ADD2292 Rough sleeping grant – Women’s Homeless Health Project

Type of decision: 
Assistant Director's decision
Code: 
ADD2292
Date signed: 
14 November 2018
Decision by: 
Jamie Ratcliff, Assistant Director, Housing

Executive summary

Approval is sought to contribute grant funding towards Central and North West London NHS Foundation Trust’s Women’s Homeless Health Project (WHHP). This funding will enable the service to continue to provide a dedicated mental health specialist outreach worker to work with the most entrenched, complex needs women who are sleeping rough. The service will provide an identified accommodation option for every client on the caseload and ensure that sixty per cent of the cohort are in accommodation at the end of year.

Decision

That the Assistant Director approves:

Expenditure of £42,000 of grant funding to the Central and North West London NHS Foundation Trust towards the cost of the Women’s Homeless Health Project, which will run from 2018-19 to 2019-20 (funding of £21,000 each financial year).

Part 1: Non-confidential facts and advice

Introduction and background

During 2017/18, 7,484 people were seen sleeping rough in London. Sixty per cent were new to the street, 47 per cent were non-UK nationals and 23 per cent were from CEE countries. Around three quarters had one or more support needs (50 per cent mental health, 43 per cent alcohol, and 40 per cent drugs). Whilst women account for only 15 per cent of those sleeping rough, this proportion has increased by one per cent over the past three years. However, this group are often hidden, and are significantly less likely to access the help and support they need; a study by Crisis showed that only 12 per cent of homeless women have engaged with street outreach teams (Crisis, 2004).

The Mayor believes we have a moral imperative to tackle homelessness, and one of the first things he did when he took office was to set up a ‘No Nights Sleeping Rough’ (NNSR) taskforce to identify, implement, lobby for, and monitor the effectiveness of interventions to tackle rough sleeping. Chaired by the Deputy Mayor for Housing and Residential Development, it brings together partners key to tackling rough sleeping in London (including boroughs, voluntary organisations and the Government). In his London Housing Strategy, the Mayor sets out his aim that there should be a sustainable route off the streets for every single rough sleeper in London. He has recently published his Plan of Action which outlines the steps that need to be taken for this to be achieved. In this, specific issues facing women sleeping rough exist. For example, women accounted for only 15 per cent of people who were seen sleeping rough in 2017/18. However, the true number of women sleeping rough is likely to be significantly higher, as – for safety reasons - women are more likely than men to sleep in more hidden places or sleep rough for very short periods interspersed with time spent in precarious housing situations .

The Mayor has responsibility for funding and commissioning a range of pan-London rough sleeping services. These are services for rough sleepers, or initiatives to tackle rough sleeping, that cannot or would not be provided at a London borough level, as they are pan-London or multi-borough in their remit. A budget of £33.8m for these services was approved for the period 1 April 2016 to 31 March 2020 (see MD1532). This Mayoral decision also approved the re-procurement of a number of key services, which have now been commissioned and mobilised. A further MD (MD2031) approved the procurement of a successor to the flagship No Second Night Out (NSNO) service, to run from 1 April 2017 to 31 March 2019, and the new service commenced on 1 April 2017. There are currently seven core services under contract with annual values ranging from £200,000 to £3.68m, as well as a number of grant-funded initiatives.

Working with the taskforce, the Mayor has also secured over £4.2m of Government funding for a number of additional rough sleeping services and initiatives (see MD2083), which include a new Safe Connections service and a new Social Impact Bond for entrenched rough sleepers launched in October 2017. They Mayor has further earmarked an additional £1.3m of GLA funding for a project to help rough sleepers with mental health support needs. The GLA has recently also successfully bid for over £3.3m from Government.

The shape and nature of the Mayor’s services is underpinned by the pan-London Rough Sleeping Commissioning Framework, which includes a priority ‘to work with boroughs and partners to meet the physical and mental health needs of rough sleepers’. In order to help meet this priority, it is proposed that the GLA continues to grant fund the Central and North West London NHS Foundation Trust (CNWL) (one of the largest trusts in the UK, caring for people with a wide range of physical and mental health needs) for a fourth phase of the WHHP, formerly known as the Female Entrenched Rough Sleeper’s Project (FERSP).

The project has had two iterations. It was previously funded by the North London Housing Partnership (NLHP) and Westminster City Council (WCC), and administered by NHLP, Westminster City Council, WCC and CNWL. Last year, in the absence of NLHP funding, the GLA provided grant funding of £21,000 to CNWL to continue working with a cohort of 25 female entrenched rough sleepers displaying certain characteristics, with the ultimate aim of securing housing outcomes for participants. As a result of the project, 10 women were housed within the year (leaving 15 still sleeping rough).

This new round of funding will provide a mental health specialist outreach worker to work with a flexible cohort of 25 people (if people are missing for a period, additional women will be referred by outreach teams). Initially, this 25 will include the 15 women who are still sleeping rough (often on night buses, or in 24-hour restaurants - known as ‘wanderers’) and an additional 10 people who are referred through a pan-London ‘wanderer’s’ meeting. As the project goes on, the cohort of 25 will be refreshed to ensure a caseload of 25 at any one time. The mental health specialist will work flexibly to better co-ordinate a range of services to help them off the streets. The total cost for the period 1 April 2018 to 31 March 2020 will be £42,000 to build on the work developed previously.

