Bright spot in the budget: UK Government backs Housing First for vulnerable homeless people

While on the whole the much-trailed ‘Housing Budget’ was considered something of a disappointment, Phillip Hammond delivered rather more on homelessness than many of us might have expected. Here’ I-SPHERE Director Prof Suzanne Fitzpatrick explores the announcements.

Professor Suzanne Fitzpatrick, I-SPHERE Director

In the budget a cross-governmental “Homelessness Reduction Task Force” was announced, and there was also welcome news of a £20 million injection of funds into private rented sector access and support schemes. However, perhaps the biggest surprise was a substantial (£28 million) investment in three “Housing First” pilot schemes for homeless adults with complex needs in the West Midlands, Manchester and Liverpool.

When considered alongside the passage of the Homelessness Reduction Act 2017 earlier in the year, and the manifesto committment to halve rough sleeping by 2022, this may seem indicative of successive Conservative administrations taking seriously their responsibilities towards some of those who are “not managing well at all’ in the current era of austerity.

However, let’s be clear that the Cameron/May administrations have plenty ground to make up on homelessness. Their welfare ‘reform’ policies, particularly Local Housing Allowance (LHA) restrictions, have contributed to sharp rises in homelessness since 2010, and a slashing (by more than two-thirds) in spending on housing support services since the Coalition came to power has decimated the help available to single homeless in many parts of England. The recent abandonment of plans to roll out LHA limits to social tenants, and Budget announcements mitigating some Universal Credit implementation problems, are welcome, but they go nowhere near far enough to undo the damage wreaked on the housing and welfare safety net over the past seven years.

That said, it would be churlish to fail to give credit where it is due and there is no doubt that this formal commitment by Government to Housing First is excellent news. The UK has, thus far, been a bit slow to the races on a fundamental change has taken place in homelessness services across much of the rest of the developed world, inspired by the ‘Pathways to Housing’model initially developed in New York City.

Housing First involves rapid access to ordinary (private or social) rental housing for homeless people with complex needs, coupled with intensive and flexible support, provided on an open-ended basis. It contrasts with the ‘treatment-first’ philosophy of traditional transitional models, which seek to promote ‘housing readiness’ in a hostel-type setting. These transitional models have been criticised for their high placement failure rate and for institutionalising homeless people. Homeless people often strongly dislike hostels, and difficulties in managing challenging behaviour in these congregate environments means that those with the highest needs are sometimes excluded.

Robust international evidence has demonstrated impressively high housing retention rates in Housing First projects (often 90% at the one-year mark). The broader outcomes of Housing First interventions on the health and quality of life of homeless people are less uniform, but still on balance positive, and better than for traditional models.

Considerable cost savings for Housing First have been demonstrated in the United States and Canada, particularly for those with the most complex needs, and are consistent with findings in the more limited UK evidence base. A feasibility study in Liverpool city region found that using Housing First to replace most of the region’s 1,500 units of 24/7 supported housing would generate estimated cost savings of £4 million.

One obvious concern raised about Housing First programmes is the shortage of affordable housing in many areas of the country. Ways forward could include identifying housing associations committed to this agenda as part of their ‘social mission’, and reassuring landlords of the reliable support packages available. The fact that support for people in Housing First programmes must be available for as long as it is needed, rather than limited to a transitional period, makes it potentially challenging to resource. This reinforces the imperative to engage the health and criminal justice sectors in this agenda, in the knowledge that many of the potential cost savings associated with Housing First will accrue in those sectors.

Housing First has, finally, been gathering momentum in the UK over the past couple of years, with Homeless Link developing a national programme in England, a ‘Housing First Scotland’ partnership being established, and fledgling developments in Wales and Northern Ireland too. Organisations as diverse as the Joseph Rowntree Foundation and the Centre for Social Justice have published reports calling on Government to invest in this model.

One might say that the evidence in favour of Housing First is now so strong that there is little need for further pilots, even well-funded ones, and we should just get on with rolling it out across the country. But the substantial ‘change management’ process involved in implementing Housing First at scale may benefit from further testing in the UK context. Let’s hope that the opportunity will be seized in the three favoured city-regions to use their experience to push forward with this progressive and evidence-based agenda at national level.

This blog was originally published 28/11/17 on the UK Collaborative Centre for Housing Evidence (CaCHE) webpage.