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Eastbourne Pop-Up Hub Pilot Final Evaluation

Prepared by

Graham Maunders Associates

5 Cromwell Place King Henry’s Road

Lewes East Sussex

BN7 1BZ

T: 01273 488775 M: 07811 115494

E: [email protected] W: www.grahammaunders.co.uk

August 2014

Eastbourne Pop-Up Hub Pilot Evaluation

Graham Maunders Associates | 1

Cover: The Citadel, Langley Road, Eastbourne

Section

Content

Page

A. Summary 2

B. Introduction 3

C. The Eastbourne Hub Pilot 4

D. Key Findings 4

E. Post Hub Review 16

F. Key Conclusions 18

G. The Way Forward 20

Appendix 1 Interviews 22

Appendix 2 Document Review 22

Appendix 3 The Street Community Pop-Up Hub Change Model 23

Appendix 4 Client Needs Summary 24

Appendix 5 Cost / Benefit Summary 26

Appendix 6 Client Outcome Assessment Summary 28



A. Summary Homelessness and rough sleeping have significantly increased in the last two years. To help address this, Pilot Pop-up Hubs, facilitating multi agency intervention to tackle and prevent rough sleeping, were piloted in Bognor Regis and Eastbourne. This evaluation of the initiative assesses it’s effectiveness, the outcomes and impact achieved and its cost / benefit. It has been undertaken utilising questionnaires, interviews, meeting attendance, desk based research and a key document review. Interim reports for both Bognor Regis and Eastbourne Pop-up Hubs were issued in May 2014, and this final report is being issued together with an overarching summary of the learning from both Hubs. The Eastbourne Hub, operated over a 3 day period, enabled client assessments to develop individual action plans, and determine agency responsibilities for support and assistance. The individual organisations involved in the Hub clearly had a wide range of expectations of the pilot at the outset. During the Hub 44 clients were assessed. 20 had slept rough over the last year, 6 for between 1 year and 5 years, and 4 for over 5 years. 39 were experiencing health related issues: 33 had mental health issues and 22 highlighted physical health issues. 31 had drug and / or alcohol problems. 23 clients had at some point served a prison sentence. 22 clients had involvement with shoplifting / burglary / theft / robbery. 20 had previously committed antisocial / violent behaviour. The Eastbourne Hub clearly benefited from lessons learnt from the Bognor Regis pilot Hub with a longer lead in time, and better briefing for the organisations concerned. The Hub was successful in attracting more clients than anticipated, but there were significant delays in getting the assessments completed and information circulated, including individual client action plans. Feedback from the organisations interviewed suggested that the Hub helped develop greater engagement, knowledge and understanding of client’s needs. Improved partnership working was also thought to be a positive outcome. The most notable achievements of the Hub was the number of clients housed and a significant reduction in Police costs in dealing with the client cohort in the immediate post hub period. Whilst a significant number of clients had health related issues assessed, the outcomes and impact achieved was very limited. In assessing the cost / value of the initiative a number of measures have been identified: potential cost / savings, opportunity cost, added value, social value (wellbeing) and the cost of inaction. A

number of potential measures that might be utilised to help assess the impact and outcomes – based on nationally assessed averages in relation to health, community safety and housing are highlighted. Ideally, local statistics and costs need to be collated to gain a more accurate picture of outcomes and impact. In developing a methodology it is suggested that this is captured on three levels: client, service and programme. Temporary accommodation and permanent accommodation, with support to maintain tenancies, are seen as key to enabling organisations to achieve longer term outcomes. In taking this forward, a far more integrated approach to health and social care is needed. Strategic and operational co-ordination and communication needs to be significantly improved. This will need to involve local clinical commissioning groups and at the strategic level, health and wellbeing boards, utilising a range of funding including pooled and personalised budgets.

Key learning points were: 1. The Hub had a good impact on clients housing and community safety. Longer term outcomes

are dependent on the follow up work which could have been better managed and coordinated.

2. Client’s complex needs require an ongoing joined up response strategically and operationally. 3. A proactive approach to housing provision is key to enabling ongoing work with clients. 4. Communication on needs, roles / responsibilities, resource use and action requires

improvement. 5. Health, especially mental health, is significant and needs a more coordinated follow up.



B. Introduction Homelessness and rough sleeping1 have significantly increased in the last two years2. During the past year, a new approach to addressing the needs of rough sleepers through Pop-up Hubs has been piloted by St Mungo’s Broadway in the City of London. Pop-up Hubs are designed to provide rapid identification and intervention to tackle and prevent rough sleeping. They are delivered through intensive short bursts of activity in targeted areas, to enable assessment and coordinated follow on action. In Sussex, local authorities and the Police are seeking to use the approach to help address rough

sleeping, street drinking, begging and anti social behaviour – a disproportionate amount of which is attributable to the street community3. The size of the community in Sussex is estimated at around 800. In 2013 it was assessed that there were some 159 rough sleepers in Sussex4. A member of the street community is defined by Sussex Police as 'a person who spends a significant amount of time on the streets or other public area and who may or may not have accommodation and will have a substance misuse issue and / or a mental health issue and / or have a chaotic history'5. The street community, not all of whom are rough sleepers, are generally thought to be made up of three distinct groups of people: 1. Entrenched and longer term rough sleepers 2. People new to the streets 3. Those who move between a range of accommodation: rough sleeping, sofa surfing, squats,

hostels and prison. The focus for the Eastbourne Hub has been influenced by a range of data, including Operation Packet6, and learning from the first pilot Hub in Bognor Regis. The pilot Pop-up Hubs in both Bognor Regis and Eastbourne are being evaluated to assess the effectiveness of the initiative, its outcomes, impact and cost / benefit, with a view to informing the future work of the Sussex Homeless Outreach Reconnection Partnership (SHORE) - a partnership of Sussex local authorities. This review was undertaken using questionnaires, interviews, meeting attendance, desk based research and a key document review. Questionnaires were used pre Hub to gauge the involvement, roles and expectations of the various agencies – both strategic and operational. Interviews were undertaken post Hub, with the key operational agencies involved. The list of participants in questionnaires / interviews is set out in Appendix 1. In addition, the reviewer has attended post Hub multi agency progress meetings to help assess the approach to the issues identified, follow up action and impact. Both in relation to both the clients and the agencies involved. A range of background documents were also considered – see Appendix 2. The client group is incredibly difficult to engage, and locating individuals is not easy. Individuals with the most compelling ‘stories’ often have the most complex issues, making them more difficult / unwilling to engage. However, in completing the final stage of the evaluation interviews with clients will be sought to obtain a more comprehensive picture of how the Hubs have worked in practice. Interim reports for both Bognor Regis and Eastbourne Pop-up Hubs were issued in May 2014. The initial findings along with a post Hub 6 month assessment of outcomes and impact are incorporated in final reports for each Hub. The final reports are being issued together with an overarching summary – Key Conclusions - of the learning from both Hubs.

1 Rough sleeping is defined as sleeping in the open air or in buildings or other places not designed for habitation. 2 Homeless Link – The value of the homelessness sector 3 Operation Packet 2 - Street Community Profile – Sussex Police 4 Rough sleeping in England – estimated and actual: Autumn 2013 – DCLG 5 Pan Sussex Street Community Project Terms of Reference 6 Ibid



C. The Eastbourne Pop-up Hub Pilot The Eastbourne Pop-up Hub operated on 14th 15th and 16th January 2014 at the Citadel, Langley Road Eastbourne, which is run by the Salvation Army. Sussex Police and St Mungo’s Broadway engaged with individuals in Eastbourne and persuaded them to attend the hub, through assertive outreach and motivational interviewing. An initial assessment of clients attending the Hub was undertaken by St Mungo’s Broadway, who provided support for clients over the three days, and referred them to other services as appropriate. The aim was for clients to be offered a package of support and assistance. A nominated key worker would then ensure that agreed outcomes were achieved. The intention for all relevant services to have a presence in the Hub was largely achieved with the involvement of: St Mungo’s Broadway, GP, Housing, Mental Health, Police, Salvation Army CRI and Action for Change.

