order to improve access to immigration advice for non-UK nationals experiencing, or at risk
of, homelessness, we ask Government to:
• Ensure that homelessness funding provides for the long-term provision of quality independent
immigration advice targeted at non-UK nationals without established status, or whose status is to be
determined. This should aim to specifically address needs for increased capacity to handle EUSS
applications and long-term and complex immigration casework.
• Reinstate legal aid for immigration matters.
6. Preventing and ending homelessness
6.1. The importance of supporting those experiencing rough sleeping to move from the streets into
appropriate, supported accommodation is paramount, but so too is the need to address the structural
barriers that push people towards homelessness and rough sleeping in the first place. A lack of
appropriate, affordable housing is one of the biggest causes of homelessness, and one that can trap
people in homelessness preventing move-on from temporary accommodation.
Social housing
6.2. A warm, safe and stable home is the platform from which people can thrive and fulfil their potential.
And those living in such an environment are far less likely to experience the physical and mental health
issues that are so strongly correlated with having no permanent home. That’s why Government’s
commitment to make the highest single funding commitment to affordable housing in a decade is
welcome. The planned provision of affordable home ownership is also a positive for those who can and
want to step on to the property ladder. But for many, this will not be a viable option. For many of those
in high affordability pressure areas, ‘affordable’ housing is simply unattainable.
6.3. As of March 2021 there were 95,450 households in temporary accommodation, a 98% increase since
March 2011 and many of whom are unable to move on to a permanent home due to lack of affordable
98
Wilding J et al. (2021) A Huge Gulf: Demand and Supply for Immigration Legal Advice in London. London: Justice Together.
99
The calculation is based on council estimates of the average cost of an NRPF household at £21,000 per year.
100
GSTT and SLC (2021) Homeless Patients Legal Advocacy Service Year One Evaluation Report. London: Southwark Law Centre
Homeless Link
25
housing.
101
Councils spent almost £1.2 billion providing temporary accommodation for homeless
households between April 2019 and March 2020. This has increased by 9% in the last year and 55% in
the last five years.
102
 With numbers in temporary accommodation continuing to grow without the
investment in affordable housing this cost will only continue to grow.
6.4. Over the long-term the most cost-effective means by which to provide sufficient affordable housing to
meet the scale of demand across the homelessness population is through the provision of the
necessary level of social homes. Research undertaken by Heriot-Watt University on behalf of Crisis
and the National Housing Federation that in order to meet the backlog of need that 90,000 social
homes would need to be built a year over a 15-year period to match the level of need.
103
6.5. The Housing, Communities and Local Government Committee were of the view that, “a social
housebuilding programme should be top of the Government’s agenda to rebuild the country from the
impact of COVID-19.”
104
Last year the Housing, Communities and Local Government (HCLG)
Select Committee agreed that 90,000 new social homes a year are needed in England.
105
Across all of
England (including London) the average grant required per social rent home £183,000.
106
This means
achieving the 90,000 goal would require an investment of c. £16.5 billion.
6.6. In order to deliver this, we ask Government to:
• Commit to a ten-year investment plan to realise the 90,000 social rent homes that England needs.
• In the immediate term, Crisis, alongside the APPG for Ending Homelessness, calls for Government to
bring forward its £12 billion Affordable Homes Programme, providing an increased focus on social rent
housing.
• Through investment in one-bed homes for social rent, ensure the programme is accompanied by a
supply of truly affordable housing to meet the scale of need for Housing First. (see 3.25)
Private rented sector
6.7. In 2019/20, ahead of the interventions put in place during the pandemic to pause and limit evictions,
57,750 households were owed either a prevention or relief duty due to the end of an Assured Shorthold
Tenancy (AST) in the Private Rented Sector (PRS). Amongst those owed a prevention duty it was the
leading cause of risk of homelessness.
