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.
Decision type: Non-key
Decision status: Recommendations Approved
Notice of proposed decision first published: 10/12/2020
Decision due: 23 Nov 2020 by Director of Adults, Health and Well-Being
Contact: Phil Holmes, Executive Director of Adults, Wellbeing and Culture Email: phil.holmes@doncaster.gov.uk.