It was intended that the St Mungo’s Broadway assessments would inform the development of action plans by other agencies, inform post Hub monitoring, and feed into E-CINS7 monitoring when eventually adopted by partner agencies. The key objectives for the Sussex Police Street Communities Project in supporting the Pop-Up Hubs8 initiative were identified as: For individuals: 1. Accommodation rescue or sourcing 2. Administrative removal by UKBA 3. Identification of appropriate solutions to promote secure, sustainable non street life 4. Referrals to appropriate mental health or substance misuse services 5. Swift health, housing and support needs assessment 6. Voluntary reconnection to home area / country For agencies: 1. Identifying clearer pathways into services for members of the street community 2. Reducing the number of people rough sleeping or at risk of rough sleeping 3. Reduction in emergency service calls in relation to begging and street drinking 4. Tackling unmet mental and physical health needs We have endeavoured to summarise in diagrammatic form the proposed change model that the Hub was set up to deliver– see Appendix 3 D. Key Findings Expectations The pre pilot questionnaire highlighted that the various agencies involved directly (operationally) and indirectly (strategically) had a wide range of expectations of the pilot:

Build on existing partnership working

Determine clients needs / support services required

Enable clients to access housing

Establish why clients do not engage

Extent of benefit to agencies

Extent of benefit to clients

Extent of GP registration

Find out what works / doesn’t work

Identify substance misuse issues

Identify who the clients are

Improve health and social care pathways / integration

Improve the quality of information / communication between agencies

Reduce street nuisance / anti social behaviour

Services impact on the project

Support other agencies

Support vulnerable clients

7 E-CINS - multi agency real time database / tracking system developed by Empowering Communities 8 Sussex Police Street Communities Project – Pop Up Hubs Proposal



Clients profile During the three days of the Pop-up Hub the profile of the 44 clients assessed was: Table 1. Age / Gender

Age Range Male (M) / Female (F) Rough Sleeping (other)

20-29 M= 6 F= 5 3M (3M) / 0F (5F)

30-39 M= 7 F= 6 3M (4M) / 5F (1F)

40-49 M= 10 F= 1 4M (6M) / 0F (1F)

50-59 M= 6 F= 2 4M (2M) / 1F (1F)

60-69 M= 1 F= 0 0M (1M) / 0F (0F)

At 32% the female proportion is significantly higher than the estimated Sussex average and the national average although in line with the 27% Eastbourne estimate in Operation Packet 29. Of the 44 clients only 1 was of central and eastern European origin – compared to 18% during Operation Packet. 31 (71%) said they had drug and / or alcohol problems. Of these 21 (48% of all clients) described themselves as problem drinkers and 24 (55% of all clients) described themselves as drug users. 14 (32% of all clients) had both drug and alcohol problems. This was a significantly lower proportion of problem drinkers and slightly higher proportion of drug users compared to Operation packet – 72% and 27% respectively. Of the 20 (45%) identified as having slept rough over the last year four men and two woman have slept rough between 1 year and 5 years, and four men have slept rough for over 5 years. A further 21 (48%) of clients appear to have utilised a range of temporary accommodation / sofa surfing. Whilst 3 (7%) were considered to have some form of accommodation. Of the 44, 39 (89%) were experiencing health related issues – higher than Operation Packet 2 and

the national survey10. 33 (75%) clients were assessed by St Mungo’s Broadway as having at least one of a range of mental health related issues.12 clients (27%) were assessed as having 5 or more of these issues. 22 (50%) of clients highlighted physical health issues. The St Mungo’s Broadway assessment of GP registration identified 26 (59%) registered with local practices, 12 (27%) with the station drop in surgery, and 6 (14%) with no practice identified. This compares to an estimated 77.5% registered during Operation Packet 2. 23 (52%) clients had at some point served a prison sentence. 22 (50%) clients were assessed by St Mungo’s Broadway as having had involvement with shoplifting / burglary / theft / robbery. 20 (45%) had previously committed antisocial / violent behaviour. Only 5 (11%) had no identified income. Most - 35 (80%), received ESA/JSA, two received incapacity benefit, one received a pension. The main income range was £53 - £122 / week. One client is employed part time. 37 (84%) out of the 44 were assessed as being at risk themselves. 21 (48%) were assessed as a risk to others. By February, 6 were being accommodated in the night shelter, 17 in Lynwood (including 6 couples and 5 already being accommodated as a Part 7 duty to temporarily house). A more detailed summary of the clients is set out in Appendix 4

9 Operation Packet 2 - Street Community Profile – Sussex Police 2013 10 Ibid and Homeless Link research : homeless.org.uk/mental health



Organisation and management

The Eastbourne Hub clearly benefited from some of the lessons learnt from the Bognor Regis Hub. With a longer lead in time, more advanced contact and involvement of the key agencies, the hub appears to have been more effective - as measured by the range of agencies participating in the hub, and the number of clients seen over the three days. Although some organisations still thought it was a rush to get things set up, and would have preferred more time to ensure adequate resources were made available. In her post Eastbourne Hub review, Helen Keats advocated an 8 week lead in time. In the light of experience and comment, this should be seen as a minimum. Organisations who attended the pre Hub briefing meeting valued finding out more about the nature and proposed operation of the Hub. This was particularly important because few fully understood the approach before the meeting. Going forward, organisations interviewed suggested that the briefing could be improved with a written outline of the scheme, roles / responsibilities and the requirements of those participating. This would also enable them to share more information with colleagues unable to attend the briefing. At the outset a draft protocol was prepared for all organisations involved to sign. Post Hub, it was still not clear if all organisations had signed. Whilst the approach helped address some of the issues understanding of roles and responsibilities, the timing of a protocol being issued needs to take into account the likely delay of organisations internal processes to get sign off. This will also help ensure that all staff involved have a clearer understanding of what is required, and put this into practice. The issue of advance invitations to clients by the Police was thought by those interviewed to have been helpful. In Eastbourne this appears to have generated a much higher number of clients

attending the Hub – 44 were assessed compared to the original target list of 30. The down side of this was that a number of people who attended were already being accommodated under Part 7 homelessness legislation, which resulted in some duplication of effort. For a number of the organisations taking part there was a lot of downtime, with only a small number of people being seen - for example Action for Change only saw 3 people across all three days. In this respect it is vital that the Hub has internet facility and organisations are prepared with portable IT equipment to enable other work to be carried out. This is also important because the most significant cost to organisations taking part appears to have been the displacement of other work. Although interviewees also commented that they had found the downtime very useful, enabling some quality networking time, as well as attending to other work. Volunteers played an important role in providing a welcome atmosphere, with the offer of refreshments helping to put clients at ease. One interviewee suggested that volunteers could play a more involved role, for example by collating basic non sensitive details of each client on arrival. This could also help speed up the process, and possibly alleviate some of the duplication whereby organisations all require the same basic core information. The feedback from St Mungo’s Broadway at end of each day was appreciated and thought to be very helpful. However, a number of people who were involved did not attend, and did not receive the information. Ways need to be found to disseminate the Hub briefing information more widely at the end of each day to improve this good practice. There were significant delays in getting the assessments completed and the information circulated. Organisations involved were not fully briefed of actions required and clients did not receiver action plans. Ways need to be found to process and share information across organisations and with clients much more quickly, to ensure the limited window of opportunity of working with clients is maximised. A number of those interviewed commented that it would be important to manage the various organisations expectations, to help maintain involvement and ensure positive impact / outcomes. There was a general concern that organisations might not commit to the follow through. Poor information flow compounded these concerns.



The need for procedure and guidelines was also highlighted, as not all organisations were clear about follow up action in the post Hub period. This, along with other comments made, highlights the need for a more developed communication strategy at the outset. The accommodation aspect appears to have worked particularly well because Eastbourne Borough Council worked proactively to arrange temporary accommodation in advance, enabling organisations to work longer with clients in the post Hub period. It was also generally recognised that Helen Keats had played a key role in keeping everyone focused, and that it is important to have an identified lead person who can coordinate all of the organisations involved. Whilst E-CINS was not used during the Hub, and the data collected has not been made readily available to all organisations. Eastbourne Borough Council facilitated the weekly follow up meetings with a spreadsheet to help track progress. Interviewees thought that even with this approach, the information was limited and there were delays in sharing it. This caused delay in follow up action, and a poorer understanding of who was involved with each client, and what action was being taken by each organisation. Critically it was also insufficient to enable an understanding of impact and outcomes achieved. Facilities The Salvation Army has a long established presence at the Citadel in Eastbourne. Organisations interviewed thought that client’s familiarity with the Citadel helped develop trust, fostered engagement, ensured they felt safe, and importantly encouraged them to come in. A further positive aspect of this was that some of the clients who came in had not previously been seen by the Salvation Army. One negative aspect of this was that 4 of the clients assessed were already being assisted under Part 7, potentially resulting in some unnecessary duplication of effort. The facilities appear to have worked well generally, with plenty of functional space for everyone. The Eastbourne Hub enabled people to see representatives from Eastbourne Borough Council, Police, GP, CRI, Action for Change and a Community Psychiatric Nurse (CPN) enabling a more immediate and comprehensive approach than had been achieved in the Bognor Hub.

