Nicky Miller, Sustainable Funding for Housing First: Part 2: Changing ‘Where’ we design, develop, deliver and fund Housing First
As a society we have accepted that individuals with a disability can receive support for the rest of their life, however we have not accepted that people with multiple and enduring support needs should be able to receive the same. Whether we work towards accepting this as a society or not, the time has come to change 'where' we design, develop, deliver and fund many aspects of current homelessness services, but in particular Housing First.
As my colleagues before me have stated, Housing First is so much more than giving someone a home, then why is it designed, developed, delivered and funded in the part of the system that addresses homelessness?
Very often, I have heard worries from Local Authorities, the part of the system responsible for homelessness is expected to take the burden of funding Housing First in the long term. Their gripe is that an individual’s homelessness has been addressed fairly quickly and their continuing challenges lie with other parts of the Health and Social Care system, to meet their ongoing needs. It is often these parts of the Health and Social Care system that failed to address somone's support needs and they subsequently fell into homelessness, so why should the wider Social Care system not be responsible for the ongoing funding of Housing First?
My colleague talked about the opportunity in the short term to fund some service users within Housing First through Self Directed Support (SDS). I agree that this can be used to some degree, however there are challenges scaling this up. As my colleagues who manage Learning Disability services, some of which are solely funded through SDS, would tell you, you can’t build a sustainable model solely on small packages or 4,5, 6 or 7 hrs per week. The challenges related to funding the gaps between each support becomes problematic and many providers won’t accept small packages due to this issue. These services will tell you that they need big packages that will then allow for smaller packages to be slotted around the bigger packages to make it sustainable.
For individuals eligible for SDS in Homelessness services, my experience is that people don’t qualify for large packages. However, we can integrate some small SDS support packages within a wider Housing First Team, sharing these small packages among the different staff members who can then fit these supports into their wider core work, rather than allowing one staff member to complete all the SDS Housing First work. We need to ensure that we recruit additional staffing to accommodate the increased hrs on top of our contractual obligations.
Turning Point Scotland continues to express our strong views around moving away from the silo’d funding approach to support. Rather than funding ‘issues’ we should be funding services and no matter what part of the system you present in, individuals should have access to a range of services through a ‘no wrong door’ approach. To ensure we fulfil our promise that Housing First can be for as long as an individual needs it, we must move Housing First away from its current position where it is generally funded through Homelessness service provision, and integrate it within the wider Health and Social Care partnership.
Despite significant challenges and learning across the country, citizens of the Housing First community are trying hard to mobilise individuals at an appropriate speed through Housing First Assessment, whilst giving enough time and opportunities for them to develop relationship with their support worker. We mentioned in our previous blog that we need all aspects of the system to adapt to deliver support in line with the principles of Housing First, through a Systems Fidelity approach. All parts of the Social Care system which affects, or is affected by Housing First, should be involved in the design, development, delivery and funding of Housing First. We need to transform how we fund Housing First services but to do this we need to build the case for all parts of the Health and Social care system to feel like active citizens within Housing First creating a sense of ownership, control and responsibility for its development.
Nicky Miller, Turning Point Scotland, November 2020.