Oral evidence: Homelessness, HC 40Monday 13 June 2016

Oral evidence, 13 June 2016.

Witnesses

Jane Ellison MP, Parliamentary Under Secretary of State for Public Health, Department of Health, and Peter Searle, Director of Working Age Benefits, Department for Work and Pensions, gave evidence.

Chair

Good afternoon. Welcome to you both to this final evidence session on our inquiry into homelessness. Minister, thank you very much indeed for coming this afternoon. We understand that Lord Freud is unavoidably detained outside of the country—not detained against his will; he simply cannot get a flight back, to put that into context. Please introduce yourself. I think you are standing in for the Minister.

Peter Searle

Yes, I am Peter Searle. I am Director of Working Age Benefits in the DWP. Lord Freud does send his profuse apologies.

Chair

The situation is that if there are questions of a slightly more political nature we raise that you do not have an answer to, you have given an assurance to the Committee that the Minister would very rapidly give us a written answer, within a few days.

Peter Searle

Indeed, yes.

Chair

Thank you both for coming. Can I just begin by asking whether you have any estimate of what the costs to your Department are of homelessness? We heard in a previous evidence session with the Minister responsible for homelessness that this is something that goes far beyond DCLG and touches on the work of many Departments.

Jane Ellison

Indeed, yes. The last formal assessment was made in 2010. The cost to the NHS and the wider health system at that time was reckoned to be around £85 million, reflecting in large part things like the additional level of A&E attendances from people who are homeless. That was the last formal assessment made. That is likely to be an underestimate, given it is a few years ago.

Chair

Is there any intention to update the figure, given it is now six years old?

Jane Ellison

We do not have a formal intention but Public Health England is undertaking quite a lot of work in this area. They are looking quite broadly at a number of pieces of work here. I am sure that when a Committee issues its report, any relevant recommendations would be something that I would want to feed into their work.

Chair

We just heard before about the ministerial group on homelessness, and I find it rather surprising that there has not been a requirement at that level for all Departments to do an assessment to try to get the impact on governance as a whole. Presumably if your Department has not done a more recent assessment, there is not one in Government crossing all Departments either.

Jane Ellison

I am not sure. I am just a small section of it, in terms of the Health bit. Although that is when we last did an estimate, it is fair to say that the kind of attention we have given the subject over recent years reflects the fact that we know that it is an ongoing challenge. We have actually put some further thought and investment into homeless health to reflect that. It is certainly an area that has been given some priority in recent years.

Peter Searle

I am not aware of an estimate from our perspective. In the DWP much of what we do is try to support, through benefits or through work support, people to move them forward in their lives. In some ways homeless or not homeless, we would still be providing support so working out what the additional cost of homelessness is over and above other states is very difficult to do. I am not personally aware of anything that DWP have done in this space.

Chair

Have either of your Departments got any specific policies which you are either implementing now to address the problems of homelessness or are looking to implement in the near future?

Jane Ellison

In the case of homeless health, there have been a couple of things. In policy terms, we have had a piece of work that actually started a few years ago but worked through to its conclusion, our inclusion health board, which concluded about a year ago. It undertook a specific series of pieces of work looking essentially at how we can more mainstream health services for homeless people but in particular also to look at some of the specific challenges. Out of that identification of some of the needs have come other pieces of investment. For example, we have invested £10 million on a homeless hospital discharge fund. That was to look specifically at the challenges around why people end up back in hospital so quickly—the revolving door to A&E that so many rough sleepers experience. That work was working with a number of different providers to see how they could essentially support people once they had been discharged to get back to full health or back to better health and not end up back in hospital very quickly. That piece of work was about looking at a number of things that could be done and then taking those forward and trying to embed them within the health system. More recently we put £40 million towards the Homelessness Change and Platform for Life programme. There were two separate strands to that investment, one around improving hostel accommodation for homeless people in particular with a view to places in which people could be trained in looking after their own health better, or where people could undertake, for example, mental health treatments. That was about improving facilities. The Platform for Life programme, which had a slightly smaller proportion of the money, was about trying to help young people who were in danger of homelessness, who have not fallen through the net yet but are in danger of doing so because they are sofa-surfing or facing uncertainty in their accommodation at a critical time in their life, where they might be facing exams or searching for jobs, et cetera. That was to try to give them a stable platform for life in which to go forward with studies, job applications, et cetera, and to ensure that they did not suffer from all those things that I am sure your Committee is well aware of that go with not being able to provide a fixed address.