However, a number of organisations would have liked to have had more private space for confidential interviews. Also, ideally, some private space for staff to take a break, network privately, and where other work could be undertaken when not seeing clients. Several of those interviewed highlighted the importance of having a good internet connection to access information / records and photocopying / scanning facility, which would also enable them to do other work. With most clients arriving at lunchtime, the Hub was open for longer than necessary. In Helen

Keats review of the Hub’s operation, 10 am – 4 pm was suggested for clients, and 9 am – 5 pm for agencies. Some of those interviewed thought opening hours could be even shorter – at least start much later. It is key that ways are found to minimise the downtime for staff and also, crucially, ensuring their availability so that clients are not required to wait too long, or worse still, asked to

come back – which they inevitably will not do. At the Bognor Hub, there had been an issue for at least one client because there was no facility for clients with dogs. This does not appear to have been an issue in Eastbourne. Partnership working In Eastbourne, agencies work in close proximity and appear to already experience a good degree of partnership working. Many people interviewed welcomed the opportunity to work closely with other organisations, and felt that the focus of resources required by the Hub benefited organisations, as well as clients. For many the close networking involved in running the Hub provided real added value.



As with the Bognor Hub, E-CINS was not operational for the various organisations either during the Hub, or for the follow up work. Consequently, there was a heavy reliance on the Broadway client assessments and the Eastbourne Borough Council action monitoring spreadsheet to manage the follow on. Organisations interviewed nearly a week after the Hub closed, still did not have a clear picture of who was assessed, the needs identified and what role / action they might need to take going forward. Also significantly, clients were not informed of proposed action plans, how they might engage, and who with. The only real coordination was provided by Eastbourne Borough Council’s facilitation of weekly post Hub review meetings. Although in practice information was circulated just prior to the meeting, resulting in a considerable amount of meeting time being taken to go through the spreadsheet. This was initially needed to determine a lead agency for each client, and latterly determining what action, if any, the various organisations would take. The response was reactive rather than proactive action. This whole process could have been significantly enhanced with more immediate access to ‘real time’ information, and organisations attending meetings with pre-arranged ideas / proposals. It was also noticeable that attendance at meetings (and consequently feedback on key actions) significantly dropped off during February. There is clearly a need for future Hubs to find ways of processing assessments much more quickly, informing clients, and earlier involvement of other organisations in the assessment follow on. Organisations need to share ‘real time’ information to enable follow up action to start immediately following the assessments. Working in partnership to address client’s needs was thought by all organisations interviewed to be a positive experience. The Police were highlighted by many as playing a key role, showing a good deal of flexibility which helped build trust and confidence with the street community. Some of the agencies had been concerned about how an assertive outreach approach involving the Police would work, but in practice this was not seen as an issue. Having both a CPN and GP working together within the Hub was also seen as a very positive step and welcomed by other all other organisations. Whilst Adult Social Care - vulnerable adults, the Benefits Agency and Housing Benefit staff were available by phone, it was also suggested that their presence at the Hub could have enhanced the offer to clients. Up to the end of February it was still not clear how the agencies would manage the follow on arrangements after the weekly partner meetings ended. Whilst it was likely that Eastbourne Borough Council would continue to play a lead role (crucial that one agency takes a lead to ensure a clear focus), it was not clear what role the other organisations would play, and how they would work collectively as a group. In April a Complex and Multiple Needs Panel of key agencies was established to address such issues. Outcomes achieved Knowledge Feedback from the organisations interviewed suggested that the Hub had clearly helped them develop greater knowledge and understanding of the 44 clients needs, and the role of other

agencies – crucial in developing action plans to achieve outcomes and deliver impact.



Engagement Most of the clients were known to the various organisations. Although the number of people that were assessed, the detail of the assessments, the multi agency approach to reviewing needs and planning follow up work, all indicate an increase in the level of engagement with clients. From organisation’s perspectives, clients clearly received help / support that they might not otherwise have, including better signposting and a raised awareness of the help they could receive. Housing A total of 23 clients attending the Hub were supported with temporary accommodation – 17 in B&B and 6 in the Night Shelter. Of these, 5 people were already prior to the Hub being accommodated temporarily in B&B under Part 7 homelessness duty, and 4 were already in the night shelter.

By mid April 10 were housed – 8 in private rented, 1 by a housing association and 1 by Eastbourne Homes. A further 10 clients were still being accommodated in temporary accommodation, whilst private rented housing was being sought. Unlike the Bognor Hub, more clients were given significantly longer time in temporary housing pending further assessment, and action to address a range of issues including housing. Finding clients settled accommodation to enable ongoing work by other agencies, was seen as a positive approach. During the post Hub weekly follow up meetings it was clear that a number of clients would need ongoing support if housed, to ensure that they could maintain a tenancy. By the end of February it was still not clear how this might be delivered, and left to individual organisations to make arrangements where this could be resourced. Health St Mungo’s Broadway assessed 33 (75%) clients as having at least one of a range of mental health related issues, which was in line with the 80% identified during Operation Packet. However, in practice only 10 clients were referred to the CPN, one of whom was seen jointly with the doctor, but was not considered to be clinically depressed. Of those seen by the CPN, all were considered to have mental health problems, although only 3 had previously engaged with the service about their mental health. As with the Bognor Hub, those identified as having mental health problems were not thought to be acute, warranting a mental health specific medical intervention. A high proportion of the clients were already registered with a GP - 26 (59%) with local practices, with a further 12 (27%) stating that they used the local drop in surgery. This probably accounts for the low number (9) that needed to see the doctor over the three days. Of those seen, a number had acute physical conditions: fractured arm; severe infection; leg ulcer; thrombosis threat; pregnancy. One client was referred to hospital for further treatment. A significant number - 31 (71%) were identified as having drug / alcohol issues. Yet at the Hub, only 6 clients were engaged by CRI and 3 by Action for Change. Both organisations appeared to play a very limited role in follow up meetings and action. For health outcomes / impact, continuity of the relationship / follow up work is seen by many as

key. This aspect of the post Hub follow up work was least clear – the focus being on housing, drug and alcohol advice / support and community safety.



Community safety The Police assessed that the cost of their work in relation to arrests of 33 of the 44 clients alone has cost the public purse £1,794,76811. St Mungo’s Broadway assessed that 22 (50%) clients have had involvement with shoplifting / burglary / theft / robbery, and 20 (45%) had previously committed antisocial / violent behaviour. A very high number of the clients 23 (52%) had at some point served a prison sentence – at least 12 (27%) in the last 3 years. Prison adds significantly to the public costs at an estimated £37,64812 / year. Most of the 31 clients identified as having drug / alcohol issues have had involvement with the criminal justice system. Clearly there is a high cost to Policing the street community, which is significantly affected by substance misuse. Employment Of the 44 clients, the only one client had employment. Given the range of health related issues that need to be addressed, employment outcomes are only likely to be achieved in the longer term. In assessing cost / benefit of the Hub it should be remembered that where intervention action does lead to employment, this will produce a significant benefit to the public purse. It has been estimated that:

For those on Job Seekers Allowance (JSA) – there is a reduced payment of £7,800 / year per individual finding employment13

For those on Invalidity Benefit (IB) – there is a reduced payment of £8,160 / year per individual in employment14

For those on Employment Support Allowance (ESA) – there is a reduced payment of £8,500 / year per individual finding employment15

When an unemployed person [on JSA] moves into work they are estimated to incur £508 less in NHS costs per annum16

When an unemployed person with a disability [on ESA] moves into work they are estimated to incur £1,016 less in NHS costs per annum17

Income All but three of the clients assessed were in receipt of some form of benefit / pension. If ultimately interventions can achieve reduced benefit reliance, and / or employment, the cost / benefit of the Hub would be significantly enhanced as illustrated above. Attitude, thinking and behaviour By the end of February, some 6 weeks after the Hub, there was no real evidence at the partnership meetings of any significant change. Although one organisation commented that there had been fewer clients gathering on the streets, and fewer complaints in the immediate post Hub period. At the conclusion of the interim review in April, it was still difficult to gauge if there was any significant change, although anecdotally individual clients appear to have made some progress.

