Responsive Project
Learning from the ‘Everyone In’ approach to providing mental and physical health support (including substance misuse), and how this can be translated to future policy and practice
Background
Across England, there is a manifesto commitment to end Rough Sleeping 2024, with a strategic focus on health. Recent reports and ongoing pieces of work evidence that the needs of individuals experiencing homelessness are often complex and housing alone is not the solution. The intersection between housing instability, criminal justice, substance use, and physical and mental ill-health leads to many of those experiencing homelessness facing fragmented care and support that does not always appropriately address all their needs. To protect those sleeping rough during the COVID-19 pandemic, there was the launch and implementation of the ‘Everyone In’ programme—the first national attempt at a coordinated offer of access to universal accommodation. This rollout presents a unique chance to learn from these new ways of working and innovative approaches. There is presently a gap in our understanding of the health impacts of ‘Everyone in’ and this project provides an opportunity to understand the potential for improving integrated, multi-agency care and access to support for people experiencing rough sleeping, and lessons learned to inform future policy.
Aim
This evaluation aims to assess what aspects of ‘Everyone In’ worked well and less well for improving physical and mental health outcomes, including substance misuse, and provide learnings that can be translated into policy.
Methods
Through cross-NIHR infrastructure/school collaboration, this project will benefit from expertise and research networks across the NIHR School for Public Health Research (SPHR), NIHR Applied Research Collaboration (ARC) North East North Cumbria (NENC) and ARC West, NIHR Public Health Policy Research Unit, (PRU), NIHR Health Protection Research Unit (HPRU, Bristol) and NIHR Greater Manchester (GM) Patient Safety Translational Research Centre (PSTRC). The research team includes the NIHR SPHR national Director who will provide cross-School links. Our project will be undertaken in partnership with Groundswell, who are a national leader in involving and providing opportunities for individuals with experience of homelessness to contribute to research, decision making and create solutions for homelessness. Since March 2020, Groundswell and their peer researchers have been championing research around the impact of COVID-19 on people experiencing homelessness.
A) Phase 1: Review of existing evidence
We will undertake secondary data analysis of a qualitative study in
North East England funded by NIHR SPHR, to develop an early
understanding of the impact the pandemic has had on health outcomes for
individuals who experienced homelessness. We will also undertake a
review to systematically synthesise the existing evidence on integrated
care interventions (comprising housing, health and social care) that are
in response to policy or system level initiatives (such as ‘Everyone
In’). The purpose of the review is to update the evidence on ‘what
works’ in the provision of integrated care for improving health outcomes
(physical, mental health including substance misuse) of people
experiencing homelessness.
B) Phase 2: Qualitative study – implementation, mechanisms of impact, and context.
This includes a case study approach to allow a deep dive of
information on implementation and learnings from different areas that
implemented ‘Everyone-In’. We are proposing to have four regions/cities
(e.g. London, Manchester, Newcastle, and Bristol). We will carry out
semi-structured interviews or focus group discussions with individuals
who experienced rough sleeping and were given emergency accommodation as
part of ‘Everyone In’, as well as with those who were involved in the
commissioning or delivery of ‘Everyone In’ across the sites.
As part of our public/patient involvement (PPI), we will run a half-day session supported by Groundswell with at least two individuals with lived experience of homelessness and two individuals who are health or social care providers to review and validate the findings and determine dissemination.
C) Integrating findings and formulating recommendations
Narratively synthesise findings from the evidence review alongside
findings from the qualitative study to draw conclusions and
recommendations based on learnings from the implementation of the
‘Everyone In’ approach.
Outcomes
- Understand the potential for improving integrated, multi-agency care and access to support for people experiencing rough sleeping
- Engage with people with experience of rough sleeping and stakeholders in policy, which is central to all aspects of this project.
- Co-produce elements of the project to enrich the study findings and impact.
- Inform future shared policy design and decision-making, influence the ‘levelling up’ agenda, shape broader inequalities reduction, and increase recognition of the differences in approaches required across the country.
- Findings could feed into the inclusion health policy agenda from the perspective of those experiencing homelessness, for example, integrated commissioning to meet complex needs.
- Support local areas to develop new, and streamline existing, policies and practice to improve health outcomes to people experiencing homelessness, generating better value for money.
We will work collaboratively with partners in Office for Health Improvement and Disparities (OHID), Department of Health & Social Care (DHSC), Department for Levelling Up, Housing and Communities (DLUHC), and relevant partners in Local Authorities, and voluntary sector (such as Crisis and Groundswell) to iteratively develop impactful outputs.