107
In 2020/21 following the introduction of the evictions pause
in March 2020, the numbers of those presenting at their local authority at risk of homelessness due to
the end of an AST plummeted, dropping by 43% compared to 2019/20. The numbers of households
owed a prevention duty were the lowest since the introduction of the Homelessness Reduction Act
2017 (HRA17).
108
6.8. The instability of the PRS and the impact of current ASTs have on risk of homelessness cannot be
overstated and we welcome the Government commitment to rental reform as announced in the May
2021 Queen’s Speech. However improved and more secure tenancy rights will not address the issues
of affordability across the PRS. In 2019/20 rent arrears was the cause for 24% of those at risk of
101
https://www.gov.uk/government/statistics/statutory-homelessness-in-england-january-to-march-2021
102
https://www.gov.uk/government/statistics/local-authority-revenue-expenditure-and-financing-england-2019-to-2020-individual-local-authority-data-
outturn
103
Bramley, G. (2018) Housing supply requirements across Great Britain: for low-income households and homeless people. London: Crisis and National
Housing Federation
104
Local Government Committee (July 2020) Building more social Housing: Third Report of Session 2019–21
105
Bramley G (2018) Housing supply requirements across Great Britain: for low-income households and homeless people Crisis and NHF
106
NHF (2019) Capital grant required to meet social housing need in England 2021 – 2031. PUB
107
MHCLG (2020) Statutory homelessness in England: financial year 2019-20
108
https://www.gov.uk/government/statistical-data-sets/live-tables-on-homelessness
Homeless Link
26
homelessness due to the end of an AST.REF And despite the pause on evictions (designed to prevent
those whose income had fallen due to the pandemic being made homeless due to rent arrears) 5,370
households presented at risk of homelessness between April 2020 and March 2021.
109
Research by
the London School of Economics (LSE) found that an estimated 400,000 households were at risk of
rent arrears as a result of the pandemic.
110
With evictions having resumed in May 2021 there are
concerns across Homeless Link’s membership that the growth of rent arrears will lead to a potential
huge wave of individuals being pushed into homelessness.
6.9. Without sufficient social housing, the PRS is the primary source of housing for those moving on from
homelessness services. To ensure that those both at risk of eviction from the PRS, and those currently
housed in temporary accommodation are able to move to secure and stable homes it is vital that
housing benefit sufficiently covers the cost of an appropriate level of PRS. In March 2020, Government
raised the Local Housing Allowance (LHA) to the 30th percentile ensuring that the lowest 30% of PRS
was affordable to those in receipt of the housing benefit or housing benefit element of Universal Credit.
This move was welcomed by Homeless Link and our members, acknowledging the vital role that the
PRS plays in the homelessness system.
6.10. However, as of April 2021 the LHA rates have been frozen at the 20/21 levels. This means over time
less and less of the PRS will be affordable to those in receipt of benefits. With rising rent arrears and
increasing numbers of people in households in temporary accommodation, a lack of affordability within
the PRS risks both pushing people into homelessness and then trapping them in the insecure
accommodation at high cost to local government.
6.11. In order to deliver this, we ask Government to:
• Unfreeze the Local Housing Allowance rate so that it continues to cover at least the 30th percentile of
local rents
• Commit to providing sufficient DHP funding via LAs in order to write-off more than two months’ rent
arrears that tenants may have accrued between March 2019 and September 2021, as a result of covid-
related job loss.
Welfare
6.12. The debt, insecurity, threat of homelessness and mental distress that come with not having enough
money to live on and pay rent, blights and burdens jobseekers. Emerging from a pandemic into an
insecure economic market only compounds that insecurity and mental distress. Indeed, rates of
reported depression have near doubled since the start of the pandemic.
111
And the debilitating effect of
unemployment isn’t just short-term: the long-term scarring effect of youth unemployment and/or
repeated instances of unemployment is well known.
112
6.13. Government must recognise that subsistence living, debt in general, rent arrears in particular and the
threat of homelessness, severely compromises a person’s ability to seek, find, secure and keep work.
