Research and analysis

​Rough sleeping and complex needs process evaluation: Rough Sleeping Grant case studies

Published 11 December 2025

Applies to England

Key findings

The Rough Sleeping and Complex Needs Process Evaluation was funded by MHCLG and carried out by the Centre for Regional Economic and Social Research (CRESR) at Sheffield Hallam University.  The evaluation examined how two funding initiatives – Rough Sleeping Grant (RSG) and Rough Sleeping Social Impact Bond (SIB) – provided support for people who had slept rough and had complex needs^{[footnote 1]} (co-occurring mental health and substance misuse needs).

The aim of the process evaluation was to provide evidence on different approaches taken to working with people who are sleeping rough who have co-occurring mental health and substance misuse needs, and to identify the lessons learned in designing, setting up and delivering these across the RSG and Rough Sleeping SIB funding programmes.

This report presents findings and learning from six case studies carried out to understand the range of ways in which the RSG programme had supported those who had multiple support needs and vulnerabilities and lived experiences of rough sleeping.  In each case study, face-to-face interviews were carried out with key stakeholders including:

• Local authority commissioners
• Team managers
• Frontline workers
• Staff from partner organisations, and
• People with lived experience of rough sleeping with co-occurring needs; and receiving support via an RSG-funded project.

The programme has developed some important lessons and practices for relieving rough sleeping and responding effectively to those with complex needs.  The following sections summarise the key learning that has emerged.  Detailed evidence and analysis are provided in Chapter 3.

Models of support: outreach services

Three RSG case study projects provided forms of outreach services.  Support for people who were sleeping rough in the case study areas came from a broad range of agencies and there was a need for this to be coordinated, and for outreach services to be integrated within this system.  Hubs were considered to be a good model for effective coordination of support and service provision.  Also, intensive outreach was vital to ensure that service users were better able to access key support including housing, health and drug and alcohol services.  Person centred approaches to outreach services provided continuity and ongoing support to sustain improvements to an individual’s housing, health and wellbeing.  However, in the case study areas there were concerns around the future viability of services beyond the RSG funding period.

Interviewees reported that other key agencies and services were not always responsive to the needs of people who are sleeping rough. Outreach teams, therefore, needed to be able to balance partnership working with other agencies alongside holding those agencies to account and advocating for their service users when necessary.  Indeed, outreach was reported to work most effectively where it did not replace other specialist services but provided extra support and navigation towards appropriate help for individuals.  However, evidence suggested that some over-stretched services tended to pull back their support for an individual once an outreach worker became involved.

Specialist services, such as teams aimed at responding directly to co-occurring mental health and substance misuse needs, have an important role in expanding provision to support people with complex needs.  Mental health and substance misuse services were reported to be more effective where they were specifically tailored to mitigate the difficulties that people who are sleeping rough can encounter under their ‘regular’ service offer – for example, providing services on the street, rather than relying on appointments at clinics.

Access to housing provision for service users is a key challenge for outreach teams.  Case study projects were more effective where there were distinctive pathways into housing for people who are sleeping rough. This required multi-organisational agreements and changes to allocation systems that provided people who are sleeping rough with timely access to suitable housing.

Models of support: housing first

Three RSG case study projects provided forms of support akin to housing first^{[footnote 2]}.  These projects could be a catalyst for change in the way that housing allocation systems operated by giving priority need to individuals who sleep rough and supporting them to gain stable accommodation. 

The ability to have choice of location was particularly important for service users, especially for those looking to move away from traumatic and dangerous past experiences.  Giving service users a genuine choice required the ready availability of different types of suitable housing across a relevant geographical area. This was a challenge in all the case study areas but those that had been best able to address it had timely access to both social and private rented sector housing. 

The housing first style schemes in this evaluation were established with the intention of creating a relatively small number of accommodation places.  As such, they were not intended as a substitute for other initiatives to relieve rough sleeping, including prevention work.

Long-term support was required to sustain tenancies.  Models where a key worker or coordinator engaged with service users were reported to work well, if access and availability from more specialist service providers was also available.  There were, however, concerns around long-term viability and sustainability beyond the RSG funding period.  Stakeholders reported concerns that the long-term support for tenants was a fundamental aspect of this housing first style model, and a lack of ‘follow-on’ funding would undermine this.

Workforce development

Stakeholders reported that working with people with complex needs who are sleeping rough requires a range of specialist skills.  Projects were best able to meet the needs of this group where staff could be empathetic and patient with their service users and could maintain a positive relationship without sanctioning.  This was summarised as ‘stickability’ – the idea of never giving up on a service user.

It was not always easy for the projects to recruit staff with the requisite skills, and there was evidence of high levels of staff turnover in the case study projects. Issues highlighted included short-term contracts associated with time-limited funding, and the challenges to staff wellbeing and satisfaction associated with long-term and intensive engagement with people with particularly complex needs.

Projects had identified scope for recruiting staff with ‘lived experience’ of homelessness, but this required investment in training and development and well-resourced supervision and management structures. In addition, it was noted in one case study area that employees who had lived experience had found it particularly difficult to sustain long-term engagement with people with complex needs and had sought to move to other roles in the homelessness sector.

Stakeholders in the case study projects identified a dearth of relevant training and development opportunities geared specifically towards working with people who are sleeping rough and have complex needs.

Multi-agency working

Based on the complex and multiple needs of service users, working with multiple agencies and services in a coordinated way was a key goal for the projects.  Multi-agency and partnership working in the six RSG case study sites was working well and seen to have a positive impact on service user experiences and outcomes.

Good quality relationships, based on trust, were reported by stakeholders to be vital and were supported by relevant skills, shared ethos and approach and commitments to sharing data and information. In case study areas where there had been frequent changes in personnel, this had impacted on relationships between service providers. Maintaining consistency in approach was reported by stakeholders to be an important strategy in sustaining the engagement of service users even when there was staff turnover.

Multi-agency working was reported to have improved referral and treatment pathways but in some case study areas there were challenges associated with service overlaps where multiple organisations were delivering similar forms of support.

The findings to emerge from the RSG case studies highlight a number of factors which appear to have made multi-agency working effective:

• strong governance arrangements
• data sharing which supports improved service user journeys
• a willingness to challenge organisational silos
• having staff with the skills to deliver high quality support and develop relationships based on trust with service users and other service providers.

Engaging with service users

All the RSG projects reported on the need to effectively engage with their service users and recognised that doing so successfully required a range of skills.  Skills and strategies reported to support effective engagement included the following aspects:

• Being knowledgeable and having good interpersonal skills, using methods of communication that are tailored to the individual.
• Being able to challenge a service user effectively (without the service user taking offence and without withdrawing support).  This involved being assertive, honest and persistent, rather than punitive.  At the same time, staff emphasised the need to be sensitive particularly around identifying needs and planning support.
• Being able to challenge agencies on a service user’s behalf.  This was described as a delicate balancing act of maintaining good relationships with partners but also holding them accountable. Workers also needed to be conscious that people’s previous experiences of contact with services and agencies may not have been positive.
• Positioning themselves as workers, and a service, that offered something new and different, helping to break down any negative perceptions fostered by service users’ previous experiences of services.

There was ample evidence from interviews with service users that they responded positively to these approaches, with many of those interviewed comparing favourably their experiences of positive engagement with the RSG projects to those of previous experiences of involvement with services. 

Funding and sustainability

The RSG was viewed by stakeholders as time-limited funding for activities that, by their nature, required long-term resourcing. For housing first style case studies, the RSG was too short a period to adequately embed the principles locally.  It also risked leaving new tenants without the intensive and ongoing support required to sustain their tenancies and recovery journeys.  Similarly, for outreach services, key stakeholders were grateful for the opportunity to learn how to relieve rough sleeping for those with complex needs, but in general, longer-term funding mechanisms were not available and stakeholders reported that funding sources to continue initiatives were very limited.  They reflected that local authorities often now rely on grant funding for homelessness initiatives, and that available local authority budgets are mostly restricted to crisis services, with little opportunity to directly fund preventative initiatives.

In only one of the RSG case study areas, the service funded through the RSG had been mainstreamed into the core housing support offer of the local authority.  This had required commitment from both the commissioners and the housing officers to prioritise funding for the service.  In the remaining case study areas, there were a range of approaches to sustainability which included funding of reduced or partial services, or the incorporation of aspects of services into other existing or proposed initiatives.

1. Introduction

1.1 Background

In December 2016 the government committed £51 million to homelessness prevention schemes across England. This included targeted support for people sleeping rough and those at risk of rough sleeping across several funding streams.  This evaluation was concerned with two of these streams:

• £20 million for Rough Sleeping Grants (RSGs) to provide targeted support for people at imminent risk of sleeping rough or those who are new to the streets.
• £11 million to support locally commissioned Social Impact Bonds (SIBs) to help those sleeping rough, and with the most complex needs.

In addition, £20 million was released for Homelessness Prevention Trailblazers to pilot new initiatives to tackle homelessness in local authority areas.

1.2 The rough sleeping and complex needs process evaluation

The Rough Sleeping and Complex Needs Process Evaluation was funded by MHCLG and carried out by the Centre for Regional Economic and Social Research (CRESR) at Sheffield Hallam University.  The evaluation examined how two funding initiatives – Rough Sleeping Grant (RSG) and Rough Sleeping Social Impact Bond (SIB) – provided support for people who had slept rough and had complex needs^{[footnote 3]} (co-occurring mental health and substance misuse needs). The evaluation focuses only on projects supporting this particular cohort (referred to as ‘projects in scope’), rather than on all projects funded by the RSG and Rough Sleeping SIB.

The aim of the process evaluation was to provide evidence on different approaches taken to working with people who are sleeping rough who have co-occurring mental health and substance misuse needs, and to identify the lessons learned in designing, setting up and delivering these across the RSG and Rough Sleeping SIB funding programmes.

This includes specific objectives:

• To understand what the different projects working with this service user group are delivering, considering the needs of the service users, any multi-agency partnerships and any constraints in the local context.
• To understand the influence of the funding mechanism on design, set up and delivery.
• To identify the process factors that stakeholders identify as working well across the design, set up and delivery of the interventions, where the challenges lie, and how these have been or may be addressed.
• Where services are near to the end of their funding period, explore any plans for sustaining the intervention in original or redesigned form and the reasons behind this.

These objectives were met through research focused on 12 projects.  Six were Rough Sleeping SIBs, and six were initiatives funded by the Rough Sleeping Grant.  Table 1.1 provides an overview of the 12 case studies.

Table 1.1: Case Studies

Area	Project	Fund	Funding Total (£)	Launch Date
A	Rough sleeping outreach	RSG	263,700	April 2017
B	Rough sleeping outreach	RSG	390,736	July 2017
C	Rough sleeping outreach	RSG	166,209	September 2017
D	Housing first style initiative	RSG	393,000	September 2017
E	Housing first style initiative	RSG	211,629	January 2018
F	Housing first style initiative	RSG	376,652	March 2017
G	Rough Sleeping SIB	SIB	1,000,000	January 2018
H	Rough Sleeping SIB	SIB	1,251,000	November 2017
I	Rough Sleeping SIB	SIB	1,261,980	November 2017
J	Rough Sleeping SIB	SIB	3,000,000[footnote 4]	November 2017
K	Rough Sleeping SIB	SIB	1,449,020	September 2017
L	Rough Sleeping SIB	SIB	1,540,000	January 2018

Qualitative and quantitative data collection was carried out.  Interviews were undertaken with a range of stakeholders, including local authority commissioners, delivery teams, partner services and service users who had used the projects in scope and had experienced rough sleeping and complex needs.  A questionnaire survey of service users was analysed, project outcome logs were analysed, and an assessment of the costs and resourcing of the projects was made.

