Agenda item

The purpose of the item is to facilitate a discussion about the health (and wellbeing) needs of rough sleepers and how those needs can be better met by better/more joined up ways of working. 

The Chair welcomed, Michael Angus, Project Manager at the Baron’s Court Project (BCP) to present the report of the Rough Sleepers Commission (RSC), which had been established in February 2017.

Chaired by Jon Sparkes, CEO of Crisis, the RSC had worked over nine months to help the council achieve its objective of ending rough sleeping in the borough, and had made 30 recommendations to this end. The report would be launched on 13 March.

Research methodology included service-user, peer-led work, facilitated by Groundswell. They had visited pilot projects such as Housing First. There had been a 15% increase in rough sleepers in the UK and the BCP had seen a 16% increase in the number of rough sleepers they saw.

Rough sleepers had poorer health outcomes and were more likely to have mental health issues. This could lead to physical health issues and the average life expectancy of a person who had slept rough was 47 years.

Michael Angus gave the example of one person who had slept rough for 20 years, experiencing both mental and physical problems and becoming diabetic. Another rough sleeper had been diagnosed with post-traumatic stress disorder. His payments of Universal Credit and PIP (Personal Independence Payment) were delayed, which meant no money and therefore no social interaction. He started attending the BCP and subsequently received benefits advice and support.

Councillor Coleman asked what the priority for HWB action should be. Michael Angus called for:

·         Jointly commissioned services, exploring other joined-up models;

·         Joined-up administration so that there were not separate compliance monitoring procedures for the CCG and the council, and separate funding applications and outcomes; and

·         Joined-up funding awards between the council and CGG as there was often a mismatch in funding durations, and the lack of alignment made it difficult to achieve long-term provision.

Councillor Coleman welcomed the suggestions. Keith Mallinson proposed that a representative from Housing be appointed to the Board, given that a lack of housing exacerbated mental health conditions. This was agreed.

Councillor Coleman suggested that it would be useful to get the input of the Department for Work and Pensions (DWP), to get a better understanding of what was going on locally. The council had been trying to deal with the consequences of the introduction of Universal Credit and had held a workshop with a wide range of local players, including the DWP.

Lisa Redfern said she would ascertain what joint work was taking place within the council. She would be able to monitor progress as she attended the Social Inclusion Cabinet Member Board briefings.

Councillor Coleman asked if it was possible to explore the idea of combining approaches and unifying monitoring, grants and timelines to co-ordinate support from the council and the CCG. Janet Cree said the CCG would support this.

It was agreed that one representative from each of the council and CCG would work jointly to explore this further, identifying needs, overlaps and opportunities for alignment. They would provide an update to the Board.

ACTION: Lisa Redfern / Janet Cree

The Board discussed the CCG’s written response to the Commission’s report. The idea of a Hackathon for Rough Sleepers was raised and Janet Cree said they would support this. She also said the CCG would aim to work more closely with the voluntary sector in designing services.

Michael Angus welcomed this. He noted that the BCP was run with volunteers and was the only-drop in centre in the borough that was accessible without a referral. This was a difficult service to model. Users preferred a drop-in accessible the early afternoon and evening so that they could have their medication. Homelessness provision throughout the sector was disjointed. St Mungo’s and BCP worked differently.

It was recognised that the complexities of modelling services would need the combined expertise of both the voluntary and public sector.

Vanessa Andreae acknowledged that there were not enough outreach staff on the streets. She said she would like to see more but said the CCG was not in a position to fund this. Michael Angus noted that St Mungo’s did outreach work three nights a week and during the day, fielding a very good but small team. They required funding to do more and be more effective.

Lisa Redfern asked if there was a pan-London group that co-ordinated work, research or policy. Michael Angus said StreetLink was a reporting service that gave information about rough sleepers to the relevant local authorities. Lisa Redfern acknowledged the competitive nature of the homelessness sector. She also suggested the link with social isolation and loneliness angle needed to be considered. Martin Burrows of Groundswell said collaborative work in terms of a pan-London group had been stymied by competition for funding.

Councillor Coleman asked about proving the benefit financially of helping rough sleepers and whether this could be costed. Martin Burrows gave the example of a rough sleeper who did not attend medical appointments until he began to be supported by Groundswell volunteers. If the cost of a missed appointment, earlier diagnosis to prevent deterioration and the management of health conditions could be quantified and evidenced, addressing rough sleeping might be shown to save the NHS money.

Martin Burrows added that the longer people slept rough, the bigger the impact on mental and physical health, which incurred greater treatment costs and led to the development of possibly more complex health needs and poorer long-term health outcomes. A Department of Health study had identified that rough sleepers were four times more likely to be unwell, with 73% experiencing physical health needs. Supporting rough sleepers would save costs for emergency services in the long term. Rearranging services to focus on prevention would also cut the cost of treatment.

Janet Cree said the patient benefits were why the CCG was commissioning health care in this area.  She acknowledged that 26% of rough sleepers ended up in Accident and Emergency departments but queried the value of doing pieces of work that looked just at the cost of not doing more. Vanessa Andreae said it was difficult to evaluate the cost benefit and that it was important to know what provision was being funded.

Martin Burrows said they worked with people who had chronic conditions to get them to their health appointments. Spending a bit more in the short term would give a long-term saving. Vanessa Andreae said that by their nature, the people Groundswell helped would have had chronic conditions. Michael Angus added that at a recent training session with 34 officers from the Metropolitan Police, none of them were aware of available provision.

Martin Burrows said that running a service with one-year, fixed term funding was very difficult. Staff worked under higher stress levels because of a lack of employment certainty.

Keith Mallinson agreed and added that commissioning and recruitment difficulties made it harder to attract good staff who wanted to stay. A longer-term planning and funding approach, similar to the approach taken in Germany, was required. Smaller organisations were consistently losing out because they could not put together joint bids.

Dr Shamini Gnani of Imperial College's School of Public Health and a local GP, said that GP practices were tired of getting one-year funding for so-called pilot projects that died after a year. Longer-term funding was required.

Councillor Coleman sought clarification regarding the variations in fixed term funding, contract commissioning planning and annual funding allocations. Lisa Redfern said some council awards were for three-year contracts and acknowledged the benefit of having a strategic contract approach across London. Janet Cree said some CCG contracts awards were also for three years, and some had the option of being extended up to five years.

Vanessa Andreae agreed with the challenges that short-term funding presented. She said the need was to commission for value, with sufficient capacity, tangible outcomes, measures and evidence. The CCG was working collaboratively with other CCGs and GPs to monitor social prescribing projects, co-ordinating and work together with people in the local community to ensure organisations had a local interface.

White City Enterprise illustrated this approach. There was a need for a discussion around community organisations which were refused funding because they could not evidence the value of the work they did.

Councillor Coleman said there was a need to make it easier for smaller charities to tender for work from the council and CCG, in line with the council’s “economic and social value” approach.

Janet Cree suggested that a working party be established to help with implementation of the Commission’s recommendations and proposed that this be a strand of work for the Board. Vanessa Andreae added that the CCG would not want to be involved in joint commissioning in a 50:50 partnership. However, a joint team to implement the recommendations would be something that could be further explored, provided that the aims were clear.

Councillor Coleman agreed that there was a need for a small group of people to come together to work out what was feasible and report to the Board, setting out a clear plan which involved the council (including Housing) and the CCG as to how the recommendations could be implemented. Graham Terry said this should address commissioning for outcomes.