Government can and should exercise its power to mitigate the threat of homelessness, not least
because every person kept off the streets and supported into work equates to a housing authority
saving, a health services saving, an income-tax and NI gain. Preventing homelessness and providing a
secure safety net saves money further down the line.
109
https://www.gov.uk/government/statistical-data-sets/live-tables-on-homelessness
110
Whitehead et al. (2021) Homelessness and rough sleeping in the time of COVID. LSE
111
ONS (2020) Coronavirus and depression in adults, Great Britain June 2020.
112
McQuaid R. (2017) Youth unemployment produces multiple scarring effects. LSE
Homeless Link
27
6.14. The inadequacy of welfare benefit levels and the strictures of the debt-inducing benefit cap have been
acknowledged by Government: once, very clearly, in the form of the pandemic £20/week boost to
Universal Credit (UC) and the increase in the LHA rate, and then again in the form of the continuing
provision of funding for Discretionary Housing Payments (DHP), payments made to households who
simply cannot live on the welfare support they receive.
6.15. As indicated in the table below, in the last year, Government have made available £50 million to shore
up the inadequacies of LHA-limited housing benefit and to effectively compensate for the effect of the
benefit cap.
Use of DHP April 2020 – March 2021
Welfare support for which DHP was
awarded
Amount allocated
Benefit cap
£28,026,173
LHA
£22,713,618
source: DWP (July 2021) Use of Discretionary Housing Payments: financial year 2020 to 2021
6.16. The belief underpinning the introduction of the benefit cap was that it is unfair that those reliant on
welfare support to survive should have a greater income than those who are working, regardless of
circumstance.
113
But in the midst of a pandemic and in its aftermath, what constitutes ‘fair’ must shift.
6.17. During the pandemic, millions of people have lost their jobs and have had to claim UC to
survive. Indeed, five million households were claiming UC by May 2021.
114
Those claimants will
have benefited from Government’s £20 a week increase to UC. But by October, this essential lifeline
will have been cut. Our members have told us that those who have gained from the UC uplift, used the
extra money to buy more fresh food and meat. As well as enhancing their diets, the people that our
members work with have also used the extra money to pay off fuel bill arrears or contribute towards the
bills of those homes they stay in temporarily.
115
6.18. In order to deliver this, we ask Government to:
• Remove the benefit cap in areas of high affordability pressure areas immediately and commit to
adjusting the benefit cap levels such that they align with the Minimum Income Standard (MIS).
• Maintain the £20 per week uplift to UC, extend it to legacy benefits and link annual benefit uprating to
CPHI. This should be backed up by a commitment to set welfare support rates in the light of regular,
independent surveys of the actual costs of living.
• Raise the Universal Credit standard allowance for all under-25s living independently to match the
amount over-25s receive, while maintaining the COVID-19 uplift. (see 4.29)
• Remove barriers to employment for young people in supported accommodation, by raising the amount
within Housing Benefit or extending work allowances to vulnerable young people through Universal
Credit. (see 4.29)
7. Recognising the role of health
113
DWP (2013) National introduction of benefit cap begins: the benefit cap starts being introduced across the country.
114
Winchester N. (2021) Universal Credit: an end to the uplift. UK Parliament
115
Homeless Link (2021) Homelessness and welfare benefits.
Homeless Link
28
7.1. The last 18 months has demonstrated more than ever the need for integration between health and
homelessness. The extraordinary measures taken by Government throughout the pandemic were
driven both by the public health concerns of the street homeless population, and by the increased
health vulnerabilities of those experiencing homelessness compared to the general public. Alongside
this the homelessness sector has been instrumental in supporting health with the vaccine rollout
amongst the homeless population.
7.2. Homelessness has a devastating impact on mental and physical health. In 2019, 778 people died while
sleeping rough or in emergency accommodation, a 7.2% rise on the previous year.
116
The ONS data
showed that the average age of death for those sleeping rough or in emergency accommodation was
only 45.9 for men. For women it was 43.4 years old.