The evaluation has produced the following reports:

• Report 1: Key Findings from the Evaluation
• Report 2: Understanding Service User Experiences and Progress
• Report 3: Learning from Six Rough Sleeping Grant Case Studies (this report)
• Report 4: Learning from Six Rough Sleeping Social Impact Bond Case Studies

Also, three short briefing notes, aimed at practitioners and commissioners, are available on the following subjects: Workforce Development, Access to Services, and Meeting Accommodation Needs.

1.3 The Rough Sleeping Grant

This report presents learning from case studies of six projects funded under the Rough Sleeping Grant (RSG) programme.

The Rough Sleeping Grant funded 48 projects across London and in 97 local authorities in the rest of England.  Applicants to the programme were asked to demonstrate how they would:

1. reduce the flow of new incidences of rough sleeping, through more targeted prevention activity,
2. ensure that people have a safe place to stay while services work with them to resolve their homelessness crisis, and
3. help those who are new to rough sleeping to get off the street and into independence, through more rapid crisis interventions and support to access and sustain move-on accommodation.^{[footnote 5]}

This phase of the Rough Sleeping Grant programme ran from 2017 to 2019.

1.4 This report

This report explores, from the perspectives of those commissioning, delivering and using the services, the models of support delivered in the case study areas, the factors that have enabled or hindered successful implementation, the impact of the funding model, and the degree to which interventions are likely to be sustained beyond the RSG funding period.  

It draws on data collected through fieldwork in six RSG case study areas carried out in January and February 2019 and involving semi-structured interviews with key project stakeholders (managers, frontline delivery staff, local authority housing/homelessness leads, commissioners, and partner organisations) and interviews with service users.

2. The Rough Sleeping Grant case study projects

This chapter summarises the key features of Rough Sleeping Grant (RSG) case study projects, which are presented in Table 2.1.

Table 2.1: RSG Case Studies

	Project	Funding Total (£)	Launch Date
Area A	Rough sleeper outreach	263,700	Apr 2017
Area B	Clinical-led outreach	390,736	Jul 2017
Area C	Early intervention outreach	166,209	Sep 2017
Area D	Housing first style initiative	393,000	Sep 2017
Area E	Housing first style initiative	211,629	Jan 2018
Area F	Housing first style initiative	376,652	March 2017

2.1 Outreach projects

Three of the RSG case studies (Areas A, B and C) delivered outreach-based projects. 

Area A

The model: MEAM^{[footnote 6]} Rough Sleeper ASSERTIVE OUTREACH SERVICE

The project worked across Area A which includes a town and smaller villages. It supported a small outreach team offering rapid engagement and support to people who were sleeping rough. The team comprised a manager, outreach workers and a volunteer co-ordinator. The volunteer co-ordinator recruited and supported volunteers so that there was more regular engagement with service users and stronger connections with the community.

Referrals come from a range of organisations, and the project is represented on a range of local groups and forums involving agencies supporting people with complex needs. This service is one part of several initiatives funded through the RSG. 

Advantages

• Service collaboration: there were close links through local partnerships and the proximity of services such as drop-in services, health services and a night shelter resulted in a close working partnership amongst agencies which worked favourably for those accessing services. 
• Long-term support: supporting service users through their ‘journey’ was central to implementation. In particular, the project provided a model of support which continued even when service users were in accommodation, which helped to sustain placements by identifying any potential issues and addressing them early.

Challenges

• Universal Credit claims caused delays.  The length of time required to get identification and bank accounts established in order to access Universal Credit was problematic. A focus of the project was on trying to develop service level agreements with banks to make the process quicker.
• Access to private rented accommodation was also difficult for this project, primarily due to a limited supply of appropriate accommodation in the locality.

Learning

• A different approach to commissioning and monitoring was needed – to move away from the traditional key performance indicator commissioning model that was not person-centred.
• Recruiting staff who could be empathetic and understanding of the challenges facing service users was a key component for successful outcomes.
• The project, and other initiatives in the area, were supported and championed by local authority members.  This was reported to be beneficial to getting the initiative off the ground and gaining the support of other partner organisations.

Area B

The Model: DUAL DIAGNOSIS STREET TEAM

The project provided a Dual Diagnosis Street Team (DDST) focused on working with people who had been sleeping on the streets long-term and had co-occurring mental health and substance misuse needs. The project aimed to:

Bring clinical expertise to the streets and offer treatment options that service users could access.

Tackle co-occurring needs through a multi-disciplinary team to address the key substance misuse and mental health problems experienced by the street homeless population.

Achieve closer working relationships with health services around voluntary admissions to hospital.

Work closely with the street outreach team in identifying those sleeping rough who need assistance to engage.

Support service user assessment at the assessment centre and support the decision-making process on the person’s readiness for resettlement.

Offer identified service users a personalised support and treatment plan for as long as they need it through their housing pathway.

Develop a holistic approach to support, clinical and criminal justice interventions by working closely with enforcement agencies such as the Police and Public Realm Enforcement Service.

Advantages

Stakeholders were universally positive about the implementation and impact of the DDST, indicating that it had enabled improved access to appropriate treatment for people who were sleeping rough in the area, and that it had facilitated more effective collaboration between service providers. Several factors were identified as being important to the project’s success: 

• The skills of the team: a new team was recruited for the project, bringing together a range of skills and backgrounds from both NHS and voluntary and community sectors. This brought understanding from both sides: health needs and rough sleeping. The ability to work flexibly with providers in a range of roles to provide a person-centred service was seen as vital to the project’s success. Interviewees highlighted the importance of the skills of the team in working across sector boundaries, which provided additional knowledge and capacity to homelessness services.
• Good governance: it was also important that, although the success of the project was dependent on the delivery of flexible and person-centred services, this was done in the context of clear guidelines and protocols. Robust governance, characterised by good clinical decision-making processes and strong adherence to data protection and safeguarding protocols, was central to the project’s success.
• Successful collaboration: the service had developed a very successful approach to service collaboration and was linked into multiple forums at city and county levels. This could be time-consuming and wider forum meetings were not always well focused, but widespread engagement was felt to be good for building relationships and co-ordinated approaches. Where inter-agency meetings were convened by the DDST, care was taken to ensure that these were small and purposeful.  The proactive response of the team was vital to successful collaboration and had enabled them to work across service silos: ‘We are good people to do business with.  If someone rings up be it from the police or wherever they will get a positive response, we will never say it’s not our remit. We’ve got good relationships and interfaces with all the services. We can talk their language’.  One very tangible outcome of improved service collaboration was that it had facilitated improved and faster referral processes.
• Data sharing:  the project had modified an existing customer relationship management (CRM) tool for use by the DDST, ensuring that information could be shared between the local authority, NHS and the third sector and enabling providers to see a service user’s total journey.
• Integrating NHS providers into outreach services: the involvement of clinicians (including a practice nurse) in outreach work enabled health issues to be addressed quickly without the need for service users to access a clinical environment. At the time of writing the project was working on developing protocols for the use of Naloxone in street contexts. 

Challenges

• Whilst the project had developed very strong processes to support inter-agency working there were occasionally service collaboration issues and some services were providing similar support to the same people.
• The skills of the team were key to the DDST’s success; however, recruitment had been challenging. The project had not managed to attract sufficient interest from applicants with experience in mental health or drug treatment services and the mix of skills in the team had needed to be modified following the recruitment process.
• The project was not sustainable in its original form as there was insufficient funding available to support the continued funding of the full DDST (four staff members). There was a particular issue with shared resourcing.  The NHS Trust was unwilling to commit ongoing resources to a non-clinical project and the local authority was unable to fund the ongoing staff costs for NHS employees.

Learning

• The project demonstrated the value of integrating co-occurring needs and homelessness support into services for people with complex needs. This ensured that people with both drug and alcohol misuse and mental health problems received holistic, person-centred care which better met their needs and improved their ability to sustain accommodation placements.
• The integration of clinical specialists into outreach teams provided ‘on-street’ health care to address health problems that would otherwise have required service users to enter a clinical setting, either voluntarily or through being sectioned. This improved referral and treatment pathways.
• The mix of skills in the DDST – including practitioners with NHS and voluntary sector backgrounds – was important in breaking down service barriers and improving inter-agency collaboration.

Attention needs to be given to on-going funding of holistic services which are addressing both clinical and non-clinical outcomes and in particular to the different pay frameworks for clinical and non-clinical staff.

Area C

The Model: EARLY INTERVENTION OUTREACH SERVICE

The remit of the Early Intervention Outreach Service was to prevent people being evicted from their properties on grounds of anti-social behaviour and, in turn, reduce the numbers of people who might subsequently end up rough sleeping.  The target population was single adults or childless couples over the age of 18 years old, who had support needs, were not engaged with services (e.g. around their drug and/or alcohol use) and who were at risk of losing their accommodation due to anti-social behaviour.  Referrals came from a range of organisations and self-referrals and were assessed internally by the project team, which consisted of a service manager and two case workers.  The service combined floating support and tenancy sustainment with a more traditional support worker role. 

Advantages

• Service collaboration and co-ordination: the project quickly became a highly valued and well-regarded service which developed good working relationships with partner agencies.  Many of the service users it supported had previously ‘fallen through the gaps’ between service thresholds and not had their needs met.  Others had been known to services through the ‘revolving door’ of provision but failed to engage effectively in the past. 
• Workforce skills: non-time-limited support and flexible support (facilitated by small caseloads) were highlighted as important in supporting people with complex needs. However, the attitudes, commitment, knowledge and skills of the staff team were identified by interviewees as being pivotal to the successful implementation of the project.  These included empathy and resilience and wide-ranging practical knowledge of services.

Challenges

The service did not engage successfully with a key social landlord, despite earlier commitments from the landlord to supporting the SIB.  The landlord had a large stock of properties but made a very small number of properties available (the total number of referrals was lower than the number of eviction proceedings instigated by the same landlord). 

There was a perception amongst stakeholders interviewed for the evaluation that referrals were coming too late i.e. when it was difficult to prevent eviction. 

Social services proved difficult to engage with.  This was felt to be primarily associated with reorganisation, internal politics and limited resources within the local authority directorate. 

Learning

Pre-existing relationships between staff and some service users assisted with engagement. 

Co-working with the anti-social behaviour team was enabled in part by a shared ethos around prioritisation of prevention/support and only utilising legal action as a last resort. 

The service manager regularly attended multi-agency fora working to raise the service’s profile and build relations.

Regular formal and informal support, assisted by the co-location of the service manager, was beneficial for caseworkers given that the work could be emotionally draining. 

The service was defined by a tolerant approach which accommodated the lifestyle and needs of its service users.  

Staff had the skills to work in partnership with agencies but were also able to hold those agencies to account and advocate on behalf of service users when necessary. 

Staff reflected that short-term funding was problematic where it provided invaluable support to service users which could not be provided in the longer-term.

2.2 Housing first style projects

As Table 2.1 shows, three of the RSG case studies were housing first style schemes. Of these schemes, two were contracted out for delivery by a provider organisation and one (in Area D) was run in-house by a local authority.

Homeless Link^{[footnote 7]} identifies seven key principles of Housing First approaches in England and suggests that services which adhere closely to these principles are more successful in generating positive outcomes for service users, regardless of the context in which they are operating. These are outlined in Table 2.2.