WCC is unable to contribute the £6,800 per annum they previously funded. However, they have committed officer time in kind to ensure the support and coordination of the mental health worker. It is therefore proposed that the GLA grant funds the project £21,000 per annum to continue the work for two years.

The targets for the project have been negotiated with WCC and CNWL and will be incorporated into the grant funding agreement (see Appendix 1 for more information).

Objectives and expected outcomes

Milestones

To work with a cohort of 25 female rough sleepers (who will be nominated by the local authority and outreach teams), with the following characteristics:

  • over 40
  • known to more than two London boroughs
  • do not use drugs/alcohol
  • may indicate a mental health concerns 

To implement full CHAIN recording for every woman in the cohort (detailing all known bedded down and non-bedded down contacts)

95 per cent of the cohort to have a health, social care and housing support plan including a short term accommodation offer identified on CHAIN (for all teams to see and implement when opportunity arises)

100 per cent of the cohort to have a short/medium and long term accommodation offer identified on the action plan field on CHAIN (for all teams to see and implement when opportunity arises).

At least 60 per cent of the cohort to be off the street by the end of each 12 month period

To improve CHAIN reporting for this group (achieved through the implementation of: a WHHP tag on CHAIN, the WHHP worker inputting on CHAIN, awareness raising with outreach teams and a new search mechanism for unknown women to better match records)

To improve multi-agency working and joint training  - linking in relevant services who lack knowledge/skills to toolkits and training particularly in relation to the Mental Capacity Act and the Care Act 2014

To have agreement between local authorities for flexible women’s beds provision – a tailor made offer for every woman will be developed in advance and negotiated via the Women’s Outreach Network and the GLA local authority rough sleeping leads meeting

To produce brief quarterly reports along with an end of year project report with recommendations for the future to best meet the needs of this group.

Feedback from service users and service providers.

Equality comments

Under section 149 of the Equality Act 2010, as public authorities, the Mayor and GLA are subject to a public-sector equality duty and must have ‘due regard’ to the need to (i) eliminate unlawful discrimination, harassment and victimisation; (ii) advance equality of opportunity between people who share a relevant protected characteristic and those who do not; and (iii) foster good relations between people who share a relevant protected characteristic and those who do not. Protected characteristics under section 149 of the Equality Act are age, disability, gender re-assignment, pregnancy and maternity, race, religion or belief, sex, sexual orientation, and marriage or civil partnership status (all except the last being “relevant” protected characteristics).

Of those seen rough sleeping in 2017/18:

• 46 per cent were non-UK nationals
• 50 per cent had a mental health need
• 15 per cent were women
• most of those seen rough sleeping (56 per cent) were in the 26-45 age group
• eight per cent were under 26 years old
• 11 per cent were over 55
• eleven people were under 18.

Those with protected characteristics of sex are under-represented among rough sleepers, whilst those with protected characteristics of mental health need are over-represented. As the client group for these services is women with a history of sleeping rough, the proposals in this paper are likely to have positive impacts on these groups.

Other considerations

a). Key risks and issues

 

Risk description

 

Rating

Mitigating action

 

The cohort may refuse to engage with the mental health outreach worker

Amber

The first three years of the project have developed practice to ensure a higher level of engagement from this challenging group. The cohort will be refreshed if people are not found to ensure a minimum caseload of 25 at any one time.    

Too many, or not enough, women in this cohort

Green

The cohort will be nominated by local authorities and outreach teams. If too many women meet the criteria, the most complex, challenging clients will be prioritised (in agreement with boroughs). If there are not enough women meeting the criteria, the criteria will be reviewed.

 

Lack of capacity of other services to work flexibly with this group

 

This cohort is likely to contain a large of number women who are not suffering from a diagnosed mental health issue of a nature or degree that warrants an assessment under the Mental Health Act.

 

Increasingly across London, secondary mental health services are accessed via telephone triage systems. This can pose significant barriers to homeless people, whose cases will be closed in they fail to attend an appointment. Often, members of this cohort will make a single approach, and then not follow it up if the process seems difficult.

 

The mental health outreach worker will play an essential role in ensuring that mental health services fulfil their responsibilities to assess cohort members. In some cases, the outreach worker can ensure that the first approach is successful, and avoid the women experiencing rejection and being lost to services.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b) Links to Mayoral strategies and priorities

 

​​​​​​​The objectives of the proposals are in line with

 

    • the pan-London Rough Sleeping Commissioning Framework 2016 priorities 3,7 and 8
    • the Mayor’s Rough Sleeping Plan of Action
    • the Mayor’s London Housing Strategy policy 7.2

 

c) Impact assessments and consultations

 

​​​​​​​The London Housing Strategy was subject to a full public consultation and the Rough Sleeping Commissioning Framework 2016+ was made available for consultation with key stakeholders and partners. Both were subject to a full equalities impact assessment.

Financial comments

This decision seeks approval to expend £42,000 to grant fund Central and North West London NHS Foundation Trust (CNWL) to run the Female Entrenched Rough Sleeper Project (FERSP) (£21,000 in each of the two years 2018/2019 and 2019/2020).

This grant will be funded from the Mayor’s Rough Sleeping services, which has been allocated total funding of £8.45m per annum for the 2018/19 and 2019/20 financial years.

Planned delivery approach and next steps

The GLA will monitor the service on a quarterly basis to assess performance against targets. As with the other pan-London rough sleeping services funded by the Mayor, the performance of this service will be reported to the Deputy Mayor for Housing and Residential Development each quarter.