117
In very many cases, death is as a consequence
of untreated or inadequately treated conditions amenable to healthcare.
118
7.3. Those without a home are substantially more likely than even the most deprived housed people to
report having chronic diseases such as asthma, chronic COPD, heart problems and strokes.
119
Chronic
homelessness is an associated marker for tri-morbidity, complex health needs and premature
death. (Tri-morbidity is the combination of physical ill-health with mental ill-health and drug or alcohol
misuse.)
120
7.4. Compromised health is not just a feature of experiencing homelessness, it can be a cause. Over
130,000 UK households experience problem debt.
121
122
The destructive interplay of high rents, low
incomes and debt can result in the development or exasperation of depression and/or anxiety.
123
Some
experiencing such circumstances will seek solace in drugs and/or alcohol. Additionally, the income
shock that often accompanies the onset of physical health issues or disability
124
can lead to rent or
mortgage arrears and ultimately homelessness.
7.5. Yet whilst the NHS Long Term Plan identifies the role of the NHS in attaining wider social goals of
improved employment, easing health-related pressure of the justice system and influencing the shape
of local communities, there is no explicit reference to the compounding relationship between health and
homelessness. This despite, as the Health Secretary says, the disease of social disparity prevalent in
the UK.
125
Having no housing is perhaps the starkest illustration of the extreme end of that social
disparity.
7.6. Historically the homelessness sector has struggled to engage with health in a sustained and
meaningful way. However, throughout the pandemic one of the biggest successes observed was the
increased partnership working and growing understanding of the need for collaboration between health
and homelessness services. This momentum must not be lost. Building on this to ensure the continued
development and growth of these partnerships is vital to the Government’s goal of preventing and
ending rough sleeping.
Primary care access
116
ONS (2020) Deaths of homeless people in England and Wales.
117
Ibid
118
Aldridge R W et al. (2019) Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality
data in England Wellcome
119
Lewer D et al. (2019) Health-related quality of life and prevalence of six chronic diseases in homeless and housed people: a cross-sectional study in
London and Birmingham, England
120
O’Connell JJ et al. (2010) The Boston Healthcare for the Homeless Program: A public health framework. Am J Public Health
121
https://www.jrf.org.uk/data/household-problem-debt
122
Households below average income: for financial years ending 1995 to 2020
123
Fitch C et al. (2011) The relationship between personal debt and mental health: a systematic review Mental Health Review Journal
124
Garcia-Gomez P. (2013) Long Term and Spillover Effects of Health Shocks on Employment and Income Journal of Human Resources
125
Secretary of State for Health and Social Care Sajid Javid (2021) The hidden costs of COVID-19: the social backlog speech given at The Grange
Community Centre in Blackpool
Homeless Link
29
7.7. One of the longest standing and critical disconnects between those experiencing homelessness and
the healthcare they need is lack of GP access. People sleeping on the streets or in precarious housing
situations will, in far too many instances, not have been able to register with a GP.
126
127
Often, when in
healthcare need, but without a GP, people who have nowhere safe and stable to stay will try and
address their healthcare needs themselves and only access professional healthcare at crisis point via
A & E.
128
7.8. The vast majority (92%) of hospital episodes where the patient is recorded as having no fixed
addressed (NFA), are recorded as emergency admissions.
129
The proportion of NFA emergency
readmissions was 92%.
130
The average length of stay for admitted patients experiencing homelessness
was 14-days. The average for those not experiencing homelessness is 6 days.
131
This is hugely
wasteful, both in terms of cost to the NHS, but also in terms of the harm to the health that those who
are precariously housed, or not housed at all, experience before accessing A & E.
Homeless Link member Pathway, delivers homeless healthcare provision that features in-hospital
GPs, dedicated nurses and care navigators, working with others to address the housing, financial
and social issues of patients. Following the introduction of this model in a number of locations
across England, A&E attendances by supported individuals fell by over a third (38%) with an almost
four fifths (78%) reduction in bed days. It’s estimated that the intervention costs £154,228 pa (plus
training costs of £11,120).