Table 2.2: Housing First Principles

Principle	This means…
1. People have a right to a home	- Housing First prioritises housing as quickly as possible. - Eligibility for housing is not contingent on any conditions other than willingness to maintain a tenancy. - The housing provided is based on suitability (stability, choice, affordability, quality, community integration) rather than the type of housing. - The individual will not lose their housing if they disengage or no longer require support. - The individual will be given their own tenancy agreement.
2. Flexible support is provided for as long as it is needed	- Providers commit to long-term offers of support which do not have a fixed end date; recovery takes time and varies by individual needs, characteristics and experiences. - The service is designed for flexibility of support with procedures in place for high/low intensity support provision and for cases that are ‘dormant’. - Support is provided for the individual to transition away from Housing First if this is a positive choice for them. - The support links with relevant services across sectors that help to meet the full range of an individual’s needs. - There are clear pathways into, and out of, the Housing First service.
3. Housing and support are separated	- Support is available to help people maintain a tenancy and to address any other needs they identify. - An individual’s housing is not conditional on them engaging with support. - The choices they make about their support do not affect their housing. - The offer of support stays with the person – if the tenancy fails, the individual is supported to acquire and maintain a new home.
4. Individuals have choice and control	They… - Choose the type of housing that they have and its location within reason as defined by the context. (This should be scattered site, self-contained accommodation unless an individual expresses a preference for living in shared housing). - Have the choice, where possible, about where they live. - Have the option not to engage with other services as long as there is regular contact with the Housing First team. - Choose where, when and how support is provided by the Housing First team. - Are supported through person-centred planning and are given the lead to shape the support they receive. Goals are not set by the service provider.
5. An active engagement approach is used	- Staff are responsible for proactively engaging their service users; making the service fit the individual instead of trying to make the individual fit the service. - Caseloads are small allowing staff to be persistent and proactive in their approach, doing ‘whatever it takes’ and not giving up or closing the case when engagement is low. - Support is provided for as long as each service user needs it. - The team continues to engage and support the individual if they lose their home or leave their home temporarily.
6. The service is based on people’s strengths, goals and aspirations	- Services are underpinned by a philosophy that there is always a possibility for positive change and improved health and wellbeing, relationships and community and/or economic integration. - Individuals are supported to identify their strengths and goals. - Individuals are supported to develop the knowledge and skills they need to achieve their goals. - Individuals are supported to develop increased self-esteem, self-worth and confidence, and to integrate into their local community.
7. A harm reduction approach is used	- People are supported holistically. - Staff support individuals who use substances to reduce immediate and ongoing harm to their health. - Staff aim to support individuals who self-harm to undertake practices which minimise the risk of greater harm. - Staff aim to support individuals to undertake practices that reduce harm and promote recovery in other areas of physical and mental health and wellbeing.

Source: Homeless Link

The RSG housing first style case study projects were in Areas D, E and F.

Area D

The Model: HOUSING FIRST style scheme

The local authority in Area D was awarded £393,000 of RSG funding to operate a housing first style scheme. The authority was considering implementing a housing first style model in the borough when RSG funding was made available and was already consulting on best practice. This informed the way the model developed. A housing first style model was complementary to the local authority’s ‘No First Night Out’ project, which aimed at preventing rough sleeping. As one stakeholder explained ‘so it’s housing first and No First Night out cos we’ve merged them together cos we were basically saying these are the same customers, it just depends where you link them up’.

Reflecting this, a housing first style model in Area D was embedded in the approach to tackling homelessness and rough sleeping and seen as a core component of the local authority’s housing solutions offer.  A housing first style approach in Area D was unusual in that it was delivered entirely by the local authority. The local authority provided both housing and support, although it was reported that new service users often continue being supported for some time by pre-existing workers (such as rough sleeping teams).  Service users were given Band 1 priority for social housing and able to bid for properties on the choice-based lettings system. Band 1 priority gives service users an extremely good chance of securing their first choice of property. It is very unlikely that most of the scheme’s service users in this area would have been awarded Band 1 priority through the usual homelessness assessment and allocation system. The local authority has also considered extending the model to include private rented sector accommodation ‘to have that as another part, so we’ll still have the council housing part but try to have as many parts of it as we can’.

At the time of writing service users were being supported by one housing first officer and one apprentice, but further staff recruitment was being planned. There were six ‘active’ service users and several new referrals.  The housing first officer worked flexibly, and sometimes intensively, with service users throughout the process. This included assisting with bidding for accommodation, preparing to move, liaising with the landlord’s maintenance service, and offering advice, assistance and support with anything that helped the service user sustain their tenancy. There was no time limit on this support.

The housing first style service was for single (i.e. without dependent children) homeless people in the areas who are over the age of 21 with complex needs. Referrals were considered by a (pre-existing) multi-agency ‘Complex Needs Panel’. Up to six people per month were referred to the panel (by any partner agency). The panel then considered the best options for meeting their needs, one of which may be the housing first style service.

Advantages

• This housing first style project rehoused homeless people with extremely complex needs, who had a very long history of rough sleeping and/or revolving round the borough’s hostels and for whom previous attempts at support and assistance had not proved effective. Service users particularly appreciated the speed of service and accessibility, and the lack of judgement.  The project’s adherence to the Housing First principles around unconditionality and no time limits to the offer of support were important in continuing to meet the needs of this group.
• The project offered a genuine choice of accommodation to service users, within the constraints of availability. Homeless people with complex needs often have valid (but not always acknowledged as such) requirements, for example to be housed away from past associates, or in environments conducive to recovery (from, for example, mental health or substance abuse) and this project was able to offer a choice of property/location to service users by virtue of their Band 1 priority.
• The referral process and structure (via a Complex Needs Panel) allowed for multiple potential pathways into the housing first style service and was likely to make it more accessible for this service user group.  Any voluntary or statutory agency working with homeless people – including the street outreach team and domestic violence services – could refer to the panel and cases were discussed and considered by a multi-agency group, not just the delivery agency. 

Challenges

• Staffing: there was some staff turnover as well as recognition that new practices (such as recruiting, training and promoting apprentices with lived experience) were needed to recruit staff with the right skills to deliver a housing first style service within a local authority context.
• From the perspective of partners, although the housing first style model in the area was described as ‘gold standard’ because of the ready access to social housing, service users were still subject to the same (reportedly sometimes ‘clunky’) local authority systems. e.g. ‘So if you put someone through for housing first, the next thing you’ve got to do is you’re going to have to go back and now make a housing application with the person…you’ve got to get them on the systems through all the same mechanisms as everyone else’.  The time lapse between referral, acceptance and housing was reportedly longer than ideal.

Learning

• The successful delivery of a housing first style service was dependent on access to the right level and type of accommodation, and a commitment to intensive, long-term support.
• Delivering a local authority in-house housing first style service required staff, and managers, who were willing to push institutional boundaries and develop a culture of innovation and ‘test and learn’. Staff with particular skills were needed to provide support and there was a need to be reflective.  Partner organisations reported that recent positive improvements had been made, based on learning and feedback from partners.

Regular and intensive support from partner agencies – particularly the rough sleeping team – was necessary in the early stages of rehousing.  However, the resource to do this was not ring-fenced to the housing first style project.  Therefore, the project took capacity away from work with people who continued to sleep rough. Housing first officers and partners recognise the need for a transition period, and for continued support from some agencies (for example drug and alcohol support services) but for referral agencies such as rough sleeping teams, capacity to do so can be limited.

Area E

The Model: HOUSING FIRST style scheme

A provider was commissioned to deliver a housing first style service in Area E with the aim of supporting up to eight people at any one time.  The project had a full-time service manager and a project worker. There were staffing changes during the funding period such that both positions were occupied by individuals other than those who were originally appointed to run the service.  The referral and admissions procedures were overseen by a team within the local authority. 

Advantages

• A small number of people who had previously slept rough were housed.
• The project was ultimately able to recruit staff with a great deal of experience of working with homeless people who could engage effectively with them.

Challenges

• The project did not work as initially intended. The overriding challenge was around securing properties for those eligible for support.  Although housing supply was limited in the area, there was a perception that the provider had not done enough in facilitating access to long-term accommodation.  People who were sleeping rough were consequently supported on the street for long periods, rendering the service more akin to outreach or floating support.
• Area E is a small town. It was not possible for some people to be moved away from negative peer groups.
• The housing first project worker was unable to secure the engagement of service users – they were not experienced in outreach work and did not possess the appropriate skills. Partnership working was subsequently damaged as partners lost confidence in the project.  Recruiting an alternative staff member led to an interruption in service provision.
• Despite staffing changes, it was difficult to recruit people with the requisite experience to implement a service based on the fundamental principles of Housing First.  The project’s support was described as reminiscent of more ‘traditional’ homelessness support.  For the provision to demonstrate greater fidelity to Housing First, stakeholders interviewed for this evaluation felt that provision needed to be more holistic, tailored and tolerant.  Assessments of need and the formulation of care plans were reported by stakeholders to be fairly routinised and often reactive in nature.  Contrary to the Housing First philosophy, support was also reported as being somewhat conditional in nature with repeated lapses in engagement not tolerated.
• Engagement was felt to be hindered by staff not being available evenings and weekends.     

Learning

• Longer-term funding is needed to give housing first style projects time to grow and overcome challenges. 
• Expectations among partners need to be managed. There was a somewhat unrealistic expectation in the area that this housing first style project would be a panacea to addressing the needs of people with complex needs who are sleeping rough. 
• Housing first does not ‘work’ or not; it is dependent on the skills, professional competencies and personal attributes of project staff. A willingness to pay higher salaries may be necessary to recruit staff with the right skills.

There needs to be an understanding that housing first is not suitable for everyone.  In some cases, more traditional supported housing is appropriate.

Area F

The model: Homeless Response Service and Housing First style SCHEME

The project aimed to provide 32 housing placements based on a housing first style model over the two years of funding (16 placements in each of two local authority areas) to the most entrenched and vulnerable individuals experiencing multiple deprivation with multiple and complex needs. A rough sleeping engagement strand also had the aim of identifying and reacting to street homelessness, to provide brief intervention to prevent homelessness and provide support around other issues (such as drug/alcohol, mental health issues, access to medical care, assistance to return to an area where there is a location connection, or support to claim benefits).

The provider was already working with a majority of the service users supported who were identified as an ‘obvious cohort’. Referrals also came from services (the council, social services, drug and alcohol services, the police, adult mental health, and hospitals). Service user needs were assessed to determine whether candidates met thresholds for support (generally if they were not engaged with other services and had high support needs).

The project worked on a trauma-informed and service user led approach, with service user choice and control being central to the project ethos.

Advantages

• Evidence of positive outcomes: the project exceeded placement targets and had very low drop out numbers.
• A person-centred approach: what counted as ‘success’ was seen as individual to service users. Because the project would never ‘give up’ on an individual it was seen as unlikely that a service user could fail. Examples of success included individuals who had previously never experienced stability in their lives who had sustained accommodation for a year or more with the support of the project. Both staff and service users reported that they preferred the service user led, intensive, and flexible approach to support through this project.
• Long-term support was available if needed: service users were given the choice over when to close contact with the service, so support was not time-limited.
• Flexible support: the provider introduced a ‘Sustainment Worker’ to their team (through 6-month funding from the local authority) as a way of reducing the level and intensity of support for service users who are deemed to be managing well. This approach allowed staff to take on more cases.
• Focus on staff wellbeing: the project was also praised by staff as having good support structures in place. Frontline staff had regular one-to-one meetings with the manager to de-brief, as well as case management meetings to discuss any service user or workload issues.

