Prevention of Homelessness Duties - A Joint Scottish Government and COSLA Consultation

We agree with the foundational principles in terms of the responsibility to prevent homelessness being a shared public responsibility and the importance of prevention / early intervention.

The provision of appropriate housing is a key factor in ensuring positive health and social care outcomes for individuals. The importance of housing is reflected in the IJB’s Strategic Plan, which recognises the central role of housing in delivering the IJB’s strategic priorities, including enabling people to live at home or in a homely setting for as long as possible.

We work closely with Housing colleagues at both operational and strategic levels to help ensure that a joined-up, person centred approach is taken to meeting housing and other needs. This includes jointly identifying solutions to resolve the housing needs of people with complex needs. It also involves working in partnership to plan and invest in future housing provision, including new and innovative models designed to meet housing, health and social care needs.

It would be good to see more explicit reference to ‘partnership working’ in the foundational principles as this is key to delivering the ambitions outlined in the consultation paper (the current wording talks of ‘shared public responsibility’ but does not mention ‘partnership’ or ‘joint working’ in relation to fulfilling this responsibility).

Yes, we agree that introducing new duties will help to ensure early intervention to prevent homelessness.

Yes, we agree that introducing a requirement to ‘ask and act’ has the potential to make a positive impact in preventing homelessness. However, it is the process that follows and the availability of appropriate resources that will be key to deliver improved outcomes.

The public bodies outlined in the consultation paper seem to the be the most appropriate. The role of third sector provider organisations is also relevant and this could potentially be reflected in commissioning arrangements.

In part. The responsibility for HSCP services to identify individuals at risk of homelessness is clear and relatively straightforward to define. However, the second part of the statement regarding the requirement to assist service users into suitable housing is more ambiguous and we would need more clarification as to what this would involve, including specific details and where each partner’s responsibility would lie.

In part. We agree that introducing a new legislative duty on Integration Authorities to identify housing circumstances has the potential to contribute to greater prevention of homelessness. However, the arrangements / processes in place to respond to this the identification of need and the availability of additional resources to deliver the interventions required will be key to ensuring the new legislation has the desired impact.

Given that housing provision is outwith IJB current responsibilities, we would suggest that the IJB’s primary legal responsibility would be to meet the care and support needs of an individual in order to enable them to take up accommodation provided by the local authority / other housing partner. This includes the provision of adaptations and technology enabled care (TEC) solutions in response to specific needs.

There is already a well-established, partnership approach to meeting the needs of individuals presenting with complex needs in East Lothian. In the majority of cases where people have complex needs, packages of care can be designed to enable them to live in mainstream housing, often involving creative approaches to providing specialist support. Where needs cannot be met in mainstream housing, even with additional support, partners work collaboratively to develop alternative provision. It is not the HSCP’s experience locally that homelessness services are often left to ‘carry the can’.

It is good to note that the proposals recognise the effectiveness of the existing Housing First approach in relation to delivering positive outcomes for individuals through mainstream housing with tailored support.

The HSCP’s involvement in the development of ‘core and cluster’ and other specialist housing provision and approaches to ‘wraparound care’ and peer support have also increasingly enabled us to meet health and social care needs in appropriate housing. Early involvement by the HSCP in the design of new housing provision is helping to ensure that more options will be available for people with complex needs in the future.

As above, it is suggested the IJB’s responsibility should be limited to meeting care and support needs to allow an individual to access appropriate housing. However, it would be useful for legal responsibility to be established for the lead agency role in cases where there are complex needs (that cannot be met in mainstream housing with support) and a partnership approach is required.

Whilst there is already good practice in East Lothian and examples of new and innovative approaches to meeting people’s health, social care and housing needs, the introduction of legislation (with the caveats noted elsewhere in this response) will help to further embed this work and also bring potential benefits in terms of any development of national frameworks, guidance, networks, etc.

We agree with the proposal that where a social worker / social care worker identifies a risk of homelessness they should make a referral to the relevant local authority service. In terms of the second part of the proposal, carrying out a social care needs assessment when unmet social care needs are considered to exist is already central to the role of social work staff. (see also Q10 above)

We agree that there should be a duty for IAs to cooperate to ensure that the health and social care needs of people who are homeless / at risk of becoming homelessness are met.

As noted above, joint working across health, social care and housing services is already well established.