11 Based on an average cost of £1,668 (Ministry of Justice - 2010) 12 Ministry of Justice - Average cost of a prison place (excluding health and education) 2011/2012 13 Total Place Cost Benefit Framework ‐ Adam Robinson, EG Partnerships Division, DWP 2010 14 Ibid 15 Ibid 16 The Department for Work and Pensions Social Cost-Benefit Analysis framework - Daniel Fujiwara (2010) 17 Ibid



In summary the outcomes achieved for the 44 clients assessed to April 2014 were: Table 2. Outcome achievement

Key issue

Ho

us

ing

He

alt

h

Co

mm

un

ity

Sa

fety

Em

plo

ym

en

t

Inco

me

Att

itu

de

Th

inkin

g

Be

ha

vio

ur

Identified needs

41 x rough sleeping

33 x mental health issues 22 x physical health issues 26 / 44 GP registered

12 /44 Using drop in surgery

33 x offenders

1076 x

arrests = £1,794,768 - arrest cost

1 x employed part time

15 x JSA 20 x ESA

2 x Incapacity benefit

1 x pension 5 x not known

1 x employed

44 x range of issues

Initial action taken

17 x B&B

6 x night shelter

9 seen by GP 1 x hospital

referral 1 x CPN referral

Outreach

Engagement

Enforcement

No action No action

Engaged

Assessed

Supported

Impact / outcome

10 x housed

10 x ongoing

temporary housing

No evidence

of change

2 x Prison

No evidence

of change

No evidence

of change

No evidence

of change

No evidence

of change

Cost / value

For stakeholders, the costs and potential savings resulting from client’s engagement with services are key considerations. This is particularly so at a time of economic restraint, more limited resources, and the need to prioritise interventions. There are potentially a number of ways in which the cost / value can be assessed. This can be summarised as: Cost / savings

Direct / indirect actual costs

Earlier cheaper intervention / prevention – avoiding high cost services – e.g. Police / Health interventions.

Opportunity cost

Cost of deferring work Added value

Engagement between clients / organisations

Joined up solutions

Longer term benefit – individuals and organisations Social value (wellbeing)

Individuals improved confidence / self esteem,

Wider society – reducing negative impact on tourism, shops, business, community safety and feeling safer

Cost of inaction

The additional likely future cost of doing nothing



In the pilot, most agencies interviewed highlighted opportunity cost as the main expense of being involved. Some of the day to day tasks that needed to be undertaken were simply deferred while the pilot took place. All agencies stressed that resources are limited, and staff are already hard pressed to complete tasks. None of those interviewed highlighted any significant consequence resulting from the deferred work. Other notable costs incurred (to April 2014) as a result of the pilot were:

The cost of B&B accommodation - £22,430 (£5,307 - Nett of Housing Benefit)

Broadway - £5,798 (Eastbourne Borough Council and SHORE funded)

Police – £2,000 (self funded)

GP - £1,210 (self funded) The issues and complex needs experienced by the street community result in the higher costs associated with more serious interventions. In particular, the health service and criminal justice work required, makes very significant demands on the ‘public purse’. This is illustrated by the significant number of street community incidents in Eastbourne18 requiring Policing between June 2012 and July 2013: ASB – 226

Public safety – 56

Crime – 39

Police activity / administration – 93 Sussex Police have assessed that 33 of the 44 Eastbourne clients have over time been arrested some 1,076 times and committed a total of 1,407 offences. The cost of arrests alone is assessed at £1,794,76819. The HM Treasury Green Book20 encourages clarity around objectives to aid evaluation, and that the social / environmental costs / benefits are important and should be considered, despite often being difficult to cost. In considering how to assess the cost / benefit of the Hub, a number of potential longer term impact and outcomes measures were identified:

Health Depression / anxiety21

The average service costs per person of depression for those in contact with services or where their condition is recognised was £2,085 in 2007

The average service costs per person of anxiety for people in treatment or where their condition is recognised was £1,104 in 2007

Alcohol22

Annual cost to the NHS of alcohol dependence per person - estimated at £1,800.

The estimated indicative cost of hospital admissions wholly attributable to alcohol is around £1,450 and the indicative cost of admissions partially attributable to alcohol is around £1,750 (Department of Health 2011)23

Drugs24

Drug treatment cost-benefit per person: NHS ‐ £1,686, Criminal Justice system ‐ £10,145

Total net benefit associated with structured drug treatment per person - £6,527

GP Visits

GP appointment - short visit £43 / long visit £6325

18 Operation Packet 2 - Street Community Profile – Sussex Police 19

Based on an average cost of £1,668 (Ministry of Justice - 2010) 20 HM Treasury Green Book – Appraisal and Evaluation in Central Government 2003 (updated 2011) 21 Paying the Price ‐The cost of mental health care in England to 2026 ‐ Kings Fund, 2008 22 National Institute for Health & Clinical Excellence - Alcohol‐use disorders: alcohol dependence costing report (2011) 23 Alcohol-use disorders: alcohol dependence Costing Report – NHS 2011 24 The Drug Treatment Outcomes Research study (DTORS): Cost effectiveness analysis (2009) 25 PSSRU Unit Costs of Health and Social Care 2012



A&E

Ambulance services – see, treat and convey - £235 (national average)26

The average cost of an attendance with emergency treatment - £14627 Hospital

Short stay £586 / Long Stay £2,46128

Community Safety

Average cost per arrest - £1,66829

Average total costs of crimes against individuals and households at 2003 prices30

Violence against the person £9,254 Common assault £1,398 Theft £857

The average annual cost of keeping a person in prison was estimated at £34,76631

Housing

Homelessness assessment – staff and direct costs £385 / each32

Staff cost per households leaving (temporary accommodation/for whom a main homelessness duty was ended) – staff and direct costs £239 / each33

Cost of B&B circa £30 / night34

Mean cost for children looked after in children’s homes - £2,839 per week35 Cost of local authority foster care for children - £408 per child per week36

Future measurement

For the Hub initiative, a number of these measures could provide short term indicators of cost / benefit – although it must be remembered that these are national average figures. For more accurate and specific local costs / benefits, a number of key measures will need to be determined and collated at a local level, such as:

Number / cost of arrests

Number / cost of offences

Number / cost of GP appointments

Number / cost of A&E admissions

Number / cost of hospital admissions

Number / cost of homelessness support

In developing a methodology to assess the cost / benefit of interventions, it is suggested that this is

captured on three levels – with a focus on health, community safety and housing outcome objectives - as these appear to be the most significant, immediate and measurable issues.

The client level – through a personal ‘contract’, which captures interventions to date and sets out

planned interventions with clear personal outcome targets – possibly based on an outcomes

Recovery Star approach37. A summary of the ‘terms’ of all contracts should contain an assessment of the financial impact.

26 Ibid 27 High quality care for all, now and for future generations: Transforming urgent and emergency care services in England – Evidence

Base NHS England (2013) 28 Ibid 29 Sussex Police - Hub Cost Assessment 2013 30 Home Office Online Report 30/05 31 Costs per place and costs per prisoner – Ministry of Justice (2013) 32 Value for Money in Housing Options and Homelessness - Shelter (2010) 33 Ibid 34 Google search 35 Unit Cost of Health and Social Care-PSSRU (2013) 36 Ibid 37 Mental Health Providers Forum – Mental Health Recovery Star



The service level – utilising a formula such as the Greater Manchester Whole Place Community Budget Pilot38 as illustrated below, for each of the key areas: health, community safety and housing.

The programme level – by capturing overall programme costs / benefits (both reduced crisis management cost and prediction of re-offending cost39 ), utilising a model such as the illustration below, based on the Solihull Troubled Families Customer Segmentation Model40.

Savings to

reinvest High

Crisis Management

A&E / Hospital

Total Cost

Ov

era

ll C

os

t

Serious Crime & ASB

Homelessness Management

Le

ve

l o

f N

ee

d

Targeted Management of Complex Needs

Adult Mental Health

Total Cost Crime & Disorder

Prevention

Supported Housing Management

Targeted Preventative

Offer

Substance Misuse Treatment

Total Cost Targeted Diversion and

Support Activities

Housing Related Outreach

Low Universal Open

Access

GP Visits

Total Cost Police Engagement

Housing Advice and Support

A summary of the Hub cost / benefit is set out in Appendix 5. Given the very limited follow up information available from the various agencies, it proved difficult to calculate the outcome / impact financial implications in more detail.