Challenges

• It was difficult for the project to find properties for people to move into straight away without a period in temporary accommodation.  Where vulnerable people had stayed in temporary accommodation before moving to the housing first style scheme, this had sometimes put them at risk.
• A challenging development for the provider, at the time of fieldwork, was learning that the project may not be re-funded. Given the complexity of the service user base it was expected that some who had made good progress in certain areas would again be at risk of homelessness.
• The RSG project found that although they had strong buy-in from a range of agencies, once it had stepped in, other services tended to withdraw support. There was an issue, then, of agencies becoming overly reliant on the project because it is so involved and intensive.

Learning

• Getting the project off the ground successfully was attributed to the provider having an established reputation and so managing to build up plentiful contacts with partner and referring agencies (such as social workers, GPs, police and probation services).
• Housing first officers worked on a highly intensive basis with each service user and recognised that the approach would not work if caseloads were too high (as they had been at points). Staff needed to be committed to a housing first, service user led approach and equipped with specific skills – but mainly empathy. Several of the staff had lived experience of issues similar to those of service users.

3. Findings from the RSG case studies

3.1 Introduction

Interviews with stakeholders and service users were carried out with each of the six RSG case study projects. This chapter discusses the findings of this enquiry to highlight the effectiveness of different processes that respond to the needs of those who sleep rough and have complex needs.  The evidence is presented as follows:

• models of support
• workforce development
• multi-agency working
• engaging with service users, and
• funding and sustainability.

3.2 Models of support

Approaches to outreach

Three RSG case study areas (A, B and C) involved forms of outreach services.  All provided some important insights into the way that outreach can be made more effective for people rough sleeping with complex needs. 

In Area A, the rough sleeper outreach service was enhanced because the local area had previously benefited from Big Lottery Fund funding to establish a Making Every Adult Matter (MEAM) initiative.  The focus of MEAM on better co-ordinated service provision for people with multiple needs provided a positive framework of partnership and multi-agency working in which the RSG project could operate.  A stakeholder reflected:

The MEAM approach has allowed us to look at […] the barriers we’re facing and who’s got the influence to overcome those barriers. Which if we as a council were trying to get someone to a hostel on our own then we may not necessarily have the same powers or the same effect, and having that approach, we’re all talking about the same people, we all want the same outcome for them and it makes sense to work in that joined up way… the MEAM approach here has allowed us to look at barriers we faced as, not just as a council but as a group of partners.

One stakeholder provided an example of how this partnership approach benefited practice by enabling delivery of a person-centred approach in the RSG project:

We had a couple that were sleeping rough and they didn’t want to be separated, they were a couple for a long time, our local hostel is for single people and they were referred to MEAM and scored enough to meet that criteria for that approach and the partnership working that we did enabled the local hostel to take them in as a couple, they’ve been in the accommodation for about a year now.

Areas A’s experience also highlighted the importance of physical infrastructure.  The provider had premises suitable for drop-ins, workshops and groups and it provided a comfortable and ‘safe’ space.  In some respects, the building acted as a hub – a location where people who were sleeping rough could seek some comfort and could be assisted to access a range of services.  Its unique offer in the area was its inclusivity. This was described by one stakeholder:

It could be they might be banned from that hostel for poor behaviour, then [the provider] will provide them with packs, hot drink, and things like that. So, the providers are absolutely integral to the work we’re doing and have played a massive part in us being able to reduce rough sleeping numbers and work positively with the service users we’re supporting, absolutely.

Service users also reflected on the benefits of a fixed location and somewhere to seek support:

People here have made me feel more comfortable than other places, the main difference is the people mainly that are here. They are kind, understanding, they try to help.

The project had received positive recognition across the broader social inclusion partnership in the area and had become an integral part of the overall efforts to tackle homelessness.  As one stakeholder stated:

They are contributing to the work we’re doing; we absolutely value what they’re doing, but across the partnership that is absolutely echoed.  The work they do is so important, and everyone understands that.

Despite the establishment of a solid partnership network and an inclusive approach to engaging people sleeping rough, the project did identify several challenges. As in other case study areas there were challenges around access to accommodation and in this area, access to accommodation in the private rented sector was particularly affected by delays in Universal Credit payments and reluctance on the part of landlords to let to Universal Credit claimants.

In Area B, the outreach service aimed to improve access to healthcare for people who were sleeping rough.  The Dual Diagnosis Street Team (DDST) provided a multi-disciplinary and holistic approach to addressing both mental health and substance misuse issues. In addition, the integration of clinical expertise into outreach services aimed to improve access to health care for those sleeping on the streets who would otherwise have needed to access a clinical setting (usually a GP surgery or hospital) in order to benefit from treatment.

The project was universally seen by the stakeholders interviewed to be a crucial asset in meeting the needs of people with complex needs who were sleeping rough. Interviewees pointed to outcomes which included the improvement of referral times and treatment pathways and a higher number of sustained tenancies. Key factors associated with the positive impact of the project included strong partnership working, which was greatly assisted by the ‘can do’ approach and skills of the DDST. In particular, the inclusion in the team of staff with clinical skills enabled them to build bridges between homelessness and health services, improving the experience and outcomes of support for service users. One stakeholder commented:

To get people who are basic with all the principles of dealing with people with substance abuse or mental health problems – experts and familiar with NHS treatment pathways (both in terms of mainstream and back up expertise) has been really great – this is something that homelessness services don’t generally have available to them. It has been very beneficial – it has allowed us to be able to push the buttons – we aren’t spending time navigating and negotiating with existing channels.

Area C’s Early Intervention Outreach Service had a remit to prevent people being evicted from their properties on grounds of anti-social behaviour and, in turn, reduce the number of people who were rough sleeping.  There was an explicit focus in this project on helping people with complex needs retain their tenancies.

The project emerged because the local authority had identified that a cohort of people with multiple needs were falling through the gaps in service provision.  They may have had contact with floating support services, but their complex needs were higher than that service could provide for, and many were not registered on the local database to coordinate services around those who are homeless or at risk of becoming so. Partner stakeholders reported the need to provide more intensive support for some people, which focused on a sustained relationship with a key worker to help them address a range of issues:

I’ve always said what we need is an intensive hand-holding project that covers everything.  So the resident can build up rapport with one person who, you can’t expect a vulnerable person who has a chaotic lifestyle and things are happening in their life, whether it be cuckooing or substance misuse, mental health, or usually everything, to liaise with that person for benefits, that person for hospitals, that person… it’s not going to work, so I’ve always said this is what we need.

The service thus combined floating support with tenancy sustainment and key worker support to individuals who could be referred by organisations or themselves.  This was widely seen by interviewees to be filling an important gap in local service provision. Factors that were identified as important to successful implementation included small caseloads and the skills of staff. 

The project was able to identify a number of challenges and it was apparent that there was a need for some system changes.  It seemed that not all service providers were aligned to the aims of the project, indicating perhaps a need for a greater degree of co-ordination between services and the potential for additional training for other services. For example, there were reported problems relating to access to accommodation in the social rented sector, the engagement of adult social services and a lack of buy-in from other professionals, including housing officers.  One stakeholder reflected on the need for other services to also work in a preventative and person-centred way, but acknowledged that influencing change could be difficult:

We could get a referral at that stage rather than at the point where somebody’s definitely losing their home.  So, I guess we haven’t been able to influence that.  We put that stuff on our leaflets, cos I don’t know if people are maybe thinking that we’re a bit, what’s the word, like teaching granny to suck eggs kind of thing, ‘if you notice these things in someone’s house it could be…’ we did have to put some stuff in so it was a bit like ‘these are the things that you might notice…’ and if I was getting something like that I’d be ‘oh yeah, you’re trying to tell me how to do my job’ so there might have been a bit of that.

A housing first style approach

The approach in Area D was for the local authority to trial a housing first style model in-house, using its own housing stock.  The local authority was considering the adoption of housing first prior to the announcement of the RSG programme and had visited other schemes.  The grant provided the opportunity to forge ahead with it.

The local authority recognised that an in-house delivery mechanism was unusual, but an interviewee emphasised its commitment to the scheme:

We organised a meeting with Homeless Link cos they had a Housing First champion, so we talked about the ethics of Housing First and they believed in the pure Housing First model and I said ‘so do we’ ….I think it was unusual at the time for a local authority to come forward and say we want to do a housing first [model].  I think we were one of the first in the country to say that… it was basically wanting to keep everything within the council cos we then had control of it.

It was reportedly important for the local authority to have ‘control of it’ because, as described by one stakeholder ‘we took huge risks in terms of the council accommodation being provided’.  Service users were given Band 1 priority for local authority and housing association housing.  In practice, this placed service users right at the top of the list when they bid for properties on the local authority’s system, thus affording them a degree of choice in relation to the type and location of accommodation that would not otherwise have been available.  Service users who had received accommodation via the housing first style service had a history of failed attempts to find decent and settled housing.  One service user had spent a long time in hostels and periods sleeping rough:

To me it’s just everything, now I’ve got a purpose, I’ve got something to call my home, I haven’t got people knocking at the door ‘have you got this? Have you got this?’ that’s 24 hours a day. It’s lovely, they’ve helped me so much.  I think to myself it would have been another year or two being in the hostel, I don’t know what would have happened.  I’m not saying I’m suicidal or nothing but you see that constantly, people coming out in bags, I’m not lying to you, this is what I actually was seeing.

Although providing Band 1 status was key to a more rapid housing solution for people who were sleeping rough, it did not circumvent a bureaucratic housing application procedure and it was still very important to support the service users through this process. One stakeholder commented:

There’s no sense of fast tracking.  So if you put someone through for housing first, the next thing you’ve got to do is you’re going to have to go back and make a housing application with the person, you’ve got to get them on the systems through all the same mechanisms as everyone else.

Local authority and housing association properties on the Choice Based Lettings system in the area were used for the project, rather than the private rented sector and this was generally regarded as a very positive feature.  The local authority was looking into using private rented sector accommodation as well to extend choice, but stakeholders who were interviewed for this evaluation had mixed views on whether this was feasible both in terms of cost, and in ensuring access to high quality accommodation.

A ‘Complex Needs Advisory Panel’ assessed referrals to the housing first style project.^{[footnote 8]}  The panel, which included representation from relevant teams and services from housing and NHS providers, considered up to six referrals a month and recommended the best options for each person, which might have included the housing first service.  Although a dual agency decision-making forum was beneficial in considering the complex needs of people who were sleeping rough, and in moving decision-making away from just the local authority, the process was described by one interviewee as ‘very clunky’, and not fully aligned with Housing First principles around non-contingent eligibility and individual’s choice and control.

The housing first style model in Area D had been embedded into a wider system of homelessness initiatives and strategies.  This was regarded as a good example of efficiency and of making sure there was no duplication, for both the local authority and for the service users.

The local authority was pleased with the development of the scheme and had secured funding to continue it beyond the RSG funding to become part of the core housing solutions service in the area.

In Area E, the housing first style service had proved more difficult to implement and retain.  The local authority contracted out the service to a provider.  It was apparent from the interviews conducted for this evaluation that some of the challenges experienced in this case study stemmed from difficulties experienced by the provider organisation in adhering to the principles of Housing First and consequent pressure to broaden the RSG reach.  A fundamental problem was access to suitable housing provision.  A shortage of available properties meant that people were being supported whilst they continued sleeping rough, and thus the service was more akin to outreach or floating support.

There was no property, so they were just sustaining them on the street, and engaging them, they were sorting out benefits and getting them to appointments and things like that, but there was no property involved… It felt like very much a floating support model, so a bit of outreach and a bit of floating support… the real ‘this is Housing First’ had been lost.