Local hospital staff in East Lothian already have good links and work collaboratively with East Lothian Council housing teams, including the Housing Options Team. The proposed changes would help to further develop these links, embed good practice and ensure consistency across all HSCP settings.

Yes, this would necessitate the development of an approach that leads to early discussion of patients’ housing needs (ideally at the point they enter hospital). Early discussion helps to facilitate the involvement of a range of professionals able to assist with housing related needs.

Clear guidance would be needed in terms of what would constitute ‘threat of homelessness’. In some cases, the health issues that lead someone to be admitted to hospital mean that there existing housing no longer meets their needs at the point they are clinically ready to be discharged. This presents a different challenge and requires a different response from when an individual has no fixed accommodation in place at the point of potential discharge. We would suggest that the proposed statutory change should apply specifically to the latter scenario.

See Q15 - would reinforce existing good practice.

We agree with the proposal that GPs should refer patients to local authority housing services where they identify a risk of homelessness. For some patients, this might be useful in terms of forming part of their management plan.

The formal mechanisms to vary GP duties are through changes to the Scottish GP contract (which is not due for review) or via a Direct Enhanced Service (DES) for those services that Health Boards are legally obliged to commission to ensure provision for patients within their area. Those DESs in operation are nationally determined and cover a limited range of service areas. The development of any new DES would require agreement from the Scottish Government and British Medical Association. Individual practices do not have to agree to undertake this work. Lastly, a Local Enhanced Service (LES) can be developed at local Health Board level, however, there is again no obligation on GP practices to participate in a LES.

Local negotiation and the development of a referral protocol through the RefHelp system provides an informal option to engage with GPs in referring patients at risk of homelessness to the local authority.

Training, information and advice would be needed to assist GPs and other primary care staff in identifying need and making onward referrals.

We would suggest that other primary care services delivered by the HSCP could also play a role in homelessness prevention – in East Lothian, that would include services such as CWIC (Care When it Counts), CWIC Mental Health and CTAC (Community Treatement and Care).

For example, in the case of our CWIC Mental Health service (which provides quick access to support with mild to moderate mental health issues), ‘risk of homelessness’ could be added to the initial assessment template used by CWIC Mental Health practitioners (with practitioners also being provided with training / guidance to help them fulfil the ‘ask and act’ role).

Our Community Link Worker service (delivered by a number of external providers) already looks at the range of needs service users present with, which would include housing issues / homelessness risk. However, consideration could be given to explicit inclusion of homelessness prevention in the next iteration of the Community Link Worker service contracts (coming up for renewal in the near future).

A case coordination approach is already in place in East Lothian. This works well in terms of facilitating input from the relevant services to improve outcomes for people with complex needs. The introduction of a statutory duty may help to underpin this approach and support further development.

As noted above, in the majority of cases, solutions are developed collaboratively to meet the housing, health and social care needs of individuals with complex needs in mainstream housing with appropriate care and support.

Use of the Housing First approach in East Lothian is a good example of an approach that facilitates joint working between a number of services to deliver person-centred outcomes. This is supported by an East Lothian Housing First protocol and an informal Housing First Core Partnership (involving staff from housing, justice social work, mental health and substance use services).

There would need to be an agreed definition of what constitutes ‘complex needs’ in this context. Agreement would also need to be reached as to the range of partners who are required to engage, their roles / responsibilities and who the lead organisation should be (although the proposal to have the IA as lead is noted).

See above

As noted above, a case coordination approach already exists in East Lothian and works well. However, the introduction of a duty for a wider range of partners to participate may be helpful in terms of further embedding this approach and ensuring involvement of all relevant parties.

It is agreed that Health Visitors are well positioned to play a role in identifying families at risk of homelessness and to request assistance in relation to this.

If a formal ‘duty’ were to be introduced this would have to be incorporated in the Universal Pathway / national health visiting guidance and consideration would have to be given to issues of consent, documentation, etc.

Health Visitors are already involved in identifying housing needs / homelessness risk and will refer individuals to housing services where appropriate. However, it is suggested that a simpler, slicker process for enabling this would be welcomed, along with training for staff to assist them in implementation.

Research tells us that not having a safe and secure place to go after being released from custody increases the chances of imminent re-offending/contact with the police. Individuals in prison usually have limited access to funds and are often not in a position to arrange housing for themselves; due to a lack of access to their local homeless department from a custodial setting, and not having the knowledge around accessing relevant supports.

