Ending homelessness together: updated action plan - October 2020

Actions we will take 5: we will join up planning and resources to tackle homelessness

Partnership working

Homelessness is about much more than housing, and homelessness prevention will be most effective when it is recognised as a priority for a range of public services. We have already set out our intention to develop protocols with public institutions as part of the prevention pathways work. This should ensure there is a multi-agency approach to the allocation of specialist accommodation (e.g. supported housing) for the small number of people who – for various reasons – do not feel ready for a permanent tenancy.

We know that there is a strong relationship between homelessness and health in Scotland, and clear evidence of a relationship between repeat homelessness, drugs, alcohol and mental health. Dr Andrew Waugh’s report, Health and homelessness in Scotland, found that homelessness affects a sizable minority of people in Scotland (at least 8% of the population as at 30 June 2015 had experienced homelessness at some point in their lives). The report showed:

• increased interactions with health services preceded people becoming homeless;
• a peak in interactions with health services was seen around the time of the first homelessness assessment; and
• higher levels of interactions with health services followed the first homelessness assessment for people experiencing repeat homelessness.

By preventing homelessness we can improve health outcomes. In turn, improved health will support people to keep their homes while they focus on other goals. This is why the cross public sector homelessness prevention duty is vital and remains a central priority to this plan. But legislation alone will not bring about the shift we need. We will continue to take forward a range of activity to build, embed and maintain partnership approaches to prevent and respond to homelessness and to achieve our vision of everyone having a settled home that meets their needs.

Dundee Survival Group provides accommodation with housing support to people experiencing homelessness in Dundee. Currently, they are working in partnership with the Housing Service and Dundee Health and Social Care Partnership on a ‘Test of Change’ project providing wheelchair accessible flats as step down accommodation. This helps provide early discharge from hospital for people made homeless because their accommodation is no longer suitable for them post treatment.

One of the more positive impacts of COVID-19 has been the way in which people have pulled together to introduce measures that might have previously taken months or years to implement. We saw swifter and more open information sharing; and more collaboration between organisations. We saw more rapid decision-making, especially when it came to funding decisions. We saw more and better cross-sector and partnership working. We saw a willingness to embrace new technologies and connect over online platforms. We saw more joined-up responses to meeting clinical and emotional needs. We also saw a reduction in bureaucracy, which led to people getting the support they needed more quickly, and with fewer barriers. 

The pandemic galvanised partners to focus efforts on what was important: protecting people from imminent harm. As a result, we found solutions to problems associated with remote working and organisational structures. We want to retain the best aspects of these ways of working. When people are encouraged to rally around a common aim with a sense of urgency we see better results. Those principles apply to the ongoing challenge of homelessness and will be crucial in bringing about an end to homelessness and rough sleeping for good.

“The multi-agency approach, that has seen everyone come together to ‘get the job done’ has in the past not been adopted by all agencies. This crisis has seen it happen and, if nothing else can be taken away from the situation we have found ourselves in, it can be built on to provide a more person-centred joined-up approach for all service users, which in turn will achieve better outcomes.” Homelessness service provider

Health and homelessness

We know people experiencing homelessness are more likely to have some form of mental or physical health problem. People who have been rough sleeping face particular risks during the pandemic as they are more likely to have chronic health conditions. 

To help keep people safe, Public Health Scotland produced guidance on infection prevention and control measures in non-healthcare settings, including homelessness settings, in March 2020. This guidance has been updated regularly during the crisis. Anyone in Scotland who is self-isolating because they are showing symptoms of coronavirus is eligible for a test.

We will continue to work with Public Health Scotland to ensure this guidance remains fit for purpose. We will also work with partners to develop separate guidance for homelessness services in Scotland.

In recognition of the links between homelessness and poor health outcomes, collaboration between health and homelessness agencies has been strengthened in recent years. We are already seeing the value from joint working being demonstrated through joint initiatives and learning from local pilots:

• At the Victoria Hospital in Kirkcaldy, health staff refer patients who are homeless or at immediate risk of losing their home to Shelter Scotland advisers based in the hospital. 
• The Housing First pathfinder is jointly funded from Scottish Government housing and health budgets. 
• Healthcare Improvement Scotland’s iHub and Shelter Scotland are working together to design a personal housing plan template.
• Public Health Scotland is undertaking research on the impact of COVID-19 on marginalised groups. Lived experience research is being carried out in partnership with Homeless Network Scotland, Strathclyde University, Healthcare Improvement Scotland, and CLiCK and is expected to report in March 2021.
• NHS Health Scotland has worked with three social housing providers to produce case studies that detail what they have learned about trauma and changes they have made to practice. These case studies will help build understanding of trauma-informed services in the housing sector. They are due to be published in autumn 2020.
• Recognising that staff working in primary care have a unique opportunity to positively impact the health and wellbeing of people experiencing homelessness, Public Health Scotland will launch a new learning resource for primary care staff later this year. 
• At a national level, both the Homelessness Prevention and Strategy Group and the rapid rehousing transition plans subgroup now include health representatives. 

Many people with experience of rough sleeping have mental health and substance use problems. In areas where there is an integrated approach to service provision, people with complex health and social problems are better supported. We have already committed to a ‘no wrong door’ approach to remove barriers to services. We will continue to promote an integrated and holistic model of care. To that end, we will improve how we use Public Health Scotland data and intelligence capabilities to ensure improved outcomes following hospital discharge into a community setting. 

The Hard Edges Scotland report, which highlights the complexity of the lives of people facing multiple disadvantage in Scotland, was published in 2019. Building on this work and on the learning during the pandemic, we are making sure that our responses to people experiencing homelessness take into account the compounded impact of substance use, experience of the justice system, poor physical and mental health, trauma, violence, domestic abuse and poverty.

“Despite hugely effective emergency measures that have seen many people transition away from experiencing chronic rough sleeping, there remain significant barriers for those with the most extreme mental health challenges who as a result are unable to accept the support on offer. Nationally we need to examine why and re-examine what needs to be done to provide effective mental health interventions for people experiencing chaotic street lifestyles along with alternative supported accommodation solutions that they will feel more able to accept and sustain.” Homelessness service provider

During the pandemic, we received positive responses from some people about a relaxation of the approach to the supervision and frequency of dispensing of opioid substitution therapy (methadone in particular). The Scottish Government also relaxed rules around the use of naloxone – a drug that can reverse opiate overdoses – and made longer-acting drug treatments more widely available.

We intend to learn from this period to further improve drug and alcohol treatment and harm reduction services.

Public Health Scotland is committed to working closely with COSLA and local authorities to support implementation of the housing, health and social care actions in this plan. Public Health Scotland will join forces with health and social care partnerships to explore what further contribution can be made to tackling and preventing homelessness, including through the equivalent of housing contribution statements where appropriate.

Employability

Employment provides a sense of achievement and confidence, contributes to equality and inclusion, results in improved general health and mental wellbeing and helps lift people out of poverty.

We had already agreed to explore how local housing strategies and personal housing plans might incorporate employability support for people at risk of homelessness as part of the housing options service. Employment support is an important part of the Scottish Government’s work to support Scotland’s recovery from the public health crisis, and additional resources have been made available to reflect this. Local work led by councils will ensure that tailored support is available to those who need it. We will work with local authorities to ensure employment and housing support is provided in a joined-up way so that people are fully aware of the range of help and advice available to them.