38 Whole Place Community Budget Pilots - Greater Manchester Mental Health Outcomes Example 39 Offender Group Reconviction Scale (OGRS) – Ministry of Justice 40 The Cost of Troubled Families – DCLG (2013)



Case Studies

Case Study – Client A Client A was male aged 39 and had been sleeping rough for some 3 months. He was assessed by St Mungo’s Broadway as having depression, being suicidal and suffering from hallucinations, with a need to be referred to the Community Mental Health Team. Client A had been arrested 67 times and committed 112 offences including theft and assault, which had resulted in a previous period in Prison. Initially he did not engage and the case was going to be closed. However, the Police argued for an extension of the temporary B&B booking while agencies worked with him. A total of 13 nights were provided. He was then accommodated in private rented accommodation – with the help of rent in advance provided by housing. Subsequently he was given a 28 week custodial sentence. Agencies were working to find a way of maintaining the tenancy during his absence

Case Study – Client B Client B was male aged 54 He had a private rented tenancy for some 6 months, but had moved into the night shelter because of arrears, and action by the landlord to terminate the tenancy. The case management meeting agreed that agencies should work with him to help maintain the existing tenancy with housing benefit. Meantime Client B had started doing voluntary work at the hub with Salvation Army

Case Study – Client C Client C was male aged 68. He had a private rented tenancy. Previously he had been evicted from sheltered housing due to anti social behaviour. St Mungo’s Broadway identified mental health concerns and that he was diabetic, which were to be taken up with his GP. Case management identified a need for agencies to work with him to provide support to maintain the tenancy.

Case Study – Client D Client D was male aged 44. He was temporarily staying at the night shelter. It was thought that Client D was a Finish national, but that he did not want to return to Finland. He was not seeking work or claiming benefits. St Mungo’s Broadway assessed that Client D had asthma and mental health issues, requiring a Community Psychiatric Nurse assessment. He declared that he had used various drugs. With one week before the closure of the shelter Client D was still waiting to see the Community Psychiatric Nurse. By April he was again sleeping rough.



Case Study – Clients D1 and D2 Client D1 was female aged 34 and Client D2 was male aged 27. Prior to be accommodated in B&B, both had been sleeping rough for in the region of 3 years.

Client D1 was assessed by St Mungo’s Broadway as suffering from depression, being suicidal and with aggressive behaviour. She had committed 11 offences including shoplifting, assault and drugs, which had involved 18 arrests and a prison sentence. Client D2 was assessed by St Mungo’s Broadway was assessed as suffering from depression. He had committed 58 offences, which had involved 55 arrests and a prison sentence. Both clients were in sporadic contact with CRI in relation to their drug use. The couple were placed in B&B for a total of 85 nights pending helping them to secure private rented accommodation with a rent deposit.

Client’s perspective During the course of the review 7 of the 44 clients were interviewed to get their perspectives on the Hub. Of these, 2 were single clients who had been rehoused in private rented accommodation and 5 (including 2 couples) were being housed in temporary accommodation. Overall clients thought that the Hub had been a good thing, particularly being able to see key agencies in one place. All commented positively on the opportunity to address the various issues they faced. However, the post Hub liaison and communication experience had been generally poor. Whilst the Hub had enabled clients to connect with the various agencies all had experienced poor follow up and an absence of outreach support. Those in temporary housing were uncertain of their position – not knowing if or when permanent housing might be secured. Clients claimed that the need for a deposit and a guarantor was proving a significant barrier to them securing private rented housing. Clients commented they were trying

to ‘stay clean’ to ensure they secured permanent housing, but found the uncertainty stressful. The two clients in permanent housing had been significantly helped by the efforts of Salvation Army to help them find and furnish somewhere. Both had been sleeping rough for more than 5 years and were going through a period of significant adjustment. E. Post Hub Review General Six months after the Hub took place the outcomes / impacts achieved were further reviewed. This involved discussion with the lead organisation – Eastbourne Borough Council, various stakeholders and clients, as well as a review of action summaries. A detailed breakdown of issues identified and outcomes achieved is set out in Appendix 6. In the post Hub period a Complex and Multiple Needs Panel of key agencies was established which and was meeting monthly. Whilst the partnership has a good cross section of organisations represented, health partners are a notable omission. The focus of the meetings appears to be on the current cohort of street homeless clients with limited follow-up on the original 44 clients. ECIN’s was still not fully operational and Eastbourne Borough Council as the lead agency still did not have a comprehensive picture of action being taken by the various agencies and limited ability to coordinate it.



However, the Hub has helped galvanise the various agencies into considering initiatives to develop the approach including: 1. A SHORE partnership bid is being developed to apply for DCLG Help for single Homeless

funding to provide revenue between Autumn 2014 and March 2016 to improve services for non statutory homeless applicants.

2. The Eastbourne partnership has invited the Eastbourne, Hailsham & Seaford, Hasting & Rother

CCG to get involved in the partnerships work. Although the initial invitation has been rejected as the CCG does not get directly involved with clients.

3. SHORE was planning a pan Sussex conference to discuss the various Pop-up Hub initiatives across the counties, share good practice and develop the approach. This had to be abandoned as not all authorities supported / prioritised the proposal. This will now have to be taken forward through a series of more local events / actions - potentially diluting the impact that could have been achieved.

Housing At the time of the Hub 23 clients were assisted with short to temporary accommodation. By the end of the post Hub 6 month review, 15 clients had been housed in the private sector, 2 by a housing association / ALMO and 2 were accommodated by friends/ relatives. A further 13 were still being accommodated temporarily in the private sector with the hope that some arrangements may be converted to more permanent lettings. This level of achievement - 32 (73% of all clients) was in sharp contrast to the Bognor post Hub position of 1 client in housing (3% of all clients). This was largely due to the proactive and flexible approach taken by the local authority. Community safety In the post Hub period the Police recorded a 24% reduction in Hub client arrests but at the same time there was an increase in the level of criminal justice costs. This appears to be largely due to 7 clients being sent to prison during this period. Of these, 3 were sleeping rough and 4 had been placed in temporary accommodation. Whilst there were 21 offenders in both the pre and post Hub 6 month periods, of the 44 clients overall the breakdown reveals that where costs in the post Hub period reduced - 10 were housed and 1 was sleeping rough. However, it also shows that of the 11 clients where costs increased in the post Hub period, 8 were housed and only 3 were sleeping rough. Health Despite an extensive range of physical and mental health issues having been identified in the original assessment, 9 clients being seen by the GP in the Hub and 26 registered with GP’s, a further 12 using the drop in surgery, there appears to have been no follow up on health related issues. In two instances mental health referrals where made but outcomes are not known. Income / employment Generally client’s circumstances did not change, with a few notable exceptions. Two clients housed in private rented housing were in employment – one maintaining previous part time employment and one obtained a job averting a need for JSA. Two clients – 1 housed by a housing association / 1 housed in private rented accommodation started job related training courses. One of the clients returning to private sector accommodation continued volunteering.



Attitude, thinking and behaviour The overall sense from a number of stakeholders was that things had improved, although only 4 clients were highlighted as having significantly changed positively. Of the 4, 3 were housed - 2 in private rented and 1 in temporary accommodation (and seeing a Community Psychiatric Nurse) and 1 was sleeping rough. Of the 2 clients highlighted where things had got worse, 1 was in temporary accommodation and 1 was sleeping rough. Cost saving

In the 6 month post Hub period the Eastbourne pilot demonstrated an overall monthly saving of £7,228 in arrest costs / £650 in JSA costs; at a B&B cost of circa £1,000 (gross) per client. Table 3. Outcomes in relation to original objectives In reviewing the original objectives the following summarises our assessment of the achievements.

Achieved Progress Made

Not Achieved

1. For individuals

1.1 Accommodation rescue or sourcing

1.2 Administrative removal by UKBA

1.3 Identification of appropriate solutions to promote secure and sustainable non- street life

1.4 Referrals to appropriate mental health or substance misuse services

1.5 Swift health, housing and support needs assessment

1.6 Voluntary reconnection to home area / country

2. For agencies

2.1 Identifying clearer pathways into services for members of the street community

2.2 Reducing the number of people rough sleeping or at risk of rough sleeping

2.3 Reduction in emergency service calls in relation to begging and street drinking No

evidence

2.4 Tackling unmet mental and physical health needs

F. Key Conclusions Overall, our evaluation of the Eastbourne pilot Pop-Up Hub is that the following key conclusions can be drawn: 1. A pilot conducted over 3 days was never going to achieve immediate change / impact. The

follow up work with the clients, the development of joint action planning and delivery, will over time define its success. The Hub has galvanised organisations into action and created useful momentum.

