Decision details

In 2019, Doncaster commissioned Imogen Blood Associates (IBA) to undertake an independent review of homelessness and rough sleeping. The review identified that those accessing the Home Options Service have a high level of additional support needs:

• 72% of those presenting as homeless had additional support needs (compared to half of those presenting nationally/regionally) and 37% of these featured physical and mental health.
• Mental health is the most frequently noted, in line with the national picture.
• Those presenting as homeless in Doncaster have higher levels of multiple needs than the national/regional average.
• Support providers and other professionals working with those experiencing homelessness confirmed high levels of complexity, including poly-drug (including Spice) use, alongside mental health problems (often linked to past trauma) and ‘revolving doors’ through homelessness, prison and housing instability.

The IBA review recognised the health aspects of Doncaster’s response to tackling homelessness and rough sleeping such as the provision of the Wound Care Clinic and GP at the Complex Lives Drop In. Groups have been set up around mental health, breast cancer awareness as well as a Hepatitis C awareness. More recently, Doncaster is exploring opportunities with Public Health England (PHE) regarding:

• health needs of rough sleepers including interventions already in place, good practice examples and where/how PHE can assist going forward as part of a Yorkshire and Humber regional initiative
• dental provision and the feasibility of some targeted work for homeless people in conjunction with NHS England

The NHS Long Term Plan notes the increase in numbers of people rough sleeping in recent years and that people affected by homelessness die, on average, around 30 years earlier than the general population. Outside London, where people are more likely to sleep rough for longer, support needs may be higher. 31% of people affected by homelessness have complex needs, and additional financial, interpersonal and emotional needs that make engagement with mainstream services difficult. Consequently the Plan sets out specific action to provide outreach services to people experiencing homelessness.

The above reinforces the importance of Complex Lives as a key component of the borough’s efforts to tackle homelessness and rough sleeping.

Complex Lives is one of the original areas of opportunity in the Place Plan, established to develop the integration of health and social care services in response to a major homelessness challenge in the borough. The programme is a whole system with an integrated delivery team at the core providing wrap-around support for people who have become locked in a cycle of homelessness, rough sleeping, addiction, offending behaviour, poor physical and mental health - often underpinned by deep trauma.

Currently, there are 111 cases on the Complex Lives cohort and rough sleeper numbers are in the region of 20, mostly in the town centre.
Capacity within the Complex Lives Team has developed during the previous period of funding, which has enabled operational management of more complex cases. This has proved an important resource as existing services are not set up to deal with the complexity of issues involved. Over time the team has become more integrated and effective through:-
• Co-location with Complex Lives team of the Single Point of Access function;
• Doncaster Council Housing Benefits Officer seconded to team
• 2 x Riverside outreach workers seconded to the team
• Dedicated Drug & Alcohol worker
• Department for Work and Pensions (DWP) worker
• Housing Options worker
• Doncaster Rape and Sexual Abuse Counselling Service (DRASACS) trauma worker commissioned for 2 days per week
• Amber workers (sex outreach service) aligned with team
• Changing Lives Link Worker seconded into team
• Doncaster Minster Pathways worker to be seconded to the team

This is in addition to a core team of a Team Manager, a senior caseworker, 4 MEAM (Making Every Adult Matter) workers and 6 Navigators alongside business admin support. Complex Lives now operates out of a multi-agency community hub in partnership with changing lives, this has allowed the provision of groups and drop-ins such as:
• Pathways (multi-agency drop-in for support)
• DWP drop-in for support around benefits work and training
• Healthy eating, arts and crafts and various other activities for health and wellbeing

This outline business case presents a request for continuation of Better Care Fund (BCF) support for the next phase of delivery leading to the mainstreaming of the Complex Lives service. This will also support delivery of the Homelessness and Rough Sleeping Strategy 2019-2024 (developed and informed by the findings of the IBA review) and the emerging delivery plans, which contain priority areas relevant to Complex Lives. This is also reflected in the Joint Commissioning Strategy delivery plans (Living Well) of which homelessness is a priority population. These include supporting rough sleepers to a life away from the streets as well as providing the wraparound support within Doncaster’s Housing First project, which is a developing initiative in the borough providing accommodation and support for people with multiple disadvantages where they are less suitable for mainstream offers of accommodation and support.

Complex Lives has been a key component of the COVID19 response in Doncaster through supporting local efforts under the national ‘Everyone In’ initiative whereby government required local authorities to provide emergency accommodation with the aim of reducing rough sleeper numbers in recognition of the particular health risks posed by COVID19 to this vulnerable population.

COVID19 has had an impact on the development and implementation of the Homelessness and Rough Sleeping Strategy delivery plans. In addition, the identification of a sustainable funding model for Complex Lives going forward has also been put on hold.

A future delivery model should be considered and an exit strategy should be identified. Both the Council and CCG shall be nominating its representatives for the sustainable funding steering
group. It is intended that the Task and Finish Board will be cited in the newly convened Homelessness Board.

To agree with the recommendation from Joint Commissioning Operational Group (JCOG), approved by Joint Commissioning Management Board (JCMB) on 29th October 2020, to contribute £281k to the funding of the Phase 2 developments of the Complex Lives Alliance model for 12 months. This is commencing from 1st April 2021 from the Better Care Fund, Non-Recurrent Earmarked reserve, subject to the Clinical Commissioning Group (CCG), Council and other partners coming together to assess existing funding streams and connect existing activity.

This decision is in accordance with recommendations made in a Cabinet Report dated 27th March 2018 which approved the spending plan for the non-recurring BCF Ear Marked Reserve as set out in the report: and delegated detailed spending decisions for the implementation of the Doncaster Place Plan £3M, other Integrated Functions £0.7m and unallocated balance £0.7m, to the Director of People in consultation with the Chief Finance Officer and relevant Portfolio Holder.

This submission covers a range of developments, all of which have been identified through action learning form the Complex Lives work to date. In each case they are regarded as the best available options to enhance the model in ways which responds to local context and learnings.