Tag Archives: Housing First

Tackling health inequalities: what does the data tell us and how can it help?

Posted on by

Health inequalities in Scotland are significant. Every year we hear about how Scotland has some of the biggest gaps in the health and wellbeing of the poorest and richest in society. In some cases, Scotland has the largest gaps in equality in the whole of Europe. And in many instances, they are rising. Scotland also has the lowest life expectancy of all UK countries.

A number of studies and research projects have been commissioned to try to identify the key indicators and factors that are creating and reinforcing these inequalities, and what sorts of interventions would work best to try and reduce or eradicate them altogether. It is hoped that by conducting research, and compiling data, policymakers can use this to identify groups and geographic areas where health inequalities are significant, and to intervene to reduce them, with data to help back up and evaluate the effectiveness of these interventions. In Scotland, work is being done by a number of organisations including the Scottish Government, Glasgow Centre for Population Health (GCPH) and Public Health Innovation Network Scotland (PHINS).

What indicators and factors are being measured?

Income inequality has a related impact on health inequalities, and the scale of low pay is significant. The relationship between health inequalities, poverty and household income is one which has been explored at length and is often highlighted as one of the main factors which influences health inequalities. Studies which look at income, and also at relative levels of deprivation can provide useful comparison points, with comparable datasets on employment status and income readily available at a national and local level. Data also considers trends over time, comparing pre- and post-economic crash data, as well as relative earnings and expenditure relative to inflation and the rising cost of living. Other factors include age (those under 25 and earning a lower minimum wage for example) and by gender, with more women in lower paid, lower skilled and part time or insecure work.

How usable is the research being created?

The research which examines health inequalities explores a whole range of interrelated factors, and highlights just how complex the landscape of inequalities is. Creating a clear and holistic picture of all of the factors which contribute to health inequalities is not easy. Many studies, while detailed and effective, are niche, and focus on a very limited number of factors across a limited demographic source. As a result, questions have been raised about the utility of this research and its applicability and scalability at a national level. In an attempt to tackle this, combined data sets are being produced which provide opportunities for comparison across data from a range of studies.

The “Triple I” tool from NHS Health Scotland is designed to help policy designers to create effective interventions to reduce health inequalities. A second edition of the tool is due to be released in 2018/19. Triple I aims to provide national and local decision makers with practical tools and interpreted research findings about investing in interventions to reduce health inequalities in Scotland. It does this by modelling the potential impact of different interventions and policies on overall population health and health inequalities.

 

What can be done to act on the data?

While the research being produced is high quality, and thorough in relation to findings, the real question is what can actually be done with the research, and what steps can policymakers and practitioners take to use the findings to inform their own practice.

There are, researchers suggest, significant opportunities presented by the recent research which has been done on income inequality. In particular, they cite the public sector and public sector pay as a key way to reduce the income, and therefore the inequality gap, particularly among higher earners and those who would be considered “working poor” or “just about managing”. In Scotland, significantly more people are employed in the public sector than in any other part of the UK, and there is, researchers suggest, an opportunity to better align and increase low wages to help to reduce the gap.

The adoption of new initiatives, such as the “housing first model”, which is due to be rolled out in Glasgow to help homeless people break the cycle of homelessness, are also opportunities not only to address inequalities, but to ensure that long term help and support is in place to prevent any relapse into chaotic or risky behaviour. In relation to housing first, the savings on front line services such as emergency admissions to hospital, or contact with the police after committing a crime are significant, and while more in depth research is needed to create a full cost benefit analysis model of the scheme and its effectiveness, early studies show that the impact on health and wellbeing on those who had previously been homeless is huge in terms of reducing inequalities and improving wellbeing. However further data on homelessness in Scotland shows how far we have to go, and that housing first is only one mechanism which can be used to begin this process of reducing inequalities among the most and least deprived communities in Scotland.

Alternatively, some have suggested a more radical overhaul of how we distribute welfare and wealth within the country. Research has been coming thick and fast on the subject of a “citizens basic income”, particularly following the trial which was rolled out in Finland (the findings of which have not yet been published). Research on how this could impact on inequalities is not widespread yet, as pilots have been small scale, However, it is suggested that a total overhaul of welfare, replacing it instead with a citizen’s basic income would be a more effective way to reduce inequalities across the board, including in health.

Summing up

Health inequalities are significant in Scotland. Much of the research focuses on the impact of deprivation, poverty and low income on health inequalities and how, in order to tackle health inequalities in Scotland we must also tackle some of the other significant social problems within our communities, including low income and insecure work, and the impact of homelessness or chaotic lifestyles on health.