It was difficult to fully identify what the challenges to finding properties had been, though there was some evidence that partnerships between housing providers, the local authority and the provider had not been working effectively.  This was exacerbated by a lack of training in the Housing First model for partners and some staffing changes that caused inevitable delays to project implementation. Access to accommodation in the private rented sector was also very limited.

Finally, the support provided through the project to people who were sleeping rough was reported by stakeholders interviewed for the evaluation as somewhat conditional in nature, and thus not in adherence to Housing First principles. Two interviewees referred to the support for service users being ‘suspended’ (due to repeated lapses in engagement), although project staff did emphasise that support was not withdrawn if a person was evicted.

In Area F, the housing first style project was considered to have been successfully implemented.  Two local authorities had commissioned a provider to run the service and importantly, from the outset, the project aimed to follow the key principles of Housing First in order to properly test the initiative.

Finding suitable (non-temporary) accommodation was a notable challenge.  Nevertheless, the provider was able to source suitable properties using a combination of stock from housing associations, the private rented sector and the local authority’s arm’s length management organisation (ALMO) and exceeded placement and sustainment targets.

Interviewees touched upon what counted as ‘success’ in relation to a housing first style project in the area. ‘Success’ for service users was characterised as specific to the individual but was summed up by the project lead as the individual not re-presenting as homeless. Because the project would never ‘give up’ on a service user it was seen as very unlikely that the service user could ‘fail’, and the end of support was very much in the hands of the service user.  One service user shared their experience of the project:

I’ve never committed [any] more crime since my last prison sentence, which was two years ago, which is excellent for me.  I’ve worked with [worker] since I’ve come out of prison and I’ve come really, really far.  I’ve settled right down and I’m having all good relationships with my kids and my grandkids and everything.  I just basically wouldn’t have been able to do what I’ve done without the help of [worker].  …she’s actually stayed.  And cause I’ve put my trust in other people and they’ve just left us and I’m back to square one… and back how I was.  But I haven’t this time, and I’m guessing it’s cos [the worker] hasn’t left me side since […] like 2017.

Because some service users required long-term support this was not characterised as dependency.  Rather, stakeholders expressed this as the result of service users having spent a long time in their lives without any support from services at all:

And I’ve seen service users that I’d have known when I was a drug worker here who, one of [project worker name]’s particularly, who’s now a year just gone in [to property] and she’s never been that stable since she was 10. She’s 32 now, so that’s 22 years and this is her first year of stability in one property and I worked with her for six years in the drugs services and she was a nightmare, in and out of prison, so that is a major success.

As I say, [service user] when she’d got her house for a year it was brilliant; for other people that’s normal but not for her. For [service user] to go and put a clean [drug] test in, that’s absolutely brilliant […] I’d say success is individual and what they can achieve […] Success is tiny bits not massive achievements.

This evaluation is focused specifically on how the RSG has been used to address the needs of people who are sleeping rough, or at risk of sleeping rough, and living with complex needs associated with poor mental health and/or alcohol and substance misuse.  It was apparent from the six case studies that the RSG had been used to plug gaps in provision, enhance or improve access to existing service provision and, importantly, create new ways of meeting the needs of this cohort, for whom more traditional service offers have proved to be inadequate.

Person-centred and flexible approaches

Responding to complex needs requires approaches that are responsive to the needs of individuals.  In Area D, for instance, service users welcomed a different approach to support to that which they had experienced previously.  In part, it was the immediacy of assistance that was mentioned as being of great value by service users – when a project was able to be immediately responsive, promised to assist and able to see that through.  This was articulated well by one service user:

This was the first time I got any help, or any kind of progress, or something sensible that actually made progress. She was so helpful and got everything sorted….

He described how the housing first officer quickly made sense of his situation, realised he needed help and did something about it promptly:

That’s all someone had to do…I don’t get how all those people [previous services who have not helped], 20 people or whatever, couldn’t do it and [project worker] could.

Other service users also implied that the responsiveness of the service was important, although they articulated this in terms of the qualities of the worker and in comparison, to their experiences of approaching other services:

Sometimes you can come in here ‘here’s another one, take a ticket’ [project worker] has never been like that, she might have said ‘hang on there’s something wrong, let’s try and do something for this man’.

Then sometimes, very rare, you’ll bump into someone like [project worker] and people that will, she won’t let me move into her spare bedroom, but she will do all that she can and a little bit more to try and help you, and it’s very few and far between.

I haven’t really dealt with anyone before like this, from the housing or anything like that, what they’ve done for me is just unbelievable, fantastic, I couldn’t praise them enough.  But then I’ve got this place, if I hadn’t, I’d be being nasty, wouldn’t I?  But no, it really is a lovely place, it’s perfect for me.

The project in Area A also highlighted the benefits accrued from offering a very flexible service and why this was important for meeting the needs of those sleeping rough.  Firstly, the project workers recognised that every person’s needs were unique and required a different approach:

We carry on working with people because somebody can be housed within two weeks and another person can be six months to eight months, we just continue to work with someone until we can get the positive outcome for them.  We don’t ever refuse referrals either.

Secondly, it was important to be flexible around times.  Staff reported that it was very common for a service user to miss or be late for an appointment and to deny this was to deny the characteristics of the target group.  As a result, the project did its best to operate outside the normal 9-5, Monday to Friday working hours.

1. Stuart is 31 and first became homeless when he was 15. Since then he has experienced periods of homelessness, sleeping on the streets and in doorways. He has lived with family members and had brief spells in prison. When he was interviewed, Stuart was staying in a night shelter.
2. He was aware of local support services and attended day centres regularly, where he received meals and used the facilities.
3. ‘It’s important. I have friends that come here as well. I do turn up a lot’.
4. He told us that he was finding life difficult and apart from attending a bike workshop once a week he spent his time ‘going around getting stoned and smoking cannabis’. He was trying to get help from drug treatment services to address this.
5. The RSG project was instrumental in securing Stuart a place at a night shelter and supporting a claim for Universal Credit.  He said that he was trying to turn his life around but found this hard to do alone, and he appreciated the personalised support provided through the RSG project.
6. ‘I need help [to sort everything out], it’s too much’.
7. ‘Being homeless on the streets… they come round and give you a coffee when you’ve got absolutely nothing.  That means a lot.  Great staff, they are friendly, they always make me smile.’
8. Without the help of project, Stuart said:
9. ‘I would be on the streets, I wouldn’t be in the shelter, I wouldn’t be sleeping as well and warm at night, I wouldn’t be inspired to go to the other shelter and seek inspiration, any way they can possibly help you they will. They are amazing. They go above and beyond the call of duty to help you if they can.’

In Area F, the provider had introduced the position of a ‘Sustainment Worker’ as a way of gradually reducing the level and intensity of support for service users who were deemed to be managing well. This approach allowed the housing first officers to take on other service users with complex needs.  But for the team as a whole, staff reflected that providing service users with choice and control was central to the project’s ethos and represented a step change from previous working practices.

One service user described what this step change meant to him:

I was on the streets, sleeping in a gutter like I was garbage, and then they come to the garage. And then I don’t know who put me in touch with them, I think it was the vicar. That was last January [two project workers] come and asked if I wanted to work with them and I said yeah. They kept coming every day to check on me and then cos I didn’t have no ID, they got us a birth certificate and everything and got us sorted with the housing. They put us in [name of temporary accommodation] a few times before I got this placement, but I was drinking at the time and kicking off a lot of times with the people staying there. I got this last March, so it was quite quick, and they paid the bond and everything, got it all furnished.

One way of describing the approach was through the phrase ‘stickability’ – the idea of never giving up on a service user. 

Person-centred approaches; we all live and breathe by that. It’s not as difficult, I just find it better. In my personal opinion I think that’s how it should work anyway. I don’t think sitting there telling somebody what they should and shouldn’t do… we’ve got no place to say something like that. We’re human beings at the end of the day and I don’t think anybody – regardless of what their issues are – appreciates being told what to do. So, it’s better just to ask and find out that way.

Similarly, one RSG project demonstrated that meeting the needs of people sleeping rough and with complex needs required understanding the cohort and providing services that did not discriminate against them.  This meant persevering with a service user and ‘not giving up’.  One of the team articulated this well:

Because we are health care workers but we are dual diagnosis, people know from the outset there’s no judgement on their substance use, we are not in a position where we’re saying ‘because you’ve used drugs we’re not going to treat you’ it’s part of the parcel so if people turn up and say ‘yeah I’ve used crack this morning’ then there’s no judgement on it, they know they can say that and you’re still going to provide the service. You keep chipping away and not taking things personally, or as a rejection, we have that unconditional positive regard for our clients, they can be awful sometimes to us and yes you maybe have to challenge that and talk to them about that, but it doesn’t mean you’re going to withdraw a service because one day they’ve been pissed and haven’t turned up for an appointment.  … I think again that helps with the relationship, the sense of trust, that there is somebody there that actually genuinely is there wanting to assist you.

(Re)connecting people with services

The RSG projects did not (nor were they intended to) provide all the help and support required by people with complex needs who were sleeping rough. As such, all the projects relied on a network of other services and agencies.  When talking with the service users that projects were engaging with, it was very apparent that there were many examples of people who had been excluded from services for a range of reasons including anti-social behaviour, violence, missed appointments, service limits on engagement, and failure to ‘engage properly’.

The RSG case study projects were thus often involved in working with people who were in critical need but did not engage with other services.  In Area A, for example, project workers reported that some service users had been banned from local hostels and therefore were rough sleeping.  The project provided a place of safety and comfort where more positive support work could be restarted. One service user commented on how he had benefited from the service:

It was useful, it was somewhere to go and people to talk to. Maybe they could help me with certain things, maybe they couldn’t. It was mainly to go and talk to someone if I needed to… somewhere where I am not outside in the cold.  ….  People here have made me feel more comfortable than other places, the main difference is the people mainly that are here. They are kind, understanding they try to help.

One staff member provided an example of how their work was meeting a critical need:

Yeah, we had an individual who was in one scheme and was failing miserably there and wasn’t staying and he was rough sleeping cos of a circumstance in the building. He was offered to move to another place, but they wanted three months’ service charge upfront, cos he was in arrears with his service charge where he was, and they didn’t want that to happen in the new place. So, we provided him with that on the understanding that we would drip feed it, and if he wasn’t living there, they wouldn’t get it.  So yeah, we did that in order for him to remain housed, cos he was failing where he was, and he was more likely to succeed in this other place, but they were insisting he paid three months’ service charge upfront before they would move him over. As far as I’m aware he’s still there, so that was the right call to make.

The project also demonstrated the benefits of a service delivered by an independent provider which enabled people to better engage (or re-engage) with local authority services. An interviewee explained why this was so important:

It just works.  Cos we’re talking about people who don’t necessarily want to engage, so they need someone to do it for them and actually the trust that the outreach team build up with those clients is really the most pivotal thing cos without that trust they’re not going to open up, they’re not going to do what they say and it’s not the council, so there is a stigma attached to coming to the council.

Many people with complex needs which include mental health and substance misuse problems have poor experiences in relation to access to and quality of the services designed to address those needs.  In Area B the Dual Diagnosis Street Team directly addressed issues around access by bringing specialist services directly to the street, and so mitigating the difficulties the people who were sleeping rough had getting to, and keeping, appointments at clinics.

The following account, given by one staff member further highlights what was necessary to help a man who had been homeless for a long time, had poor mental health and was using drugs.

