Terms of Reference
The Committee will be looking to examine:
How effectively the Welsh Government is planning for the future of HSG in light of rapid rehousing transition and the forthcoming Homelessness Bill;
Efforts to make homelessness ‘rare, brief and unrepeated’ and removing the requirement for households to be ‘tenancy ready’ under Rapid Rehousing has put HSG’s role into the homelessness spotlight. RRH cannot be delivered without the availability of good quality support provision that is timely and responsive to the needs of residents.
In the wake of RRH and the Covid-19 pandemic Monmouthshire has seen an increase in presentations of complex needs households. The HSG funding for Monmouthshire isn’t sufficient to enable the Council to providing adequate complex needs provision which means some service users are not receiving the essential support with the level of intensity they require to successfully move away from homelessness.
Whilst the Council welcomes increases in funding, The allocation of HSG funding in this regard has not kept up with the ambitions of Rapid Rehousing. As we turn to the impending changes to homelessness legislation as proposed in the White Paper there has not been any indication from WG of any plans as to how they will amend HSG allocation. Positively though WG has acknowledged to the Council that the current approach to allocating HSG needs reviewing. It is anticipated that the proposed duty to retain accommodation will largely fall to housing support teams. If this comes to fruition there will be a significant expansion in demand of HSG services, and potentially for a longer period of time. At present it is not known what, if any, plans WG have to address this, which makes planning for the future very difficult.
Monmouthshire receives one of the lowest allocations of HSG funding in Wales. The allocation provided does not meet the current needs of the residents of the county.
The present allocation process means that the CouncilHSG will be unable to meet all identified need and. The absence of certainty around budgets for the following financial years makes it challenging to plan ahead effectively.
Current and anticipated pressures in the delivery of HSG-funded support services, including pressures on the workforce;
HSG services are under significant strain. For the reasons mentioned above, it is anticipated that the pressure on HSG will continue to grow. In Monmouthshire, the view is that HSG services are as important as the provision of homeless accommodation, particularly due to the generally high levels of need currently being experienced
The costs faced by services are continually rising due to staff salary uplifts, inflation and the cost-of-living impacts. During the year 2023-24, the HSG Commissioning Team managed to uphold the capacity of housing support services by working in partnership with providers, but even with services maintained there was a waiting list of 95 households for support at the end of the financial year.
Monmouthshire’s HSG programme is currently going through a review and recommissioning process that will see services remodelled to better reflect current need and to become resilient and financially sustainable. In doing so it has become apparent that the HSG budget falls short of meeting the needs of residents regardless of financial remodelling or streamlining. This means that HSG cannot support the number of people who require it.
Need overwhelming service capacity has not been helped by the struggle of the industry to recruit and retain staff. The rate of pay for support workers does not incentivise people to consider the support sector as a career, especially with the responsibilities and conditions involved. As Monmouthshire is a rural county the costs associated with transport also eats into the income received by staff, particularly as most support officers do not live within the County itself. The third sector has seen a migration of staff to other industries such as catering and retail. Staff retention and recruitment has had a significant impact on actual service delivery and quality relating to high staff : client ratios in Monmouthshire
At the time of writing it is not clear what Welsh Government’s intentions are with regards to the increase in NI contributions for third sector providers. If the increase is not reflected in HSG allocations there is a strong possibility that this may impact on project sustainability.
How much is known about service performance, including data on outcomes;
Monmouthshire HSG team collect information on services through the use of reviews which are conducted periodically, through exit questionnaires and through data supplied by the provider which is audited.
WG introduced the new outcomes framework in January 2023 to be implemented April 2023. The two major changes to the framework are the new primary and secondary outcomes, and the removal of Lead and Secondary Need.
WG have enforced the removal of duplicate entries on the new framework, meaning that each service user can only appear on the framework once in a reporting period. Whilst this makes sense in one way, a lot of information is lost when doing so i.e. if a service user is working with more than one service during a reporting period, only the latest information is captured as data from the previous service is overwritten.
In removing the Lead and Secondary need from the new framework MCC have had to find new ways to collect this information, but in doing so the efficacy of the data has been reduced.
It is felt that it would be helpful to collect information on a client’s journey with the new framework, i.e. there would be one entry for start of support, and a separate entry at end of support for comparison. Whilst this would lead to increased work and more checks to be carried out before submission to WG, this would provide stronger evidence of the positive work carried out by services.
Going forwards and through the impending review and recommissioning of the HSG programme, the intention is to strengthen monitoring arrangements to better identify and understand performance outcomes, progress and benefits whilst also understanding challenges.
How effective is joint working between housing support services and public services such as health and social care;
Monmouthshire HSG team facilitates two housing related panels to discuss complex cases. The Housing Intervention and Housing First panels have a varied membership and is largely well attended. Actions are taken by a number of stakeholders to provide holistic support to households who are at risk of homelessness and these have been effective in obtaining positive outcomes.
On the frontline there can be fluctuations in joint working between services. The Housing First team has been identified as a service who have embraced partnership working to provide the best possible support to their clients.
There are occasions however where the desire for partnership working between agencies does not seem to be reciprocated as strongly. There have been some concerns about the willingness of Social Care to assist in cases where there is a HSG support worker present, or where Social Care are involved they are not felt to be as proactive.
This can also be experienced with DTRs. There is a perception from providers that safeguarding teams do not trust their professional judgment or that in some cases the support received is inconsistent and dependent upon individuals. The result is that providers can feel that they are having to manage complex and sometimes high needs clients alone.