Data can be used in a number of ways to help inform policy decisions, some more radical than others. But creating a complete understanding of inequality in Scotland is challenging. It is up to researchers and policymakers to work together to create a better understanding of the conditions and factors which contribute to inequality, and what can be done to help tackle systemic and entrenched inequalities in our communities through policy levers and evidence based policy making.

If you liked this article you may also be interested in:

Universal basic income: too good to be true?

A world of evidence … but can we trust that it is any good?

Follow us on Twitter to see what topics are interesting our research team

Record number of rough sleepers – is enough being done?

Posted on by

homelessBy Heather Cameron

Rising for the seventh consecutive year, the number of rough sleepers in England has more than doubled since 2010. This is despite various initiatives over the years and a recent surge in political activity around homelessness.

The government has committed to halving rough sleeping by 2022 and eliminating it altogether by 2027 but given this alarming growth, it is difficult to see how this will be realised. Perhaps even more concerning is the recent revelation by the UK’s new Homelessness Minister, Heather Wheeler, that she doesn’t know why these figures have increased so significantly in recent years.

Highest ever recorded level – an underestimate

The government’s most recent annual rough sleeping count shows the highest ever recorded level. On a given night in autumn last year 4,751 people were recorded sleeping rough – an increase of 15% on the previous year and 169% since 2010.

However, the actual figure has been suggested to be much higher as these estimates only count the number of people sleeping rough on one night.

Recent research by homelessness charity, Crisis, found that more than 8,000 people were currently sleeping rough across England, predicted to rise to 15,000 by 2026, if nothing changes. The base estimate for rough sleepers across the UK is 9,100 – a figure that Crisis suggests is set to rise by 76% in the next ten years. And even these figures are recognised as an underestimate.

What’s behind this surge?

Lack of housing and rising property prices, along with government cuts and welfare reforms have been widely blamed for the increase in rough sleeping. However, Heather Wheeler has also said that she did not accept the suggestion that welfare reforms and council cuts had contributed to the rise.

Despite admitting she did not know the reason for the huge increase, Wheeler did hint at two contributory factors. She referred to a “classic” reason for rough sleeping as coming out of prison with no support and “a real problem in London with people coming over [mainly from Europe] for jobs, sofa surfing with friends, and then the job changes and they have a problem.”

Wheeler also highlighted the lack of supply of affordable housing as the real issue. Indeed, Crisis has also highlighted this as a particular issue that, if addressed, could lead to ‘particularly noteworthy’ reductions in rough sleeping.

But while lack of supply is cited as an issue by most, so too are welfare reforms and funding cuts – including by a recent parliamentary briefing paper:

“Factors identified as contributing to the ongoing flow of new rough sleepers to the streets include: welfare reforms, particularly reductions in entitlement to Housing Benefit/Local Housing Allowance; reduced investment by local authorities in homeless services; and flows of non-UK nationals who are unable to access benefits.”

A recent report from youth homelessness charity Centrepoint reported that 85% of local authorities said welfare reform aimed at young people is a barrier to delivering housing duties. It also highlighted a need for more funding.

Findings from the Institute for Fiscal Studies have also shown that government cuts mean that housing benefit no longer covers rent for almost 70% of people in social housing.

‘A step in the right direction’

Successive governments have introduced initiatives to tackle rough sleeping, including: The Rough Sleepers Initiative, No One Left Out and No Second Night Out.

More recently, there has been a surge of activity around homelessness which could provide grounds for optimism. The government has pledged £28 million for Housing First pilots in the West Midlands, Manchester and Liverpool. This approach has been proven to reduce rough sleeping in other countries and a recent study in the Liverpool City region concluded the scheme could save £4 million compared with current homelessness services.

The Homelessness Reduction Act, introduced last month, gives local authorities new responsibilities to step in earlier to prevent homelessness and support more people facing homelessness. Concerns have however been raised that councils will be unable to fulfil their new duties due to a lack of funding.

The government has also announced a new package of measures to tackle rough sleeping, which includes:

  • a new Rough Sleeping Team made up of rough sleeping and homelessness experts to drive reductions in rough sleeping
  • a £30 million fund for 2018 to 2019 with further funding agreed for 2019 to 2020 for local authorities with high levels of rough sleeping
  • £100,000 funding to support frontline Rough Sleeping workers to make sure they have the right skills and knowledge to work with vulnerable rough sleepers.

Crisis has described the government’s new rough sleeping initiative as “a step in the right direction” but argues that “it falls short of what’s required to truly end rough sleeping”.