Bob, who’s in his 30s, had been homeless for four years, was living in a van when he had one or a tent in the summer, and accessed the churches in the winter.  It was obvious to everybody that there was some psychosis, he had lots of very fixed delusional ideas about conspiracy theories, never seemed to be quite ill enough to come into contact with services but looked like he used cannabis as a coping mechanism.  For four months, literally, our approach to engagement was one of going to the churches he was attending twice a week in the evenings, a very softly, softly ‘hi Bob, how are you doing, what article are you reading there?  It’s nice to have a bit of cottage pie tonight’ literally giving information about what we did, sitting next to the person and ‘can I get you a cup of tea?’ that sort of approach.  By the end of the four months we’d got to the point where we’d swapped contact details, a couple of weeks after the churches finished that person got in contact ‘you said you might be able to help me with benefits, actually I’ve realised that I’m not really up for working at the minute and I think I’d like to apply for benefits’, applied for benefits, got him on some medication, got him into accommodation, which he’s sustained.  So, we got him into temporary accommodation, got him down to the council, into temporary accommodation cos he was priority need and then into (another project) I think May, June time, he’s still there, he’s starting to do some work. He was somebody who would never voluntarily have gone along to mental health services, he still doesn’t really identify that he has a mental health problem, he says he gets depressed, he says he gets anxious, but just through that, he was somebody on the radar, we knew that he would benefit from our help but we couldn’t be in his face like ‘right well Bob, obviously you’re unwell and delusional, let’s get you on some anti-psychotics’ that was never going to work with that kind of person. So with partnership agencies sometimes there will be real concerns expressed about somebody and they’ll raise that to us, we call it as being on our radar, they’ll go on our list at the bottom of our board, we try and engage them repeatedly and eventually we mostly get there with getting them to sign up and engage and work with us.

A very common theme relating to meeting the needs of those sleeping rough with complex needs was the mismatch between services who adopt rigid and (frequently) difficult systems for entry and longer engagement, and the ability of people to use these services.  Stakeholders reported that it was often the administrative and bureaucratic systems of vital services such as housing, health and social care that were incompatible with the needs of people who were sleeping rough and living with complex needs.

The housing first style projects included as case studies in this evaluation had made attempts to provide quicker and non-conditional access to housing for people who were sleeping rough.  All these projects had encountered significant challenges in their attempts to do this, but one worker from a partner organisation explained how the housing first style project in Area D was a break from the norm in providing people sleeping rough with choice in relation to their accommodation:

I look at the three people we put in – I don’t think they would have stayed in their flats if those flats had been Clearing House properties in [the area] or just in a part of [the area] that they didn’t want to be in.  We had one person who was: ‘I want to be near [the] High Street’ and he’d spent so long rough sleeping there and had got so hacked off with us failing to provide offers that he ended up being like ‘I’m going to live round here or I’m just going to stay on the streets, that’s it’ and that was it, so Band 1 actually gave us a chance to say ‘right you can choose a flat, you can just wait for something to come up, there you go’. 

The above quote represents a significant departure to the way that housing is currently allocated in most areas of England.  Some positive outcomes were identified by stakeholders.  An interviewee in one partner organisation, for example, reported that service users for whom they had previously been unable to secure any accommodation (because they didn’t meet criteria, or they couldn’t engage or sustain progress) were now in their own tenancies and had sustained those for many months:

Having housing first for some of our longer rough sleepers, or people we’ve had no chance of actually getting them to sustain any of the things we’ve given them…. I’m sure some of the others have highlighted that some of the people that we have currently in there, it’s amazing that they’re off the streets… It’s unbelievable for a couple of them.

One tenant in Area D described how the ability to choose where to live had removed barriers to getting a flat:

Yeah, I was dreading coming back to [the area] …Bad memories, bad people, too dangerous for me, it was very dangerous for me.  I just wanted to be out the way basically, and I am kind of out of the way now.

This was very different to the other alternatives for someone sleeping out, as one stakeholder explained:

They’ve got a choice, they get to pick where they want to go….  When you’re in supported housing you’ve only got X amount of properties, so you can only go where the vacancies are. There’s only about five main hostels, one is female only, so after a while you exhaust the options and it’s the same clients going round all of them.

In Area F, it was reported that where the housing first style project took the most chaotic and entrenched individuals off the street it meant that other services had far more capacity to work with others who were sleeping rough and whose needs were less complex.  In this project, meeting the needs of service users was enhanced through understanding of the local context and the service user group’s characteristics.  The majority of the project’s service user base was reported to have typically been in and out of hostels, although four or five of their service users were sleeping on the streets for 10 or 20 years prior to entering the project.  This reflects the local context of homelessness in the area, which is served by large hostels and does not have high recorded numbers of people sleeping rough.  The project lead noted how they had to adapt to the needs of their service user base. One example was recognising that the majority of female service users had experienced domestic violence but were not connected with appropriate support services. They received funding from the local authority to employ a Complex Needs Domestic Abuse worker who operated alongside the project team:

Our client base very quickly became half men, half women and the majority were domestic violence [survivors] who couldn’t go to refuges because they had substance misuse [issues].

10. Prior to her involvement with the project, Chloe had been moving in and out of hostels and sofa surfing. She also had substance misuse issues which were not being managed. Chloe received some support from the local council through being a care leaver, but she said they didn’t realise how much support she needed. Chloe told us that she felt she was being housed inappropriately in supported lodgings and described feeling left behind and lost. In the hostels, Chloe was surrounded by lots of older people and found herself getting involved in dangerous situations and becoming addicted to various drugs. Getting her own self-contained flat through the housing first style project instilled Chloe with a sense of pride and control over her own space. Most importantly she felt safe. Chloe was now engaging with a drugs service, whereas before she described not being in the right place to accept support. Chloe described how she had developed a relationship of trust with her housing first officer that was different to her previous engagement with agencies – she never trusted anyone enough to tell them about her mental health and substance misuse issues, partly because “they wouldn’t understand”. Her housing first officer helped with day-to-day tasks, emotional support and managing her home and tenancy. Chloe explained: ‘This is my first property on my own and sometimes I do get worried and scared but, I don’t know, obviously I’ve been given advice and if this happens you do this, it’s basically just making things, cos I make a mountain out of a molehill and I think everything’s really drastic but it’s just having someone to say it’s not that bad’. Chloe’s quality of life had improved, and she now felt able to sleep, eat and look after herself. Chloe aspired to help people who had gone through similar experiences: ‘Whatever I do I’d like to help people cos you come from nothing and some people might still have nothing and you just need someone to help you get something’.

Area A’s RSG project provided a good example of how equipping service users with some basic rights of citizenship helped to improve their lives.  The project had helped people to get passports, personal identification, birth certificates and photo IDs, all of which were required for opening a bank account, making a welfare claim, making a housing application and getting a job.  As a staff member said, “those little things make a massive difference.”  The project also made good use of personalised budgets which was helpful in removing barriers.  As a staff member said:

I think it allows the staff to get creative, helping to find solutions to problems that [service users] wouldn’t ordinarily be asked for their input into.

3.3 Workforce development

Across the six case studies, workforce recruitment and development emerged as a key theme.  The projects’ recruitment and retention of staff with suitable skill sets and the availability of appropriate training were challenges faced by all projects to some degree. 

Recruiting staff with the requisite skills to work with service users who have complex needs has been challenging.  In Area B, for example, there was a need for staff with specialist mental health and substance misuse skillsets alongside the ability to work with people who were rough sleeping.  The project was able to recruit successfully to the Dual Diagnosis Street Team, but one stakeholder reflected on the challenge that this posed:

We wanted each member of the team to have a direct background in either mental health or substance misuse needs, but we had to go for a more diverse skill set. Offering two-year secondment (fixed term) doesn’t appeal to everyone but there does seem to be a shortage within the NHS of people with requisite skills.

Of interest to this evaluation was the use of ‘person-centred’ practices which were regarded by stakeholders and service users to be fundamentally important when working with people facing complex and multiple needs.  It was reported in many areas that adopting a person-centred approach was a step change and required a different skillset.  There were different responses to this issue.  In several case study projects, workers were offered retraining.  In Area A for example, the project team reported that training was readily available and while it was not compulsory, staff were encouraged to attend where possible.

However, in other areas, access to training had been more problematic, particularly for innovative projects that had a specialist focus and were being trialled for the first time.  In Area B, one case worker reported:

I think the problem is, like, the lack of research there is with this service user group.  There’s a lack of training out there that would really benefit us. The dual diagnosis thing is so limited, we’re relying on our past experience and knowledge and skills and pulling that all together with little bits and bobs of training that you have along the way that might be applicable and you have to pull it all in.  I guess that relies on our ability to be able to do that.

Thus, like other case study projects that were exploring new ways of working, project teams were having to ‘upskill on the job’. In projects that had been able to draw on training and development, interviewees reflected on the skills that were essential for service user focused initiatives.  These included:

• approachability
• listening skills
• patience and calm
• empathy
• good communication skills, and
• a non-judgemental approach to understanding people’s situations.

The latter was seen to be particularly important because person-centred approaches were not universally adopted by services, and many service users had engaged with multiple services over long periods of time without making much progress towards better health and wellbeing.  Two project workers in different areas highlighted this:

Empathy without being condescending – I think that’s one of the biggest things. And talking to people at their level rather than talking down to them and talking to people with respect.

I think empathy, good communication skills and definitely to be non-judgemental, some experience of care work.  One of the other staff members was an outreach worker in the past, has history of working with homeless people, knows the local demographic, and knows the area.  It’s a mixture.  People bring loads of different skills, life experience as well.  [We] always welcome people that have had lived experience, it doesn’t necessarily have to be in rough sleeping, could have experience of mental health issues, physical health issues.

Several service users also discussed the benefits of understanding on the part of workers.  One service user, for instance, talked about her experience of Area C’s project:

Since I’ve been here, I’ve had a lot of help, a lot of time given, they listen to you.  I’m not very good on paperwork or anything like that, they helped me with my paperwork, and they fill in forms, whatever I need help with they help me with.  I have no problem with them at all, they’re very good company and lovely people to work with.

The ability to be empathetic and communicate well is, therefore, key within project teams.  As the quote above highlights, several RSG projects are also keen to include people with ‘lived experiences’, either of homelessness or other relevant issues, in their workforce.  This was reported to offer teams important insights into the lives and challenges faced by service users, but it also gave service users a positive example of ‘hope’, that life could get better:

Empathy, like you can put yourself in someone’s position. You can stand outside and say, ‘what would I do in that situation?’ and I’m lucky enough now to say I’ve been in their shoes. And I think that helps them to learn to trust me. You don’t go into it a great deal at first, but you tell them little bits. You can see them looking at you thinking, ‘you do understand’.

Several projects had the advantage of being able to overcome workforce development issues by drawing on learning from previous initiatives.  In Area D, for example, managers reported that they learnt through being a Homelessness Reduction Act Trailblazer that there was a shortage of people with appropriate skills to carry out direct work with people sleeping rough, particularly those with complex needs.  In response, the local authority has developed an apprentice scheme which adopts a different approach to recruitment, as one interviewee explained:

And we’re not going to go through the normal channels, we’re not going to go to Jobcentre Plus and say can we have such and such.  So, we went to all our stakeholders, we hosted open days so people could come in here, see what it was like, shadow what the service was doing.  We went to the various hostels, partner agencies, explained what we were trying to do, and asked them if they were aware of anybody who was working in those organisations that would be useful for this project, both the homeless reduction and this work.

Other projects engaged people with lived experience in a voluntary capacity. In Area F, for example, the project team included one ‘expert-by-experience’, a former service user who was supported by the project and then volunteered there.

