National and local contexts
Shelter described homelessness as affecting 81,000 households during 2013-14, of which 2,414 were people rough sleeping, a rise of 37% since 2010. An ongoing rise in officially estimated rough sleeper numbers remained evident in 2014, with the national total up by 55 per cent since 2010. At 14 per cent, the 2014 country-wide was the largest since 2011 (Homelessness Monitor Report, 2016).
Since bottoming out in 2010/11, homeless placements in temporary accommodation have risen sharply, with the overall national total rising by 12 per cent in the year to 30th June 2015; up by 40 per cent since its low point four years earlier. Although accounting for only eight per cent of the national total, B&B placements rose sharply (23%) in the most recent year. 'Out of district' placements also continue to rise, now accounting for 26 per cent of the national total, up from only 11 per cent in 2010/11. Such placements mainly involve London boroughs.
Homelessness is linked to high levels of crime, mental health issues, substance misuse, high unemployment and high levels of benefits:
- 45% compared to 25% in the general population, have a long term health problem
- 41% compared to 28% and 36% have used drugs and/or 27% use or are recovering from alcohol problems.
- 79% of prisoners who reported homelessness before custody reoffended within a year of release compared to 47% of those unaffected by homelessness.
As well as issues relating to offending and substance misuse, homelessness also has health implications. Homeless people have poorer health outcomes than the
general population, and an average age of death 30 years below the national average. Living on the streets or without a stable home can make people vulnerable to illness, poor mental health and drug and alcohol problems. Homeless people often seek medical treatment at a later stage during illness, leading to costly secondary health care and worsened health outcomes. This situation is exacerbated by the reduced potential for recovery due to many homeless people returning to insecure accommodation or rough sleeping after medical treatment. In some cases, accommodation may be lost during their time in hospital.
Research carried out in 2010 showed that the total cost of hospital use by homeless people is estimated to be about four times higher than the general population. Looking at inpatient costs alone, the difference is eight times higher among homeless people.
Evidence about what works
A report by the Centre for Health Service Economics & Organisation (CHSEO) in 2011 showed that projects and models which have been implemented to improve admission and discharge practice have demonstrated cost benefits in two different ways:
- Reduced average length of stay as homeless people are more likely to be discharged sooner if their houseing and next steps are adequaterly addressed
- Greater recovery rates through timely discharge to suitable accommodation, resulting in fewer emergency readmissions to hospital within 28 days.
The first report from the Ministerial Working Group on tackling and preventing homelessness, Vision to end rough sleeping: no second night out nationwide (2011) included a commitment to improve hospital discharge for homeless people. The following year, Homeless Link and St Mungo’s were commissioned by DH to explore how the system of hospital admission and discharge was working for homeless people, and what more needed to be done to improve where the system was failing to discharge homeless people into appropriate accommodation. The report, Improving hospital admission and discharge for people who are homeless, published (May 2012) showed that more than 70% of homeless people had been discharged from hospital back onto the street, without their housing or underlying health problems being address. This was further damaging their health and increasing costs to the NHS through ‘revolving door’ admissions.
Government investment of £10million was announced in May 2013 for the Homeless Hospital Discharge Fund, for voluntary sector organisations, working in partnership with the NHS and local government, to bid for money to improve hospital discharge arrangements for homeless people. Homeless link was commissioned by DH to evaluate these projects focusing on what works in supporting homeless people from being readmitted to hospital (both through emergency and planned admissions) and securing stable housing and support after a hospital stay. The findings identified key features of effective models and practice for future replication including:
- Having a model which combines access to accommodation alongside link workers. Outcomes data showed that where this was available, more clients were discharged into appropriate accomodation (93% compared to 71% overall).
- Making intensive support available for people once they have found accomodation is important to improve their recovery and discharge process.
- Clarification of the ‘client group’ that projects/schemes are intended to work with (eg rough sleepers, those at risk of homelessness, groups with specific needs such as mental health or substance misuse issues, hostel residents).
Potential outcomes achieved through Shared Lives
A Shared Lives arrangement provides an alternative option for people with a complex profile of support needs including people who are homeless or at risk of
becoming homeless. With its careful matching process, Shared Lives is ideally suited to manage such complexity in an individual way, giving the person living in a Shared Lives arrangement the opportunity to realise their full potential.
This is an area where Shared Lives has the potential to offer a unique combination of accommodation, tailored support and a relationship with a Shared Lives carer and a clear focus on building new networks and communities. This latter point is an important one to stress in terms of breaking the cycle for people coming out of rehab/prison where their networks are all based around their drug using/criminal behaviour etc. Shared Lives gives people an opportunity to build new social networks as well as providing support to look after their health, get and retain paid work and plan for the future.
Stories of lived experience
Dave is a man in his fifties who sustained head injuries inflicted by his father as a child and has experienced a lifetime of mental health difficulties. These have often presented themselves in the form of symptoms of bipolar disorder, which he is not able to recognise and manage himself. Dave has never been able to live fully independently and has spent many years living in various hostels and shelters, where he was seen as “looking like a tramp” and was very vulnerable. He has been living within Shared Lives for nine years in two very successful arrangements. Although it is possible he may never live completely independently, Dave now has a network of positive friendships and relationships and attends the local football club with the son of his previous Shared Lives carer. He dresses smartly and manages his personal care with support, receiving regular medical and dental treatment. When his mental health deteriorates it's noticed and he gets the right support.
Andrew was living in a homeless hostel before being referred to Shared Lives by his Drugs and Alcohol team. He has seizures and was generally in poor health as a result of his alcohol dependency. Within a few months his health, wellbeing and appearance improved. Previously unable to manage his money, he now has support to manage his finances. He now moderates his alcohol intake and he and his Shared Lives carer have become friends.