Way forward

The evidence suggests that the rise in rough sleeping numbers is down to a number of contributory factors, including welfare reforms and funding cuts. And while the recent surge in activity is welcomed, frustration remains over the government’s failure to recognise the “baleful influence of welfare reforms”.

The chief executive of Crisis has argued that if the government doesn’t invest in social housing and change direction on welfare reform, any reduction in rough sleeping won’t be sustainable:

“We must acknowledge that the continued rise in rough sleeping is a result of welfare cuts, decline in social housing, soaring private rents and chronically underfunded support services. Until we do we will only be tackling the symptoms and not the causes.”

If you enjoyed reading this, you may be interested in our other posts on housing solutions for prisoners and Finland’s Housing First approach.

Follow us on Twitter to see what developments in policy and practice are interesting our research team. 

The year that was: looking back on a year of policy and practice on The Knowledge Exchange blog

Posted on by

Before bidding farewell to 2017, there’s just time to reflect on some of the issues we’ve been covering in The Knowledge Exchange blog during the past twelve months. There’s been no shortage of subjects to consider, from health and social care and devolution to  universal credit and town planning.

Missing EU already?
Of course, the major issue dominating policy in the UK this year has been Brexit. In July, we reviewed a new book by Professor Janet Morphet which assessed the UK’s future outside the European Union. While not claiming to have all the answers, the book provides a framework for making sure the right questions are asked during the negotiation period and beyond.

One important consideration concerning Brexit is its potential impact on science, technology and innovation. In August, we noted that, while the UK government has been making efforts to lessen the concerns of researchers, anxieties remain about funding and the status of EU nationals currently working in science and technology roles in the UK.

Home thoughts, from home and abroad
Throughout the year, we’ve been looking at the UK’s chronic housing crisis. In May, we considered the potential for prefabricated housing to address housing shortages, while in August, we looked at the barriers facing older people looking to downsize from larger homes. In October, we reported on the growing interest in co-housing.

The severe shortage of affordable housing has had a significant impact on homelessness, and not only in the UK. In April, we highlighted a report which documented significant rises in the numbers of homeless people across Europe, including a 50% increase in homelessness in France, and a 75% increase in youth homelessness in Copenhagen.

One European country bucking this trend is Finland, and in July our blog looked at the country’s success in reducing long term homelessness and improving prevention services. Although the costs of Finland’s “housing first” approach are considerable, the results suggest that it’s paying off: the first seven years of the policy saw a 35% fall in long term homelessness.

Keeping mental health in mind
A speech by the prime minister on mental health at the start of the year reflected growing concerns about how we deal with mental illness and its impacts. Our first blog post of 2017 looked at efforts to support people experiencing mental health problems at work. As well as highlighting that stress is one of the biggest causes of long-term absence in the workplace, the article provided examples of innovative approaches to mental illness by the construction and social work sectors.

A further post, in August pointed to the importance of joining up housing and mental health services, while in September we explored concerns that mobile phone use may have negative effects on the mental health of young people.

Going digital
Another recurring theme in 2017 was the onward march of digital technologies. In June, we explored the reasons why the London Borough of Croydon was named Digital Council of the Year. New online services have generated very clear benefits: in-person visits to the council have been reduced by 30% each year, reducing staffing costs and increasing customer satisfaction from 57% to 98%.

Also in June, we reported on guidance published by the Royal Town Planning Institute on how planners can create an attractive environment for digital tech firms. Among its recommendations: planners should monitor the local economy to get a sense of what local growth industries are, and local authorities should employ someone to engage with local tech firms to find out how planning could help to better facilitate their growth.

Idox in focus
Last, but not least, we’ve continued to update our readers on new and continuing developments at the Idox Information Service. Our blog has featured articles on the Research Online, Evaluations Online and Ask-a-Researcher services, as well as the Social Policy and Practice database for evidence and research in social care. We were proud once again to sponsor the 2017 RTPI Research Excellence awards, and highlighted the winning entries. And following an office move, in September we explored the fascinating history behind the building where we now do business.

Back to the future
2018 is already shaping up as an important year in policy and practice. One important issue exercising both the public and private sectors is preparing for the General Data Protection Regulation. The Knowledge Exchange blog will be keeping an eye on this and many other issues, and the Idox Information Service, will be on hand to ensure our members are kept informed throughout 2018 and beyond.

Thank you for reading our blog posts in 2017, and we wish all of our readers a very Happy Christmas and a peaceful and prosperous New Year.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

How Finland put housing first

Posted on by

Earlier this year, official figures showed that rough sleeping in England had risen for the sixth successive year.