2. The initial engagement has been far more successful than anticipated, with more clients attending the Hub. This is thought have been influenced by the choice of location - the Citadel is well known and trusted by the street community, aided by the outreach work undertaken particularly the advance notice given to clients. All but three of the target group of thirty were engaged, and a number of clients who were not known to agencies also attended.



3. The Hub itself involved a good range of organisations covering all key areas: housing, health and community safety. Whilst it appears that there were no significant issues that could not be addressed on this occasion, future Hubs could be could be enhanced by directly involving Benefits and Housing Benefit advisors.

4. The pre Hub briefing session for the various organisations helped develop understanding of the purpose and arrangements for the Hub, roles / responsibilities. A more formal briefing and process map, that could be shared with other staff involved unable to attend, and the organisations more generally, would help the delivery of the Hub and particularly the follow up work. The debriefing at the end of each day also helped understanding.

5. There was delay in getting assessment information shared and follow up work started. Post

Hub meetings could have been better planned and attended. Ways need to be found to involve all organisations more immediately in making the assessments, sharing ‘real time’ information, identifying follow on lead roles, and in developing and delivering action plans.

6. The flow of information between agencies, and coordination of follow up action, could have

been significantly enhanced by the use of a joint data base such as ECINS. To ensure timely and effective ongoing action, agencies need real time information that addresses data protection / professional confidence issues. There appears to be a general recognition of the need for, and the benefit of, such data sharing.

7. Weekly follow up meetings helped share knowledge / understanding, but the follow up actions

and lead roles were less clear. Clients did not receive action plans. Most of the clients have multiple / complex needs that are not going to be resolved in the short term. Beyond engagement and assessment, there has to be a longer term proactive, coordinated and resourced approach to recovery.

8. Housing is a key part of the solution – both temporary and ongoing. The proactive approach

taken by Eastbourne Borough Council in securing temporary accommodation for at least a month has been important, enabling agencies to work intensively with clients. Seeking to use a range of provision – public / private utilising advice and rent deposits, has helped secure permanent accommodation for 10 clients.

9. The health follow on work has focused on mental health and drug / alcohol issues. The action

being taken to address physical health and more generally how GPs and the Care Commissioning Group are being involved is less clear, and needs further work.

10. The Hub has delivered a number of key outputs / outcomes primarily

Engagement

Temporary housing

Permanent housing

Community safety

Employment and training

Follow on action, particularly in relation to housing and health related issues, will be key in helping to ensure the longer term impact and success of the initiative.

11. The pilot has also provided a significant source of learning and has galvanised agencies into

developing the approach taken. Although the poor engagement by health services given the extent of clients needs is an aspect that requires significant development.

12. There appears to be a strategic gap in that the work of the partnership does not fit clearly, nor is it recognised sufficiently as a strategic priority, within either district or county local authority. A wide span of control and influence is necessary to ensure the partnerships effectiveness given the range of issues that need to be tackled. Managing the partnership and coordinating resource allocation / use with such a diverse group of providers is therefore inevitably going to be difficult to achieve without a strong strategic steer.



G. The way forward

In developing the approach, all key agencies involved will need to assess the need, resource implications and outcomes / impact of the Pop-Up Hub approach.

Research undertaken by Sussex Police41, and other partner agencies, has already demonstrated that there are a significant and growing number of clients with a range of needs across Sussex. The clients assessed as part of the Eastbourne Hub, were a significant group with multiple and complex inter-related issues – homelessness, offending, substance misuse and mental health.

Understanding the complex needs of clients in order to plan, manage and monitor interventions by

a range of agencies, requires good quality shared ‘real time’ data. E-CINS has been designed to achieve this, but has not been widely available, and the roll out in the Hub Pilot areas has been protracted. This has resulted in limited hard evidence being available for the evaluations.

One of the principle costs of running the Eastbourne pilot has been the staff provided by the various organisations. Participating organisations in the pilot highlighted the opportunity cost of deferred work as one of their main costs. In the main staff were carrying out normal duties, albeit for a longer and more intensive period with the client group than normal. This suggests an occasional 3 day intervention could be resourced again. Whilst this pilot demonstrated some savings, the evaluation highlights significant potential savings that might be achieved.

The other key consideration is the provision and cost involved in providing temporary accommodation. In Eastbourne, Bed & Breakfast and the Night Shelter provision enabled working with clients for a longer post Hub period. For organisations dealing with other issues, temporary accommodation / permanent accommodation is key to enabling them to work more intensely with vulnerable clients to address their complex needs - which inevitably require longer term interventions.

In the Hub follow up meetings, the need for ongoing tenancy support for both temporary and permanent housing was highlighted as key to achieving other outcomes. Clients could benefit from ongoing support / advocacy to help empower and motivate them.

If a form of hostel and support could be utilised, this would address the issue of a lack of short term provision, provide a cheaper option to bed & breakfast, provide a more settled environment for clients, and better enable Hub follow up work. A further option could be working with private sector landlords to utilise a portfolio of properties. Good use was made of the private sector in Eastbourne to achieve significant housing outcomes.

An assessment of the impact and outcomes of the Eastbourne Hub has been difficult because of

the limited post Hub coordination between agencies and the lack of information on client’s circumstances. The true cost / benefit of a Hub can only really be reassessed if all the agencies

involved fully participate in collecting and sharing ‘real time’ key information – on an ongoing basis.

The initial findings from the Eastbourne pilot appear to suggest, that a number of outcomes and impact can be achieved from the multi agency intervention delivered by a Hub. However, a lot more needs to be done to realise the potential outcomes and impact that a multi agency intervention through a Hub could deliver through:

Clearer shared objectives and targeting of scarce resources

Ensuring joined up solutions to problems

Developing more effective agency partnership working

Collating better data / evidence to demonstrate the cost : benefits – to the wider ‘public

purse’ and indirect benefits– such as reduced nuisance / anti social behaviour which adversely affects shops, business, tourism and leisure

The appointment of SHORE funded outreach workers for 2014 / 2015 presents a significant opportunity to draw further on the St Mungo’s Broadway experience of running Hubs in London, and develop more effective multi agency interventions.

41 Operation Packet 2 - Street Community Profile – Sussex Police



For example, good connections with GP services and substance misuse support will alleviate future costs associated with substance misuse, self neglect and homelessness. This is supported by both studies in relation to substance misuse42 and reoffending. As shown above, a significant proportion of offenders re-offend. Studies have assessed that43:

The proportion of offenders who re-offend is 26%

The average number of re-offences per re-offender is 3 This is further illustrated in Transforming Rehabilitation44 which highlights the need for a proactive approach to meet housing needs of offenders; reducing reoffending is a key driver for the Probation Service to improve resource use and impact. Critical to the success of the engagement achieved by the Hub, and the ongoing recovery for clients, is funding for accommodation and support services. Innovative ways need to be found to fund the temporary accommodation to enable joint assessments / action plans to be developed and ongoing support to help clients with complex needs to sustain tenancies. The Mental Health Concordat 2014 - signed by key national health, social care and criminal justice organisations - aims to help ensure people who need immediate mental health support at a time of crisis get the right services when they need them, and get the help they need to move on and stay well. It covers policy making and spending decisions in anticipating, and preventing, mental health crises wherever possible. The Concordat highlights the expectation that in every locality in England, local partnerships of health, criminal justice and local authority agencies will sign up to local Mental Health Crisis Declarations of commitments and actions. Clearly there is significant synergy with the work of the SHORE Partnership in relation to the street community that should be developed. As illustrated by this pilot, the acute services stand to gain most in staff time and budget savings from successful interventions. Ways need to be found of harnessing service budgets such as health and Police, to underpin these interventions, which will help provide longer term solutions and save the public purse. Could the Police fund the temporary accommodation and health services the ongoing support? There are funding opportunities for radically alternative forms of service delivery. These include personalised budgets enabling tailoring of provision to meet individual needs, and through various sources of funding. Examples of funding are the Police Innovation Fund and the NHS Challenge Fund. The Department of Health - Transforming Primary Care: proactive personalised joined up care for those who need it most (2014) also points the way to a far greater focus on those with complex needs, through better integration of health and social care. At the heart of this local Clinical Commissioning Groups should be playing a significant role. The pilots both illustrated a significant disconnect between identified client needs and the community health services being

provided – particularly in relation to mental health issues. At a strategic level, health and wellbeing boards will also have a key role to play in delivering a more joined up approach. It is clear that overall no individual agency alone can resolve all the issues. Further, where agencies do invest time and resource, the costs and benefits will not be shared equally. However, this review does illustrate that there are potentially significant savings that can be achieved for the public purse overall, where a reduction in high cost emergency services can be reduced through earlier low cost interventions. Joint service commissioning, pooled budgets and ring fenced shared savings will all be important to ensure appropriate resource allocation, ongoing follow up action with individual clients, and impact going forward. Therefore it is imperative that a dynamic partnership approach is developed at both East and West Sussex at a strategic county level, and at a local operational level, to maximise the effectiveness of the Pop Up-Hub initiative.

42

Tackling the Drug Problem – National Audit Office (2010) 43 Proven reoffending quarterly bulletin July 2011 to June 2012 - Ministry of Justice

44 Transforming Rehabilitation: a summary of evidence on reducing reoffending – Ministry of Justice (2013)



Appendix 1 - Interviews

GMA would like to acknowledge and thank the following people who took part in interviews and those who additionally responded to the pre hub questionnaires** Angie Bigsby – Temporary Accommodation Co-Ordinator - Eastbourne Borough Council

Anne Marie Ricketts – CPN – Sussex Partnership NHS

Becky Speight – Service Manager - Action for Change**

David Barratt – Project Co-ordinator - Kingdom Way Trust**

David Squirrell – Major – Salvation Army**

Helen Keats - Helen Keats Associates

Ian Watling – Deputy Services Director Adult Mental Health Services – Sussex Partnership NHS**

Jacqui Davies Smith - Service Manager - CRI**

Joe Batty – Regional Manager - St Mungo’s Broadway

John Routledge – Project Coordinator - SHORE

Julian Williams - Sergeant - Sussex Police**

Moh Hussein – Interim Housing Team Leader - Eastbourne Borough Council

Stephen Lytton - Doctor – Seaside Medical Centre**

Appendix 2 - Document Review

The following key documents were reviewed in developing the evaluation:

Brighton Rough Sleepers Hub – CRI Summary

Bristol ‘Streetwise – Street Drinker’ Evaluation – Bristol NHS

Homeless Link – The value of the homelessness sector

Leeds Offender Programme – CRI

Lessons learned from the Eastbourne Hub - Helen Keats Associates

Operation Accent Analysis – Sussex Police

Operation Packet 2 - Street Community Profile October 2013 – Sussex Police

Police Professional - Street Life Article 24th January 2013

St Mungo’s Broadway Client Assessments

Strategic Profile: The Street Community in Sussex 2013 - Sussex Police

Street Community Strategic Profile – Sussex Police

Sussex Outreach Prospectus – Sussex Homeless Outreach Reconnection & Engagement

(SHORE)

Sussex Police Street Communities Project: Pop Up Hubs Proposal - Helen Keats Associates

Terms of Reference for the Street Community Project

The Cost of Troubled Families – DCLG (2013)

Unit costs of health and social care 2012 – PSSRU

Value for Money in Housing Options and Homelessness - Shelter (2010)



Appendix 3 - The Street Community Pop-Up Hub Change Model

Stage 5

Long Term

Outcomes

Stage 4

Intermediate

Outcomes

Stage 3

Hub

Stage 2

Pre Hub

Stage 1

Initial Set Up

Street Community

Identified

Hub Identified Agencies

Identified

Operational

Plan Agreed

Engagement

Issues

Identified

Focused Resource

Allocation

Multi Agency Solutions

Housing Health Community

Safety Employment Attitude

Thinking

Behaviour

Income

Agency

Liaison

Outreach

Work

Information

Requirements Resource

Allocation



Appendix 4 – Client needs summary During the three days of the Pop-Up Hub the profile of the 44 clients assessed was as follows: Age / gender

Age Range Male (M) / Female (F) Rough Sleeping (other)

20-29 M= 6 F= 5 3M (3M) / 0F (5F)

30-39 M= 7 F= 6 3M (4M) / 5F (1F)

40-49 M= 10 F= 1 4M (6M) / 0F (1F)

50-59 M= 6 F= 2 4M (2M) / 1F (1F)

60-69 M= 1 F= 0 0M (1M) / 0F (0F)

Homelessness Of the 20 (45%) identified as having slept rough over the last year – the breakdown of duration on the street was as follows: Less than 6 months – 4M / 2F 6 months to 1 year - 2M / 2F 1 year to 5 years – 4M / 2F 5 years to 10 years – 2M / 0F 10 years to 20 years – 2M / 0F The remaining 24 clients appear to have utilised a range of temporary accommodation / sofa surfing and tenancies. Origin At 14 (32%) the female proportion is significantly above the estimated Sussex average and well

above the national average45. Of the 44 clients only 1 (2%) was of central and eastern European origin – compared to 18% in Operation Packet - 201346. The client appears to be in the UK legally. Of the 44, only 14 (32%) identified that they originated from Sussex. Health Of the 44, 39 (89%) we're experiencing health related issues. St Mungo’s Broadway assessed 33 (75%) clients as having at least one of a range of mental health related issues: depression, anxiety, eating disorders, hallucinations, delusional thoughts, suicidal thoughts, panic attacks, aggressive behaviour, memory problems. 12 clients (27%) were assessed as having 5 or more of these issues. 22 (50%) of clients highlighted physical health issues including: gallstones; leg ulcer; high blood pressure; pregnant; asthma; arthritis; gout; 3 x hepatitis C; slip disc; broken ribs; cirrhosis of the liver. The St Mungo’s Broadway assessment on GP registration identified 26 (59%) with local practices 12 (27%) the drop in surgery and 6 (14%) with no practice identified.

45 Operation Packet 2 - Street Community Profile – Sussex Police 46 Ibid



Community safety 23 (52%) clients had at some point served a prison sentence. 22 (50%) clients were assessed by Broadway has having had involvement with shoplifting / burglary / theft / robbery. 20 (45%) had previously committed antisocial / violent behaviour. Income Only 5 (11%) had no identified income, most received ESA (15) /JSA (20), two incapacity benefit, one received a pension. The main income range was £53 - £122 / week. One client is employed part time. Drugs and Alcohol 30 (68%) were identified as having drug / alcohol issues. Of these: 20 (45%) described themselves as problem drinkers 24 (55%) described themselves as drug users 14 (32%) said they had drug and alcohol problems. 28 (64%) of the clients identified as having drug / alcohol issues had been involved with the criminal justice system. 20 (45%) of the clients who admitted to drug use – 10 had used IV. Drugs of choice were: cannabis (9), cocaine (10), crack (14), methadone (11), heroin (16), and other (3). Lager and cider are the main drinks consumed. Housing As at 14th February – 5 were being accommodated in the night shelter, 17 in Lynwood (including 6 couples) and 4 were being accommodated as a Part 7 duty to temporarily house. Risk 37 (84%) out of the 44 were assessed as being a risk to themselves. 21 (48%) were assessed as a risk to others.



Appendix 5 - Cost / Benefit Summary

Organisation

Personnel

Direct Cost

Indirect cost

Potential cost / intervention

savings *

Opportunity Cost / Benefit Added value

Social Value (wellbeing)

Cost of inaction

Outcomes* Cost Estimate

Additional Cost?

St Mungo’s Broadway

Manager

Assessment Worker

2 x Outreach Workers

SHORE funded

£5,798

Travel costs

On costs

£43 GP visit

£146 per A&E visit

Ambulance services -

£235 / time

Short hospital

stay - £586

£1,668 per arrest

£2,897 per month in prison

£385 per homeless

assessment

Circa £30 / night B&B

Housing

freeing up night shelter bed space

Cost of deferred

work

Engaged

Joined up solutions

Longer term impact

Economic benefit

Business

Tourism

Individual

Confident

Self esteem

Society

Feeling safer

£ Crime

£ Health

£ Benefits

£ Tax loss

19 X Housed

13 x Temporary

housing

2 x job related training courses

2 x employed

(1 x -£650 JSA/ month)

7 x Prison - +£20,279 /

month

Reduced arrest costs

-£7,228 / month

4 x significant positive attitude / behaviour change

CRI 2 x Senior Recovery Workers

2 x Recovery Workers

2 x Nurses

Manager

£208

£121

£506

£60

Travel costs

Doctor Doctor

Nurse

£630

£180

Prescriptions - £400

Housing

Co-Ordinator

Circa

£2,100 -

*Based on prices quoted earlier in the report



Organisation

Personnel

Direct Cost

Indirect cost

Potential cost / intervention

savings *

Opportunity Cost / Benefit Added value

Social Value (wellbeing)

Cost of inaction

Outcomes* Cost Estimate

Additional Cost?

Mental Health

CPN £315 -

On costs

£43 GP visit

£146 per A&E visit

Ambulance services -

£235 / time

Short hospital

stay - £586

£1,668 per arrest

£2,897 per month in prison

£385 per homeless

assessment

Circa £30 / night B&B

Housing

freeing up night shelter bed space

Cost of deferred

work

Engaged

Joined up solutions

Longer term impact

Economic benefit

Business

Tourism

Individual

Confident

Self esteem

Society

Feeling safer

£ Crime

£ Health

£ Benefits

£ Tax loss

19 X Housed

13 x Temporary

housing

2 x job related training courses

2 x employed

(1 x -£650 JSA/ month)

7 x Prison - +£20,279 /

month

Reduced arrest costs

-£7,228 / month

Criminal justice costs +£126,266/

month

4 x significant positive attitude / behaviour change

Salvation Army

Community Development

Manager £335

Refreshment

Heating Lighting

Night Shelter Trustee

Project Manager

Volunteers

No anticipated additional

cost

Donation based funding

-

Police Sergeant

2 x PCSOs

1 x PC

£2,000 -

Action For Change

3 Workers

Manager

£150

£60 -

*Based on prices quoted earlier in the report



Appendix 6 - Eastbourne Hub client outcome assessment summary

Cli

en

t

Key Issues / Outcomes

Notes Housing Health

Community Safety

Employment Income

Attitude Thinking

Behaviour

1 Other Private rented

Unemployed JSA

2

Other Depression Panic attacks

Unemployed ESA Registered doctor Whereabouts / circumstances not known

3

Rough sleeping Depression Drugs

Former prisoner Theft Burglary In prison

Unemployed ESA Aggressive / violent behaviour

Registered doctor Had temporary accommodation provided

4

Private rented Returned to private rented

Depression Memory problems Gallstone

Former prisoner Firearm

Unemployed Child Benefit Registered doctor

5

Other Temporary accommodation

Depression Alcohol

Former prisoner Unemployed ESA Registered doctor

6

Other Private rented

Offensive weapon Unemployed Attending a woodwork course

JSA Significant change

7

Rough sleeping Rough sleeping

Leg injury Depression Suicidal Hallucinations Drugs / Alcohol

Former prisoner Theft Assault Fraud Served prison sentence

Unemployed ESA Violent behavior Registered doctor Had temporary accommodation provided



Cli

en

t Key Issues / Outcomes


Community Safety

Employment Income

Attitude Thinking

Behaviour

8

Rough sleeping / Other Private rented

Asthma Leg ulcer Memory loss Depression Drugs / Alcohol

Former prisoner Theft Kidnap Robbery Burglary Due in court for shoplifting

Unemployed Income Support Violent behaviour Registered doctor

9

Rough sleeping Temporary accommodation

Depression Suicidal Drugs

Former prisoner Shoplifting Assault Class A drugs

Unemployed ESA Aggressive / violent behaviour

Registered doctor

10


Anxiety Depression Drugs / Alcohol

Former prisoner Shoplifting Drunk & disorderly GBH

Unemployed JSA Violent behaviour Registered doctor

11

Temporary accommodation Temporary accommodation

Bipolar Depression Alcohol Seeing CPN

Former prisoner Criminal damage GBH

Unemployed ESA Violent behavior Engaging - significant change

Registered doctor

12

Other Sanctuary HA

High blood pressure Depression Declined CPN

Unemployed Undertaking a security course

ESA Registered doctor

13


Depression Drugs / Alcohol

Unemployed Incapacity Benefit Registered doctor Lost temporary accommodation provided


Pregnant Unemployed JSA Registered doctor



Cli

en



Community Safety

Employment Income

Attitude Thinking

Behaviour

15


Liver disease Depression Arthritis Asthma Alcohol

Former prisoner Drunk & disorderly

Unemployed ESA Violent behaviour Engaging - significant change

Registered doctor

16

Rough sleeping / Other Temporary accommodation

Suicidal Asthma Arthritis

Former prisoner Harassment Drug trafficking

Unemployed JSA Violent behaviour ASB

Registered doctor

17


Depression Asthma Drugs / Alcohol

Begging Unemployed JSA Registered doctor

18

Rough sleeping / Other Living with girlfriend

Depression Gout Drugs

Drugs Unemployed ESA Registered doctor

19

Private rented Returned to tenancy

Depression

Theft Unemployed Volunteering

Not known Registered doctor Assisted to pay bills to maintain tenancy

20 Rough sleeping Piles Former prisoner

Fraud Unemployed JSA Whereabouts /

circumstances not known

21


Epilepsy Depression Asthma Drugs / Alcohol

Former prisoner Drugs Theft Fraud Firearms Served prison sentence

Unemployed ESA Registered doctor



Cli

en



Community Safety

Employment Income

Attitude Thinking

Behaviour

22


Gall bladder Bipolar Hepatitis C Drugs / Alcohol

Former prisoner Shoplifting Fraud Drugs


23


Depression Drugs

Theft Unemployed JSA Registered doctor

24 Other Eastbourne Homes

Arthritis Asthma

Former prisoner Robbery Drugs


25


Depression Alcohol

Shoplifting Assault

Unemployed ESA Violent behavior Behaviour has regressed

Registered doctor

26


Asthma Epilepsy Depression Hepatitis C Drugs / Alcohol

Former prisoner Shoplifting Fraud GBH

Unemployed JSA Registered doctor

27


Hepatitis C Bipolar Drugs / Alcohol

Former prisoner Assault Weapon

Unemployed ESA Violent behaviour Registered doctor

28


Arthritis Depression Drugs / Alcohol

Former prisoner Shoplifting Begging ASB




Cli

en



Community Safety

Employment Income

Attitude Thinking

Behaviour

29

Rough sleeping Drugs

Former prisoner Burglary Assault Theft In prison

Unemployed JSA Violent behaviour


Slip disk Alcohol

Drunk & disorderly Dinking & driving

Unemployed Incapacity Benefit Registered doctor


Unemployed JSA Registered doctor

32


Broken ribs Depression Drugs / Alcohol

Former prisoner Shoplifting Fraud Deception


33


Hepatitis C Drugs / Alcohol

Former prisoner Assault Theft

Unemployed JSA Violent behaviour Registered doctor

34


Depression Arthritis Anxiety Drugs

Shoplifting Assault Criminal damage Served prison sentence


35

Other Sofa surfing

Diabetic Blood pressure Depression

Driving Harassment Assault / damage

Retired Pension Registered doctor Lost private rented housing

36 Other Rough sleeping

Asthma Drugs

Stealing cars Not known Not known Violent behavior Engaging



Cli

en



Community Safety

Employment Income

Attitude Thinking

Behaviour

37 Other Living with Mother

Bipolar Drugs / Alcohol Seeing CPN



Depression

Applying for JSA Employed

Applying for JSA

39


Depression Alcohol

Unemployed ESA Regressed Registered doctor Lost temporary accommodation

40

Other / Depression Anxiety Drugs

Theft Fraud Drugs

Unemployed JSA Registered doctor Whereabouts / circumstances not known

41

Rough sleeping Depression Stress Drugs

Former prisoner Assault Driving In prison

Unemployed JSA Violent behaviour Registered doctor Had temporary accommodation provided

42 Rough sleeping / Other

Private rented

Mental health Drugs

Shoplifting Part time Varied Registered doctor

43


Asthma Heart attack Depression Paranoia Drugs / Alcohol

Former prisoner Shoplifting Burglary


44

Other Cirrhosis of the liver Depression Alcohol

Former prisoner Shoplifting Violent assault

Prison

Unemployed Income Support Violent behaviour Registered doctor Lost temporary accommodation

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