Overall, RSG projects working with people with complex needs reported that they aimed to recruit people with the right skills to directly engage service users in a different, more person-centred way; and were keen to elevate these criteria above technical knowledge, qualifications or work experience. This had led to new approaches to addressing needs around workforce recruitment and development.

Interviews with several projects suggested that careful management was needed in order to maintain workforce morale and wellbeing.  This included regular supervision and reflective practice with space for staff to talk about the negative impacts of working with people facing very difficult circumstances.

3.4 Multi-agency working

Collaboration between services was central to the RSG projects which aimed to improve service quality and efficiency to better meet the needs of people rough sleeping who had complex needs. On the whole, multi-agency and partnership working in the six RSG case study sites was working well. Good quality relationships, based on trust, were vital:

There are times when you might have to have a difficult conversation, why was this person referred or we’re not sure that this is correct, but that’s so much easier cos of the relationships that are in place, everyone has respect for each other, everyone respects what’s in that person’s remit, what they can and can’t do and it just works really well.

Having teams with the right level and kinds of skills to develop strong and positive relationships, and to deliver effective services, was key to building trust. A shared commitment to person-centred working was important. In Area A, for instance the MEAM (Making Every Adult Matter) project aimed to embed a service user-focused approach across all agencies working to support people who are rough sleeping:

There are some extensive supportive staff in all of the services in the council, we work really closely together with pretty much anybody who deals with any rough sleepers within the council and other services locally as well. [The project manager] and the team have forged amazing relationships with all of those services, and we link hand-in-hand with them and we provide support to them and conversely, they provide support to us as well.

Similarly, in Area C, a shared ethos around support had enabled effective partnership working between the Early Intervention Outreach Service (EIOS) and the anti-social behaviour (ASB) team. The ASB team co-ordinator described very good on-going communication with EIOS and effective co-working with service users. Using language which was understood by all when discussing the needs of homeless individuals was important. In Area B, the cross-sector focus of the Dual Diagnosis Street Team (DDST) highlighted how services in different sectors conceptualise, describe and explain needs and support options differently. The skills of the DDST in helping to navigate and overcome some of the barriers to collaboration associated with the use of different service languages was seen to be a key success of the project.

Effective data sharing was also vital to improved collaboration, and there were examples from the RSG case studies of the ways in which good data sharing can support improved service delivery. In Area B, a single service user record was used to record both hard and soft outcomes, enabling all providers to see all aspects of the service user’s journey. A simple referral form (developed with service users) was used to collect the necessary information from service users only at an appropriate time in the engagement with the service. In Area A, a commitment to data sharing reduced the amount of time spent in assessment thereby freeing up time for support, enabling service users to tell their story only once (instead of multiple times) and helping providers to deliver the most appropriate support. A stakeholder described it thus:

And we always say to a service user, say they’ve been to [a provider], they’ve given their permission for them to contact us and then they come and see us, we’ll say [a provider] put you in contact, we’ve had the discussion with them, we know why you’re here. Some of our meetings with the service users can be quite long, so we don’t want to take up their time having to tell us all that information and to relive it, there’s no benefit to be had from someone having to keep retelling their story, so the fact that we can freely share that information in a legal, regulated way is absolutely beneficial to the service user, it helps us but it helps them as well.

The most important impact of multi-agency partnership working was improved referral and treatment pathways.  However, some case study areas had experienced ongoing challenges, associated particularly with service overlaps, and a lack of clarity around boundaries and the potential for ‘stepping on toes’. 

Frequent changes in personnel were also highlighted as an issue, potentially impacting on relationships between service providers, and the quality of relationships with service users. Whilst it is not always possible to maintain continuity in staffing, consistency in approach was important in maintaining positive relationships. This was highlighted in one area where early relationships between the project and the local authority homelessness team had been affected by a high number of agency staff who were less likely to ‘buy in’ to the ethos of the service:

I think what happened was there was maybe a lack of appreciation by the frontline homeless team of how [the project] fit into their day job, and rather than assisting them I think some members of staff, particularly at that time we had quite a lot of agency staff who I think have moved on, we’ve had a restructure, but certainly the agency staff I think seen it as, I don’t want to say a hassle, but something like an additional burden for them to have to engage in the process.

3.5 Engaging with service users

All the RSG projects reported on the need to effectively engage with their service users and recognised that this was a complex and skilful role.  In Area C, staff interviewed for the evaluation outlined the skills and strategies they used to support effective service user recruitment and engagement. They suggested the following requirements.

• Be knowledgeable and have good interpersonal skills, using methods of communication that are tailored to the individual.
• Be able to challenge a service user effectively (without the service user taking offence and without withdrawing support).  This involved being assertive, honest and persistent, rather than punitive.  At the same time, staff emphasised the need to be sensitive particularly around identifying needs and planning support.
• Be able to challenge agencies on a service user’s behalf.  This was described as a delicate balancing act of maintaining good relationships with partners but also holding them accountable. They also needed to be conscious that people’s previous experiences of contact with services and agencies may not have been positive.
• Position themselves as workers, and the service, as offering something new and different to the service user, to help break down any negative perceptions held by the service user.

Staff suggested that where they had a pre-existing relationship with a service user, this made engagement easier.

For the Area C project, the above points acted as an informal blueprint for engagement, and many of these characteristics were shared by other projects.  There was evidence that this ‘blueprint’ was effective.  Stakeholders described project staff as ‘amazing’ and ‘outstanding’ and praised them for their abilities to engage and achieve results with service users.  Several service users offered their take on the way staff had engaged with them:

If I’ve got an appointment and I can’t make it I just phone her and cancel it and she doesn’t shout at me, she understands you cannot make it here so can you make it tomorrow and she’ll say ‘if you don’t I’ll come to you’ which is good, she doesn’t let me away with it… It makes you want to come, you don’t want to let your key worker down.

Some people just fob you off, they don’t care, but I come here when I need something, like they phoned me today, yesterday, she came to see me the day before, make sure I was ready to go for the interview and she came with me yesterday.

You don’t want to start all over again, but cos I knew a lot of them, the manager […] I knew for like 10 years, I knew her from a hostel, I knew [..] for years, so going back to people I knew, going to familiar… they knew what kind of person I was, it was like ‘we know what you do’ so alright… [The manager] knows how many hostels I’ve been kicked out of, so they know what sort of person I am, but if somebody doesn’t know and they come along and say blah, blah, you don’t understand why I got kicked out of hostels, you don’t understand the reason, what you think ain’t why I got kicked out.

Similarly, Area A’s project emphasised the need to treat people in a respectful way and how important it was to keep promises.  For example, if a service user was offered an appointment at 11am, they would be seen at that time. One worker explained why developing good relationships was imperative to meeting service users’ needs:

The guys are working face to face with all the rough sleepers and I think between them they know every single one and they know their background and they know their wants and aspirations, we do have a lot more input into their forward progress and we don’t drop them as soon as they move in, we do, I don’t know whether we’re supposed to or not but we do maintain contact, especially for those that are a little bit tenuous, they’ve been put into accommodation and we’re not entirely sure whether it’s going to succeed, we want them to maintain a relationship with us so that if they don’t succeed then we can pick them up straight away and sort them out and get them to a place where they’re going to succeed.

There are particular ‘engagement skills’ required to meet the needs of people with complex needs, but it is also critical that there is housing availability and specialist services that can fully meet their needs.

3.6 Funding and sustainability

The RSG has been a catalyst for local authorities to tackle a range of issues associated with helping, supporting and accommodating people sleeping rough with complex needs.  New ways of working have been adopted by local authorities and their partner agencies.

However, the limited timescales for the projects meant that the focus had necessarily been on successful implementation, perhaps at the expense of learning, and the overwhelming response from RSG case study projects was that sustainability – the ability to carry on projects and initiatives beyond the term of the grant – was severely restricted.  For projects that were commissioned out, voluntary service providers reported that their ability to continue to meet the needs of this group was heavily dependent on local authority funding.

Recognising that it would be impossible to retain services in full without further grant funding, several case studies reported that their sustainability plan was to retain certain elements of services.  In Area B, for example, it was reported that the project could not be continued in its current form, but attempts were being made to ‘preserve the best of it’:

[We are] going to have to work quite hard to keep the best of it. Key stuff is around the nurse and [mental health] service manager, key posts, but at the moment looking dodgy.

Local authority commissioning managers here also reflected on the fact that creating a service with ‘new money’ was positive and led to important outcomes, but it did raise questions of how to replicate it from their regular budget. For example:

We will be able to keep two posts going – but at the cost of losing the two most experienced individuals – the NHS as an employer, we are a bit short in what we are able to put forward in terms of salaries and on-costs and NHS can’t cover the shortfall. People don’t want to work for less or move outside of the NHS.  It’s all conditional and that’s fine when you are trying to scope things but it’s about individual people and their lives and mortgages and so on. The service was with all new money, when the money is gone, we have to look around to find the money – we have looked at this pot and that pot, and it’s pushed what we have got to the limit. There is no substitute funding available.

As the above quotation alludes to, attracting skilled and experienced staff into specialist roles (and from employers such as the NHS) may mean offering salaries that are higher than local authority based services (and commissioners) may be used to offering.

In Area E it was reported that the local authority would not be recommissioning the RSG housing first style service.  However, it was committed to funding something else to sustain the work that has been achieved with some service users.  Although there had been some difficulties implementing a housing first style model in the area, an interview stated that future commissioning would build on what had been learned, and crucially seek to maintain those housing outcomes that had been achieved:

We were considering whether or not we would want to recommission it and you won’t be surprised that we won’t be looking to recommission it in the same way, but we equally don’t want to lose some of the good work and we recognise the fact that there are people now who are in properties who we can’t just withdraw the support from, so we will look to put our own funding into something else, we never really had the housing element of it anyway so it probably would be more about tenancy sustainment.

In one case study, the service provider and other partners had lobbied the local authority to re-fund the project as it was ‘a vital service that will be missed’ and had become a ‘necessary element of the service provision landscape’.  Stakeholders here criticised the RSG for only providing short term funding that allowed pilot studies to be established, an essential service to be set up and then provided no mechanism for maintaining the provision.

For many stakeholders, this issue was reported to be particularly distressing when there was clear evidence that a project was meeting a need, filling a gap in service provision and demonstrating positive outcomes.  In Area C, for example, stakeholders were concerned that there were ‘drastic consequences’ as a result of projects coming to an end. One interviewee explained:

Once I had to explain it to all our partners and they were up in arms really, some people were contacting the deputy leader of the council and she’s been on to some of the commissioners, everyone’s been really happy with what the project’s achieved and the support it gives for them to do their work.

Frontline workers were often significantly affected by the loss of a service, obviously because of job losses, but because the closure of services risks replicating the sense of being let down by services that people with complex needs had often experienced in the past. As one manager explained:

I got an email a couple of months ago out of the blue saying the funding has stopped and I literally couldn’t believe it, my team were just gutted, it was like what are we going to do?  And it’s a genuine fear… I have never in my career been as concerned about losing a service as I am about losing this one… unfortunately [the commissioner] can’t plug the gap…We’re all just a bit bereft.  Floating support will not cut it.  It’s like giving someone the best Christmas present ever and then three months down the line taking it away.  I just don’t know what we’re going to do for the most vulnerable people.  This service is for the most vulnerable people that we deal with and you can’t take it on yourself… the best thing we’ve ever had is going.

Staff in this case study also expressed serious concerns for their service users:

I’m seriously worried about the welfare of these people given the experiences they’re going through, what that could lead to. I think people could die from drug overdoses. I think people could take their own lives because it all gets too much.