The data showed that 4,134 people slept on the street in 2016, an increase of 16% on the previous year’s figure of 3,569, and more than double the 2010 figure. Many of those enduring long-term homelessness have complex and multiple needs related to mental health or addiction. While this is a growing problem in the UK, housing exclusion is by no means confined to these shores. As we reported in April, there is growing evidence of an alarming increase in homelessness across Europe.

But one European country is bucking this trend. Since 2008, the Finnish government has been working with housing agencies to reduce long term homelessness and improve prevention services. The adopted approach, called ‘Housing First’, has had a big impact, achieving a 35% fall in long term homelessness over seven years. Finland is now the only country in the European Union where homelessness continues to fall.

Housing First: what it means

Housing First is not a uniquely Finnish approach to tackling homelessness, nor is it a new idea. The practice began in Los Angeles in the 1980s. It’s based on the principle that housing is a basic human right, and turns on its head the notion that vulnerable people are only ‘housing ready’ once they have begun to engage with support services.

As the name suggests, Housing First means providing vulnerable people with permanent, affordable housing, and then offering specialised support to ensure that they don’t return to sleeping on the streets. However, acceptance of that support is not a condition for access to housing. The approach has been adopted in various American cities, as well as parts of Australia, Canada, France and Japan. But it’s in Finland that Housing First has achieved some of its most impressive results.

Housing First: how it works

One of the key players in Finland’s Housing First strategy is the Y-Foundation, an association of local authorities, church, construction, trade union and health organisations that has been supporting homeless people for more than thirty years. Starting in 2008, the foundation converted homeless shelters in Finland’s biggest cities into rental housing. At the same time, the government set targets for local authorities to build new flats in mixed housing developments. The programme is backed by money from government grants and the proceeds from Finland’s not-for-profit gambling monopoly.

Housing First: why it works

The cost estimate for Finland’s Housing First programme is €78 million. But Juha Kaakinen, chief executive of the Y-Foundation, has no doubts about its value for money. In an interview with Inside Housing, he explained:

“It’s not only good social policy; it has a big safety and security angle, as the more homeless people there are on the streets, the more unsafe the city is. And there’s an economic argument, too: taking care of these people is a good investment.”

He estimates that taking each homeless person off the streets saves social, health and emergency services around €15,000 a year.

Housing First in the UK

Homelessness charities in Britain have been taking great interest in the success of Housing First in Finland.

“It’s a stunning result,” Matt Downie, director of policy and external affairs at Crisis, told Inside Housing.  “They used to have a bigger homelessness problem than we have.” But he was less sure whether the programme could be replicated here. “We’ve got a system that is the exact opposite of Housing First. In Finland they made a strategic choice; that allowed them to change everything.”

Even so, Housing First is already gaining ground around the UK:

Scotland
A pilot project in Glasgow by Turning Point Scotland was the first Housing First project to be implemented in the UK. Between 2011 and 2013, the project provided mainstream social housing and 24/7 floating support to 22 individuals who were homeless, aged 18 or over, and involved in substance misuse. An evaluation of the project by Heriot Watt University found that none of the tenants were evicted from their flat and the majority of participants retained their tenancies.

Wales
The Welsh Government has announced that it is considering moves towards a Housing First policy. The communities and children secretary for Wales told the Welsh Assembly in April 2017 that he would be reviewing homelessness prevention in Wales, and is exploring Housing First initiatives.

Northern Ireland
Working with the Depaul youth homelessness charity, the Northern Ireland Housing Executive funded a Housing First pilot scheme in Belfast. An evaluation of the 18-month programme reported a number of positive results, including a high rate of tenancy retention, improvements in participants’ self-care, confidence and living skills, and reductions in their dependence on drugs and alcohol. A further Housing First programme has since been established in Derry.

England
In 2015, the University of York published findings from a study of nine Housing First services in England. The authors reported high levels of success in reducing long-term and repeated homelessness, with 74% of service users successfully housed for one year or more. There were also significant improvements in the physical and mental health of Housing First tenants and high levels of satisfaction. The Centre for Social Justice has called on the UK government to set up a £110m national Housing First programme, arguing that the investment would save money and lives.

Final thoughts

There is no quick fix to the problem of homelessness, but Finland has shown that adopting new ways of thinking about the problem can virtually eradicate rough sleeping. As Juha Kaakinen observes:

“Housing First means ending homelessness instead of managing it.”

Further reading on homelessness: