Monday, 17 February 2014

Joining the dots: homelessness, substance use and lessons for future commissioning

At the end of January, Crisis and the Joseph Rowntree Foundation formally launched their Homelessness Monitor England 2013 report. This research, carried out by leading academics in the field of housing and homelessness, looks at the impact of a range of economic and policy developments on homelessness. This includes the post-2007 economic downturn and housing market, the impact of welfare reform and reduced public sector spending, and more generally, other government policies that might have implications, such as the localism agenda.

The research has been funded from 2011 to 2015 and covers (separately) Great Britain, England, Scotland, Wales and, from 2014, Northern Ireland. The research focusses on the numbers rough sleeping, single homeless people, statutory homeless households and the hidden homeless, such as ‘sofa surfers’ and people living in crowded or insecure housing.

While the causal relationships are complex, the connection between substance use and homelessness or housing need is clear. 28% of rough sleepers contacted in London in 2013 had support needs relating to drugs, while 41% had needs relating to alcohol. From the treatment sector’s perspective, in DrugScope’s State of the Sector 2013 research, housing and housing support was identified as the support need most often presented, the most common local gap in provision and also as an area of support where availability appears to have deteriorated over the previous 12 months. As a key component of recovery capital, this may pose some challenges.

Another relevant factor is the removal of the Supporting People (SP) ring fence in 2009. While this has not been without implications for drug and alcohol services and their clients, the impact on homelessness services has been more marked, with some evidence of substantial localised disinvestment. However, while there are similarities, the current position, for community drug and alcohol services at least, is not quite analogous. The funding formerly provided within the Pooled Treatment Budget has been rolled into the broader Public Health Allocations, the latter being ring fenced for public health purposes until at least 2014-15, but there is at least the risk that greater discretion around funding and commissioning could have similar effects on drug and alcohol services.

The last speaker at the Crisis Homelessness Monitor launch was Paul Downie, Deputy Director of Homelessness and Support at the Department for Communities and Local Government, who argued that while financial pressures faced by local authorities are real, outcomes and services can be maintained (or improved) at the same time as making savings through intelligent commissioning, joined-up service design and breaking out of silos.

As one of the four partners in the MEAM Coalition, DrugScope believes that joined-up commissioning and services can improve outcomes for people with multiple needs and also offer value for money. It remains to be seen, however, whether there is sufficient scope to commission intelligently and align and sequence interventions in such a way that outcomes can be protected in the face of such significant pressure on local authority budgets.

One concern is that if breaking out of silos and aligning services was especially easy, more progress would have been made by now – the suggestion itself is not novel. Where there may be grounds for optimism is in the Community Budget concept, which builds on some of the learning from previous initiatives including the previous government’s Total Place. Four areas took part in the Whole-Place Community Budget Pilots from 2012. Last year, the government announced that nine additional areas will receive support via the Public Service Transformation Network to incorporate some of the lessons from the pilots.

Drug and alcohol treatment hasn’t itself been a specific priority for the four pilot areas, which focussed on domestic violence, health and social care, work and skills, the Troubled Families agenda, children and young people, reoffending and making better use of local authority assets. The importance of addressing substance use has, however, been highlighted at almost every step and the Community Budget model suggests at least the potential to positively transform local public service delivery.

The Community Budget model is above all intended to be owned and designed locally.  Its principles broadly include bringing together local government, central government agencies and others with the aim of pooling resources and commissioning coherent and proactive services that are more focussed on long-term outcomes and the individual, rather than on process. Evaluations of the first four pilots have been positive, and the National Audit Office was broadly supportive in its report. The Local Government Association commissioned Ernst and Young to review the potential savings, which they estimated at between £9.4bn and £20.6bn over 5 years.

The Communities and Local Government Committee reported in October 2013 that Community Budgets have the ‘clear potential to facilitate cheaper and more integrated public services. They can also be used to make public services more effective by focusing on the specific needs of local areas and individual service users. However, achieving their full potential will require strong leadership at a local level as well as a commitment from central government to facilitate local partnerships and the flexibilities needed to develop local strategies and solutions to specific local issues’.

With all this, realism is needed. Ultimately, local authorities will need to spend less and commission fewer and / or smaller services.  However, the Community Budget approach does at least give cause for optimism that this can be done - while protecting the interests of the people who use them.

DrugScope provides the London Councils-funded PLUS (pan-London umbrella support) for organisations working around homelessness in London, in partnership with Homeless Link and Shelter. Please contact Paul Anders for information.

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