A community justice approach to pre-release planning is essential. Access to the names of those due for release (at least three months prior to release) is vital for any pre-release planning to take place, as is access to the individuals concerned.

If local authorities can be provided with this information, multi-agency meetings can co-ordinated on a regular basis to aid a smoother transition back into the community. I know in East Lothian being able to communicate with prisoners via e-mail as well as in person visits has been helpful for pre-release planning.

Where a custodial release date is known, the option of guaranteed ‘homeless’ accommodation must not be considered as appropriate – leaving custody and being put into a B&B or hotel does not meet service user need. Current practice often means that accommodation is guaranteed, but the address is not known until presentation at the housing office – this is not acceptable.

It’s more difficult for those on remand who are released from Court, or for those whose sentence is backdated and release is on day of sentencing. In these cases, being directed to the Court social work office might be the first port of call. There enquiries could be made to local housing office.

Working together and sharing information can only be of use to co-ordinating the support required. There is also precedent set in the form of MAPPA – all local authorities already have involvement and are versed in such working.

It is important that any new duties do not become too complex / dominated by form filling. Everyone is busy and adding in new ways of working is most effective if the right people are involved and decisions can be made easily.

For the critical few complex cases there needs to be ‘fast track’ access to services. This needs to be understood and agreed at a higher level to avoid inconsistencies.

Ongoing support and review is also important as individual’s needs and risk change over time.

A community justice approach to pre-release planning is essential. Access to the names of those due for release (at least three months prior to release) is vital for any pre-release planning to take place, as is access to the individuals concerned.

If local authorities can be provided with this information, multi-agency meetings can co-ordinated on a regular basis to aid a smoother transition back into the community. I know in East Lothian being able to communicate with prisoners via e-mail as well as in person visits has been helpful for pre-release planning.

Where a custodial release date is known, the option of guaranteed ‘homeless’ accommodation must not be considered as appropriate – leaving custody and being put into a B&B or hotel does not meet service user need. Current practice often means that accommodation is guaranteed, but the address is not known until presentation at the housing office – this is not acceptable.

It’s more difficult for those on remand who are released from Court, or for those whose sentence is backdated and release is on day of sentencing. In these cases, being directed to the Court social work office might be the first port of call. There enquiries could be made to local housing office.

Currently East Lothian Justice Services have good links with homelessness services and monthly meetings are already taking place, along with the Police and substance misuse services to ease the transition back to community living. All agencies involved in this agree that our planned approach saves time later on.

Issues with data sharing between NHS and Council services can be an issue for HSCP services, and there is certainly potential for this to create a barrier to joint working with respect to the proposed homelessness prevention approach. The frequent need for a quick response in situations where there is risk of homelessness makes the straightforward sharing of data an important enabler. However, the early development of approaches / protocols relating to data sharing would help address this, and there are certainly existing examples of approaches that work well (for example, public protection functions).

The resource implications for IAs will depend on which elements of the proposals go on to become part of the new legislation. There are certainly implications in terms of additional HSCP staff time required to fulfil any duties. This could include, for example, setting up new processes and procedures, attending additional case coordination meetings, completing necessary monitoring / reporting, etc.

There would also resource implications should the IJB be given primary responsibility for meeting accommodation and support needs where cases are too complex for needs to be met in mainstream accommodation with support.

For some teams / individuals, the legislation would not change their practice significantly, however, it does bring a welcome opportunity to embed existing practice, carry out further development and ensure a consistent approach across teams / services and between partners.

Yes, in the longer term, early intervention and prevention is likely to impact positively on local authority housing costs. Less tangible perhaps, but still important, are the potential cost savings for HSCP services where the prevention of homelessness also prevents an escalation of other needs that would require more intensive health and social care support.

Training would be required for staff to enable them to fulfil their ‘ask and act’ responsibility. This training should be proportionate and in line with the role and responsibilities of individual staff groups – for example, for some staff training would be limited to awareness raising and guidance regarding referring / signposting to housing services.

Monitoring information to be recorded could include referrals made to East Lothian Council Housing Options / Homelessness teams. Information relating to the case coordination approach could also be logged (including attendance and outcomes). However, we would be keen to see the additional administration burden to be minimised as far a possible given the significant existing monitoring and reporting requirements on HSCP services.