As the quote below infers, so called ‘pilot project fatigue’ was regarded as an issue in several areas, where partner agencies often became suspicious of projects starting up and then ending within two years.  This made engagement with partners more difficult.

So, I think we’ve definitely made a difference to people and it’s such a shame, there’s going to be a big void again and people get forgotten about.  I think though there’s been a history that that happens.

In addition, the RSG case studies revealed that this ‘fatigue’ was often felt strongly by partner services that felt the benefit of the RSG-funded project, and feared they were soon to feel the increased pressure on their service as a result.  In Area C, for example, two partner services were concerned that the closure of the RSG project would result in more referrals to their services (that they were not equipped to handle) and that it would reduce their effectiveness to work with service users where joint-working was taking place.

For two RSG projects, plans were underway to fully sustain them.  Area D had successfully incorporated a housing first style model into its core service offer, making it a key part of its homelessness strategy.  Despite the local authority’s drive to make savings, it was keen to continue funding the housing first style service and recognised the quality of the service, the benefits it brought to individuals and the savings that it could achieve in other areas of council expenditure:

If you think about health, crime, pregnancy, exploitation, by us doing the wraparound service in that area we’re making savings in other areas.

In addition, the local authority accepted that the housing first style service had become established and needed more time to realise its real value.  One of its partner organisations made this clear:

I think it’s become embedded in our delivery.  It’s a service that works, it helps housing because if we sent seven of the people we currently have in there and if they were to show you the amount of time that has been wasted with those people in various accommodations, the amount of time they’ve spent in there and the amount of times they’ve been evicted from those places and the ongoing battle with the police and other things external to them, it will save housing.

In Area F, two local authorities had commissioned the RSG project. One local authority had funded the service for a further year after the RSG funding ended. In the other, the provider was closing cases due to a lack of future funding. The prospect of losing service users was seen as very unfortunate, given the complexity of the service user base and that, once unsupported, service users who had made good progress in certain areas, were once again at risk of homelessness:

We’ll be fairly shocked if within a couple of months they’re still housed cos it’s the team’s work with the landlords and the benefits that keep them housed, as soon as you lose that they’re going to stop paying the rent, Universal Credit’s one of those things where they can stop very quickly, get the money and that’s what they’ll do.

The decision not to re-commission the project was explained as a budget decision.  The local authority concerned was in the process of setting up a multi-agency safeguarding hub to include homelessness and housing specialist support and other safeguarding aspects.  This hub would mean service users have one point of contact but with a team behind that individual. They had used part of their homeless prevention grant to fund a homelessness specialist to be part of that team, as well as funding from their ALMO and the police.

This suggests that even in the context of a service with the same criteria, offering the same service and that has the same level of success, different local authorities make different decisions about continuation funding.  The process and pressures on local authorities are highly complex, but it does highlight that there are significant inconsistencies in service level provision throughout England, even in neighbouring areas.  This was an issue that several of the housing first style projects reflected on – that there was patchy coverage.

Look at the Homeless Link principles and my ask of government is just define Housing First, tell us what it is, give us a project brief, something that we know so that all the contracts are the same. I know it’s difficult cos homelessness is supposed to be localised, but there just seems such a divergence with all the different Housing First schemes that run… it felt like us and the people that held the contract had different views completely… The other one is having it clear in the funding is where the units are going to be sourced from…So how do we secure accommodation, to me to be permanent it should be social, we shouldn’t be going anywhere near the private sector unless there’s a five year lease on the property.  So there’s lots of unanswered stuff like that, very practical stuff which I’m guessing they’ll never tell us… and specifically for your non stock-holding authority, you’re basically having to sell Housing First as a package to them and they’re not interested cos it doesn’t cover any of the financial risks.

The RSG projects’ experience of housing first style models raises questions about the need to provide longer-term funding regimes for such initiatives and the need to resource projects in a manner that reflects both the local availability and accessibility of housing and the complexity of service users’ needs. 

4. Conclusions and Lessons

4.1 Introduction

The RSG programme can make a strong claim that it has stimulated new approaches to working with people with lived experiences of sleeping rough and multiple complex needs.  Local authorities have welcomed the opportunity to plug gaps in service provision and explore innovative and alternative working practices.  Moreover, the programme has provided proof that prioritising the needs of people who are sleeping rough and understanding the difficulties and barriers they face trying to live and improve their lives is possible and can be highly effective.

It also became clear that these interventions require longer-term funding.  The six projects in scope of this evaluation would have benefited from (and welcomed) longer-term funding.  The prospects of finding funding from local authority core budgets was reported to be limited at present and gaining extra funding via grants from central government limited local authorities’ ability to make long-term strategic responses to homelessness.  Furthermore, the RSG programme has revealed that the broader range of services that individuals require at the point when they are homeless and sleeping rough are not fully compatible with the precarious nature of living on the streets and dealing with addictions and poor mental health.  In that respect, seizing on this evidence and seeking ways to change and adapt key services so that they provide equal access to people who are rough sleeping would be a significant legacy of the programme.

The RSG programme has developed some important lessons for relieving rough sleeping and responding effectively to those with complex needs.  The following sections discuss and summarise the key learning that has emerged.

4.2 Models of support

The RSG projects demonstrated clearly why new and bespoke ways of supporting people who are sleeping rough, or at risk of sleeping rough, are required.  It was clear that most service users had a history with a range of services and support,^{[footnote 9]} and yet positive outcomes had not been achieved.  The RSG projects had recognised this clearly.  It is, therefore, critical to avoid replication of past failures, and to ensure that any new engagement with people sleeping rough leads to a noticeable improvement in their experiences of support.

The RSG projects also clearly demonstrated how to engage with people sleeping rough and with complex needs, and there was some emerging evidence that these practices had the ability to relieve rough sleeping and maintain improvements.^{[footnote 10]} The RSG has stimulated new ways of approaching the problems of rough sleeping by taking intensive and person-centred approaches.

There were several key messages.  Firstly, for service users with complex needs, and often dealing with a chaotic life, intensive key working support was seen as beneficial.  For example, one benefit was the ability of key workers to negotiate better access to a broad range of services that are required by an individual with complex needs.  Secondly, the broad range of specialist services required to support individuals with complex needs who sleep rough are not always geared to respond effectively to precariousness of their lives and may offer their services on a conditional basis that is very difficult (or impossible) for some people in this cohort to uphold. There is clearly a need to challenge housing, health, social care, employment and welfare benefit services to adapt to better cater to this cohort. Thirdly, services that can provide quick (or immediate) assistance are required to meet the needs of this group.  Engagement requires momentum – making help and support happen more quickly is regarded as highly desirable by service users who have previously suffered delays and barriers to getting appropriate help.

Housing is the key component to success but providing stable and decent housing remains a significant challenge and distinctive pathways into stable housing are required.  Too often, temporary housing (including Bed and Breakfast accommodation) is the only option, with no obvious pathway towards permanent housing.  There were reports that some service users preferred to sleep rough rather than go into particular hostels that they found problematic.  Housing first style models are difficult to implement but it has the potential to provide a radical and positive disruption to the way in which the UK’s housing system currently meets the needs of individuals who sleep rough.

The availability of suitable housing throughout a broad area is key to the success of Housing first style models.  The evidence suggests that models that look to make use of social housing and the PRS may have much merit for people with complex needs.  This extends choice of area, and potentially, increases availability.  To successfully deliver this strategy:

• ‘Buy-in’ to the radical principles of Housing First must be achieved by key stakeholders including housing providers, key local authority departments, health services and voluntary sector organisations where they are involved.
• Appropriate referral structures, managed by multi-agency panels, are required to ensure fairness and independence where social housing stock (or council nomination rights) is being used. An appropriate balance is required in order to avoid unnecessarily delaying access to housing.
• Projects with staff who are specifically trained to engage and negotiate access to the PRS are required, including staff who are able to form positive relationships with landlords and offer reassurances about the support being offered to the tenant. 
• Housing first style services will require longer implementation periods in areas where there has not been previous positive engagement between rough sleeping services and housing providers (including private landlords).

4.3 Workforce development

The findings of this report highlight that people sleeping rough with complex needs require a specialist response.  To achieve this, there are important workforce-related considerations.  Working with people sleeping rough with complex needs requires a broad range of skills.    Attitude and interpersonal skills were particularly valued.  Projects may have to be more diverse in their recruitment practices to attract the right candidates and overcome high levels of staff turnover.  There is scope for recruiting staff with ‘lived experience’ of homelessness but this requires investment in training and development and well-resourced supervision and management structures.  All projects identified that a range of interpersonal skills were needed to work with people with complex needs. These included empathy and resilience. Staff also needed a wide range of practical skills and knowledge associated with working with individuals who had a wide range of needs. There is a need to review relevant training opportunities geared towards upskilling staff to work with people sleeping rough and having a range and complexity of needs.  Training and workforce development across services may be needed also, especially where there are not established cultures of collaboration, or where there are different service approaches to engagement (for instance, conditional or unconditional support).

4.4 Multi-agency working

The experiences of the RSG projects in relation to multi-agency and partnership working confirm the importance of co-ordinated and collaborative approaches to provide holistic services which are responsive to individual service users’ needs. The implication here is that future interventions should prioritise working across and with the range of providers who are supporting people who are sleeping rough with complex needs. Arrangements for collaborative working will be dependent on local circumstances (which include local service landscapes and the strengths and weaknesses of local service provision).

Local authorities had a key role to play by coordinating services and working towards shared goals.  Multi-agency working was also enhanced by effective data-sharing.  The Chain system operating in London was a good example of this.

4.5 Engaging with service users

Although the cohort of people who sleep rough and have complex needs may be commonly described as a ‘hard to reach group’, the RSG Programme’s learning contests that label.  Rather, it is a cohort of people that require a particular approach to engagement and recruitment.  The following recommendations for good practice emerged:

• Staff have relevant skills: are knowledgeable and have good interpersonal skills, are empathetic and patient, and able to challenge a service user in a positive manner.
• Safe places, open to all, are important for building trust and rapport in a comfortable environment.  Such places should remain accessible to people who may have previously ‘broken the rules’. 
• Related to this, projects were more successful when they treated service users with respect and in a professional way.  Keeping promises was highly valued by service users.

4.6 Funding and sustainability

There is a need to consider options for longer-term funding in future commissioning and funding activities.  There is considerable scope for shared learning across services that are supporting people with complex needs who are sleeping rough, and in particular for shared learning around strategies for the incorporation of aspects of services that ‘work’ into mainstream and future initiatives.

1. The term ‘complex needs’ was used throughout the evaluation and in this report to refer to people who were sleeping rough and also experiencing one or more other needs which included mental and physical ill-health, substance addiction and offending behaviour. In many cases these needs are severe and long-standing. ↩

2. This evaluation did not include testing the fidelity of these projects against the Housing First Principles. These three projects offer housing first style support but are separate from the Housing First Regional Pilots which are currently taking place in Liverpool City Region, Greater Manchester and West Midlands. ↩

3. The term ‘complex needs’ was used throughout the evaluation and in this report to refer to people who were sleeping rough and also experiencing one or more other needs which included mental and physical ill-health, substance addiction and offending behaviour. In many cases these needs are severe and long-standing. ↩

4. This includes a contribution of £1m from the host authority. ↩

5. Rough Sleeping Programme Bidding Prospectus. ↩

6. Making Every Adult Matter. ↩

7. Homeless Link (2016) Housing First in England: The principles. ↩

8. This panel predated the housing first style project and its purpose is wider than Housing First. ↩

9. See also: Rough Sleeping Complex Needs Evaluation: Understanding Service User Needs and Progress. ↩

10. Ibid. ↩