What services should be commissioned in future to effectively support people with complex needs to find and keep a home.
· Medium-long term and temporary complex needs provision
The cultural shift away from hostel type accommodation for homeless households has come at the expense of suitable accommodation for those with complex needs.
At present, due to a lack of suitable temporary and supported accommodation options within Monmouthshire, those with complex needs are being accommodated in ‘general needs’ accommodation with additional security which is not appropriate for their needs. Many of these individuals have been identified as candidates for Housing First but due to suitable stock shortages face a lengthy wait for permanent accommodation. This means that the housing teams with floating support providers are frequently managing crises in an attempt to save tenancies from irretrievably breaking down. Where attempts to prevent evictions fail those with complex needs can end up street homeless.
There are also a significant minority of homeless households, or households facing homelessness, that would not successfully manage a tenancy independently even with the intensive support of Housing First. These households are currently in limbo, spending prolonged periods of time in unsuitable accommodation that frequently breaks down.
A residential complex needs provision, both temporary and more long term, is required to provide stable housing with dignity to homeless households with complex needs. Such an environment would support those with complex needs to maintain a tenancy.
· Services with a harm reduction ethos
Many of those with complex needs will have support needs around substance misuse. There is a gap in service provision with a harm reduction ethos, perhaps due to the misplaced fear of being seen to ‘encourage’ substance misuse. At present there is a focus within support on abstinence which does not meet the needs of service users who are not ready to cease using substances. Forcing such services users down a path of abstinence rarely, if ever, leads to sobriety. Providing a safe space for service users who use substances will assist in stabilising people, provide a more accurate picture of people’s support needs and potentially save lives.
· Multi-disciplinary teams
Those with complex needs require holistic support to maintain a tenancy and access housing. Whilst HSG funding allows for a range of support services to be commissioned, due to budget constraints the support tends to be provided by generic support workers as opposed to specialists. This can make accessing certain specialist services, such as mental health provisions, incredibly difficult and add to the pressure on support workers who cannot be experts in all areas. Support for those with complex needs would be improved by the presence of multi-disciplinary teams for complex needs.
Monmouthshire already facilitates and chairs a ‘Housing Intervention Panel’ where professionals from relevant agencies meet to discuss complex cases, but whilst outcomes are largely positive progress can be hampered by patchy attendance from some organisations and on occasions an understanding of attendees role. Identifying key bespoke solutions (perhaps outside of normal policy and resource availability, can be challenging. An MDT would take this model further by funding dedicated professionals across a range of public services such as mental health services, drug and alcohol services, social care and the police, whose function is to directly work with those who have complex needs (i.e a specific role). The MDT group could then meet about households of concern and escalate within their own services when required. They would also be dynamic and so able to provide some level of outreach helping to bridge the gaps between those hard to engage and the services required.
· Psychological/ therapeutic interventions
The introduction of trauma MDTsand psychologically informed working appears prominently on the Welsh Government’s agenda for working with vulnerable groups. In Monmouthshire it is now a requirement for all homelessness services to be trained to work in a trauma informed way. Whilst there has been progress towards this in terms of delivering training, the ethos of both trauma and psychologically informed working practices requires a complete change in culture to deliver effectively. Progress in general has probably been hampered by organisations seeking to manage high levels of demand from high needs individuals within a highly reactive environment.
In 2012 South Lambeth and Maudsley NHS Trust in partnership with London Borough of Lambeth funded a pilot Psychology in Hostels Project. This project saw psychologists embedded in three complex needs hostels in Lambeth curating an immersive psychologically informed approach to support. The impact was significant for both support staff and residents. Those with complex needs who typically found it hard to engage with services responded well to the flexibility of building a relationship at their own pace with professionals who became familiar; the psychologists on site provided a direct route to statutory mental health services where needed, and staff benefited from specialist training and reflective practice. The outcomes included a decrease in emergency service use, a decrease in drug and alcohol use and a reduction in contact with the criminal justice system. Residents were, generally speaking, sustaining their tenancies for longer[1].
Homeless (or threatened with homelessness) adults with complex needs in Wales would benefit from such services being imbedded operationally to support tenancy sustainment and obtain stability of personal wellbeing.
· More funding for supported accommodation of all types with effective move on or step-down provisionM
There are a limited number of supported accommodation placements in Monmouthshire across two locations (north and south). The supported accommodation that currently exists is a young person’s provision with a small number of complex needs placements. The number of units across the provision is not able to meet demand and as a result there is a waiting list. In light of the proposals contained in the White Paper on Ending Homelessness the demand for these units could increase rapidly. There needs to be an increase in funding to expand these projects and also provide meaningful step-down provision to create flow through the system and ensure a smoother transition for service users.
In addition Monmouthshire is also in need of additional refuge space, particularly in the south of the county.
· Increase capacity of services
Monmouthshire has seen an increase in demand for all services, including those which support households with complex needs. As well as a need for funding to expand the types of provision commissioned, there is a need to increase capacity in the services already available. In particular Monmouthshire would benefit from an increase in Housing First, Substance Misuse, Mental Health (and Hoarding), Family Intervention capacity.
The Committee would be very keen to hear your views and would be grateful if you could provide written evidence by Friday 7 February 2025. Further information on how to provide written evidence can be found here.
We will be taking oral evidence on this inquiry in March and will be in touch separately if necessary.
Kind Regards