132
Data indicate that, for patients receiving this intervention, the
proportion of people who return to the streets is reduced and quality of life scores (EQ-5D-5L) are
significantly improved.
133
The increased quality of life cost per QALY is £26,000.134 (The NICE cost
effectiveness threshold is £20,000 to £30,000 per QALY.)
135
Mental health
7.9. The compounding relationship between being precariously housed, or not housed at all, and mental
health issues is well documented.
136
137
Mental health issues are the most commonly reported support
need experienced by people accessing accommodation providers (42%) as well as day centres (50%),
reflecting earlier studies showing that mental health problems are particularly prevalent among people
experiencing homelessness.
138
7.10. A study of people experiencing homelessness in Nottingham showed that pre-existing but managed
mental health issues were further exacerbated by life events like homelessness.
139
The debilitating
effect of chronic mental health issues not only compromises the lives of those who experience them.
To not effectively address these issues also impacts negatively on health and local authority budgets.
126
Doctors of the World. (2017) Registration Refused: A study on access to GP registration in England Update
127
Elwell-Sutton T. (2017) Factors associated with access to care and healthcare utilization in the homeless population of England. Journal of Public
Health
128
Garrett J et al. (2020) Reducing Health Inequalities for People Living with Frailty A resource for commissioners, service providers and health, care
and support staff Friends, Families and Travellers
129
McCormick B & White J. (2016) Hospital care and costs for homeless people Clinical Medicine
130
Ibid
131
Field H et al. (2019) Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service
evaluation BMC Health Services Research
132
Hewitt N et al. (2016) Randomised controlled trial of GP-led in-hospital management of homeless people (‘Pathway’) Clinical Medicine
133
Ibid
134
Ibid
135
National Institute for Health and Clinical Excellence (2013) Updated guide to the methods of technology appraisal
136
Singh A et al. (2019) Housing Disadvantage and Poor Mental Health: A Systematic Review. American Journal of Preventive Medicine
137
Pevalin D J et al. (2017) The impact of persistent poor housing conditions on mental health: A longitudinal population-based study Preventive
Medicine
138
Homeless Link. (2019) Support for People Experiencing Single Homelessness in England.
139
Reeve K et al. (2018) The mental health needs of Nottingham’s homeless population: an exploratory research study. Sheffield Hallam University
Homeless Link
30
However, specialist provision means those experiencing homelessness can access the support they
need to manage and improve their mental health. Specialist homelessness mental health provision
delivers a c.20% saving on the costs where a person has no planned treatment
.
140
141
142
And,
standard case management - assessment, treatment planning, signposting and referring, advocacy
and monitoring - in collaboration with relevant services, improves housing outcomes, thereby providing
savings to local authority budgets.
143
144
7.11. In their service review, Pathway identified key elements to effective mental health provision for people
experiencing homelessness:
• psychologically informed provision to facilitate informed interventions, led by the experiences of the
service user
• mental and physical health nursing capabilities
• occupational therapists to identify and develop practical skills that support and enable structured
living
• housing and social care advice
• drug and alcohol support
• talking therapies
• access to primary care
145
7.12. Specialist homelessness mental health provision delivers a c.20% saving on the costs where a person
has no planned treatment
.
146
147
148
7.13. In order to deliver this, we ask Government to:
• Invest in the delivery and rollout of a national trauma training programme in England mandated for local
authorities and providers of commissioned services (see 4.6)
• Following the Pathway model, invest £154,228 per year to A&E departments in the areas with the
highest levels of homelessness to provide GP-led in-hospital primary care provision to divert patients
from emergency care to primary care.
• Invest in a pilot programme providing £16,250 per person per year in specialist homeless mental health
services for each verified rough sleeper in the areas with the highest levels of homelessness.
