Housing First Feasibility Study for the Liverpool City Region Final Report Imogen Blood, Ian Copeman, Mark Goldup, Nicholas Pleace, Joanne Bretherton & Shelly Dulson, Contents Glossary 4 4.9 Mental health 62 Forewords 6 4.10 Access to health and social care 63 Introduction 8 4.11 Peer support 64 4.12 Asset-based community development 65 Chapter 1: The current homelessness system in LCR 12 4.13 Referral routes and assessment 67 1.1 Current homelessness provision 12 4.14 Estimating demand for the Housing First model in the LCR 68 1.2 Demand for homelessness services in LCR 14 4.15 The cost of the proposed Housing First model 68 1.3 Participants’ views on how existing service provision is working 16 4.16 How will the Housing First service link to the wider Housing-Led system? 69 1.4 Barriers within the wider system 17 4.17 Examples of existing LCR resources which Housing First 70 1.5 Strategic challenges, threats and opportunities for LCR in relation to 19 might support people to access homelessness Chapter 5: Financial and Commissioning Implications 72 Chapter 2: Current provision and use of services by people 22 5.1. Housing First: Commissioning approach 72 with complex needs 5.2. Financial Implications: Potential for cashable savings and 78 2.1 Existing services and initiatives focusing on people with complex needs 22 efficiencies from implementing Housing First in LCR 5.3. Housing First Implementation: Potential transitional and phasing 84 2.2 Homelessness service usage by people with complex needs 23 arrangements 2.3 ‘Revolving doors’ and ‘burned bridges’ 28 2.4 Rejecting the homelessness system 32 Chapter 6: Policy Context 88 2.5 Wider system response to people with complex needs 33 6.1 The current strategic context on homelessness in LCR 88 6.2 The Role of Housing First in the Context of the Homelessness 90 Chapter 3: Developing Housing First as part of a solution 34 Reduction Act to homelessness 6.3 Welfare Reform and Housing First 93 3.1 What did homeless people tell us they valued and needed? 34 6.4 Housing First in Combined Authorities 96 3.2 What is Housing First and how does it respond to these needs? 35 6.5 Housing First and Health and Social Care Policy 98 3.3 The Case for Housing First 36 6.6 Housing First and Criminal Justice Sector Policy 100 3.4 Housing First within Integrated Strategies 41 6.7 International Lessons 102 3.5 Developing a Housing-Led Strategy for LCR 42 Chapter 7: Conclusions 106 Chapter 4: Developing a Housing First and housing-led model in 52 Liverpool City Region Appendix 1: Overview of Liverpool City Region 109 4.1 Definition 52 Appendix 2: The Research Team 114 4.2 Target group for the Housing First service 53 Appendix 3: Methodology 116 4.3 Description of the Housing First service 54 Appendix 4: Costing of proposed Housing First Model 123 4.4 Duration and intensity of support 55 Appendix 5: Detailed Calculations of Sizing the Cohort for Housing First 127 4.5 Access to housing 57 Appendix 6: Method for assessing potential for cashable savings 131 4.6 Hours of operation 58 and efficiencies from implementing Housing First 4.7 Access to housing 59 Appendix 7: Potential for efficiencies: Value for money analysis 140 4.8 Types of properties to be used for Housing First 61 4 Housing First feasibility study for Liverpool City Region 5 Glossary Assertive outreach is a way of learning disability, which tend to NHS, Housing First typically involves Mainstay is an assessment and organising and delivering care via a interact with each other. case management only (see section referral gateway and database specialised team to provide intensive, 3.3 for a discussion of this). In this for commissioned homelessness highly coordinated and flexible support CRISS (City Region Intensive Support report, we sometimes use ‘High accommodation and floating support for people with complex needs. Service) is government (DCLG: Fidelity’ to distinguish Housing First services across LCR. The focus of the work must be on Department of Communities and Local from lower intensity Housing-led engagement and rapport, building Government) funded service providing services. Property Pool Plus/ Under One Roof: up, often over the long-term, strong assertive outreach during office hours Property Pool Plus is a joint allocation relationships. to those with the highest levels of House in Multiple Occupation (HMO): and choice-based letting system for complex needs in the five authorities in is a property rented out by at least 3 social housing in Liverpool, Halton, (Priority) Band: Councils decide who LCR outside of Liverpool city. people who are not from the same Knowsley, Sefton and Wirral. St Helen’s gets offered housing based on a 'household' (e.g. a family) but share is not part of Property Pool Plus, but ‘points’ or ‘banding’ system. Points and Floating support: visiting support facilities like the bathroom and kitchen. has its own choice-based lettings bands are based on housing need and provided to a person who lives in their Landlords of larger HMOs must be system called Under One Roof. start with the letter A being the highest own property. licensed. priority. Supported Housing can be described Housing-led can be distinguished Liverpool City Region (LCR): Liverpool as any housing scheme where Cashable savings are savings which from “Housing First” by its lower City Region includes the following housing, support and sometimes care make a difference to the budget line, intensity of support, range, duration local authorities: Liverpool, Halton, services are provided to help people to usually by reducing fixed costs. and the lower needs clients it targets. Knowsley, Sefton, St Helens, and live as independently as possible in the In this report, we argue that Housing Wirral. A map and a demographic/ community. Combined authority (CA): comprises First should operate within a ‘housing- housing profile of the region is two or more elected local authorities led system’, in which the the default included in Appendix 1. Waves of Hope is a lottery-funded that collaborate and take collective approach is to support all homeless partnership providing holistic and decisions. people as quickly as possible into Local Housing Allowance: For people intensive case management support independent tenancies with supported renting from private landlords, Housing to people with the highest levels of Commissioned/non-commissioned as needed, by-passing the need for Benefit is based on a flat-rate ‘Local complex needs in Liverpool city. supported housing: ‘commissioned’ compulsory and/or longer stays in Housing Allowance’ (LHA) which is here means that the council funds communal supported housing. based on the 30th percentile of local Welfare Reform describes a package (and therefore monitors) the support market rents, covering areas known as of changes to the benefits system within a scheme – this is true of the Housing First is a system of support Broad Rental Market Areas. introduced by the 2010-15 Coalition vast majority of hostels run by charities for homeless people with high and Government, including Universal and/or housing associations; ‘non- complex needs which is designed Local Lettings Agency: A Social Credit, Benefit Cap, Removal of the commissioned supported housing’ to deliver a sustainable exit from Lettings Agency is a not-for-profit Spare Room Subsidy, and Personal generally refers to private sector HMOs homelessness by helping them to lettings agency which provides a range Independence Payment. (see definition below) which have been access an independent tenancy as of services to private sector landlords classified as supported (or ‘exempt’) quickly as possible and providing the and (prospective) tenants, ranging housing under the Housing Benefit support they need for as long as they from a tenant/ property finding regulations and are therefore able to need it to sustain this tenancy. function right through to a full housing claim higher levels of Housing Benefit; management service. In this report, we we are also aware of a small number ‘High fidelity’ Housing First stays close use the term Local Lettings Agency, of non-commissioned hostels run by to the original Housing First model since our vision for such an agency in religious charities in the region. set up in the US by Sam Tsemberis; Liverpool is that it might also offer a strictly speaking this would include an similar range of services to social as Complex needs means that ‘assertive community outreach’ team well as private sector landlords. people have multiple issues in providing healthcare to Housing First relation to mental health, drug use, tenants; however, in the UK where homelessness, offending and/or healthcare is provided through the 6 Housing First feasibility study for Liverpool City Region 7 Foreword from Jon Sparkes Foreword from the peer researchers There is overwhelming international evidence that Housing First ends We are a group of peer researchers who have personal experience of homelessness. Resettling someone quickly into a long term home with access homelessness, we were invited to be part of this study to help gather information to the flexible support services that gives them choice and control has shown from people who are currently homeless. It was felt that we could better gather significant improvements in health and wellbeing, and most importantly leads to this information due to our ability to relate to those individuals because of our people sustaining tenancies. At Crisis we are excited to be part of a project that personal experiences. looks at transforming Housing First in the UK to a default solution for addressing homelessness. Whilst our findings were mixed there were some recurring themes that came from the people we interviewed.