140
Pathway. (2018) Homeless and Inclusion Health standards for commissioners and service providers
141
Maguire N et al. (2020) Service Model Review of UK Mental Health and Rough Sleeping Services. Pathway
142
Ibid
143
Canavan R et al. (2012) Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities
BMC Health Services Research
144
Burn T & Hwang S W. (2014) Health interventions for people who are homeless. The Lancet
145
Maguire N et al. (2020) Service Model Review of UK Mental Health and Rough Sleeping Services. Pathway
146
Pathway. (2018) Homeless and Inclusion Health standards for commissioners and service providers
147
Maguire N et al. (2020) Service Model Review of UK Mental Health and Rough Sleeping Services. Pathway
148
Ibid
Homeless Link
31
Appendix 1
In July 2021 Homeless Link conducted a poll of 137 members in relation to short-term funding. The below are
the findings of this poll.
Questions on financial resilience and long term funding:
Our organisation is coming out of the pandemic financially resilient (N=136)
Strongly agree
36
26%
Agree
60
44%
Neither agree or disagree
20
15%
Disagree
17
13%
Strongly disagree
3
2%
All agree
96
71%
All disagree
20
15%
I am concerned about my organisations income over the next 12 months (N=137)
Strongly agree
13
9%
Agree
34
25%
Neither agree or disagree
25
18%
Disagree
46
34%
Strongly disagree
19
14%
All agree
47
34%
All disagree
65
47%
I am concerned about my organisations income over the next 2 years (N=137)
Strongly agree
14
10%
Agree
57
42%
Neither agree or disagree
27
20%
Disagree
29
21%
Strongly disagree
10
7%
All agree
71
52%
All disagree
39
28%
I am concerned about my organisations income over the next 5 years (N=136)
Strongly agree
24
18%
Agree
58
43%
Neither agree or disagree
21
15%
Disagree
27
20%
Homeless Link
32
Strongly disagree
6
4%
All agree
82
60%
All disagree
33
24%
Impact of short term funding
Proportion of staff on fixed term contracts of 12 months or less:
• 7% of respondents have 50% or more staff on fixed term contracts of 12 months or less
• 19% of respondents have 25% or more staff on fixed term contracts of 12 months or less
• 54% of respondents have some staff on fixed term contracts of 12 months or less
Short-term funding has a negative impact on staff wellbeing (N=128)
Strongly agree
55
43%
Agree
49
38%
Neither agree or disagree
14
11%
Disagree
9
7%
Strongly disagree
6
1%
All agree
97
81%
All disagree
9
8%
Short-term funding has a negative impact on the quality of the services we are able to provide (N-126)
Strongly agree
58
46%
Agree
36
29%
Neither agree or disagree
18
14%
Disagree
11
9%
Strongly disagree
3
2%
All agree
94
75%
All disagree
14
11%
Short-term funding impacts on long-term staff retention (N=128)
Strongly agree
63
49%
Agree
33
26%
Neither agree or disagree
21
16%
Disagree
10
8%
Strongly disagree
1
1%
All agree
96
75%
All disagree
11
9%
Short-term funding leads to inconsistent support for people experiencing homelessness
Strongly agree
61
48%
Homeless Link
33
Agree
45
35%
Neither agree or disagree
10
8%
Disagree
10
8%
Strongly disagree
1
1%
All agree
106
83%
All disagree
11
9%
Homeless Link
34
What we do
Homeless Link is the national membership
charity for frontline homelessness services.
We work to improve services through
research, guidance and learning, and
campaign for policy change that will ensure
everyone has a place to call home and the
support they need to keep it.
Let’s end
homelessness
together
Homeless Link
Minories House, 2-5 Minories
London EC3N 1BJ
020 7840 4430
www.homeless.org.uk
Twitter: @Homelesslink
Facebook: www.facebook.com/homelesslink
© Homeless Link 2020. All rights reserved.
Homeless Link is a charity no. 1089173 and
a company no. 04313826.