Chair

Mr Searle, have you got anything to add to that?

Peter Searle

I will quickly outline three or four policies that are very relevant in this area. The first is something we brought in July 2014 but are bringing forward into universal credit, which is around making sure there is an easement around work search requirements for homeless people on jobseeker’s allowance, so if they talk to their work coach and talk about homelessness as a potential barrier to moving into work then we can ease the requirement until they get back into stable accommodation. The second, running across a whole range of our welfare reforms, is discretionary housing payments. There is £870 million worth of funding for the next five years to enable local authorities to help people with the transition with welfare reforms. Again, that can help avoid or address homelessness. The third is the temporary accommodation management fee, which was abolished as of April 2016, with the funding plus a little bit extra moving across to local authorities for them to integrate better with the support they provide to help people in temporary accommodation.

Jane Ellison

In terms of the broader homelessness, in terms of people at risk of homelessness or in poor accommodation, that is one of the areas in which we feel that the move to public health leadership in local authorities from 2013 onwards can really benefit groups like this. It gives people an overall view across a whole series of services that sit in local government, with public health right at the heart of that. The work that Public Health England does, for example, as it works with local authorities is often about how you bring different frontline services together to provide that joined-up approach, looking through things like the strategic needs assessments in areas. We are really beginning to see benefits of that, as people having that single view of the problem are beginning to tackle problems upstream, but seeing them in classic public health terms, rather than just dealing with an acute end result.

Chair

Are there any examples of good practice where that is happening that you could show us?

Jane Ellison

Yes, I can perhaps write to you with some examples. Duncan Selbie, the Chief Executive of Public Health England, has literally met the head of every single top-tier authority in the last 18 months or so. Often this is exactly the sort of thing they have looked at. There are some good regional examples of people doing some very good joined-up thinking, so I would be very happy to write with some examples.

Chair

That would be very helpful, thank you.

Kevin Hollinrake

This is a question to Mr Searle. We have heard a lot of evidence over this inquiry that the ending of the shorthold tenancy agreement is now the leading cause of homelessness. What role have recent benefit changes made to the affordability of property in the private renting sector in particular?

Peter Searle

It is an area where the local housing allowance changes and the freeze to local housing allowance have reduced the amount of support that is available through the housing benefit system. We have heard similar issues. From our perspective, in terms of the number, we have roughly the same number of people on housing benefit in the private renting sector that we had before, so there is no strong evidence that we have been getting that private landlords are not willing to rent any longer to housing benefit claimants. Certainly, our experience is that an awful lot still do.

Kevin Hollinrake

We have heard a lot of evidence in this inquiry, and certainly in the Government’s own report on homelessness it quotes as the leading cause the ending of the shorthold tenancy agreement. It must be something that you have got concerns about.

Peter Searle

We want to make sure that we do whatever we can to support people to have stable accommodation. In the end it must be between the private landlord and their tenant whether they wish to continue with that tenancy or not. It is not something that we see as having driven through the benefit system a large number of changes.

Kevin Hollinrake

In terms of the perspective of landlords, there was a Crisis report into this; 55% of landlords did not want to rent to somebody who is on housing benefit. Do you think the changes to direct payments to landlords has had a role to play in that perception among landlords that this is a less safe place to be in terms of renting to people on housing benefit.

Peter Searle

The change to direct payments for private landlords was something that came in some time ago. That has been the state of play—payments direct to the individual—for some years largely there.

Kevin Hollinrake

2008.

Peter Searle

Yeah, so for quite a while. The change in universal credit direct payments for tenants is primarily about social housing and social landlords. It is something we have talked an awful lot about with the sector. Across the Government there were lots of concerns raised. We have taken great care to design a system so that where people cannot cope with that we get early notification of it and bring in alternative payment arrangements, can work with local authorities and individuals to try to get them into a position where they cope again and build up their independence, but until they can, we maintain that payment direct to the landlord, so there are alternative payments available.

Kevin Hollinrake

It is almost a perfect storm. You have got rising rents, which makes it more attractive for landlords to go into the private sector and with it the benefit cap, and in terms of being able to give direct payments, there might be a sequential, gradual erosion of the attractiveness of this sector for many landlords.

Peter Searle

We need to keep a very close eye on it, and absolutely we will. The early signs we have had are that we can put the necessary protections in place. The other thing we have done around direct payments is make sure that we can, if arrears do build up, get more of those arrears out of the monthly benefit payments that go out, so landlords can get rent arrears back more quickly, and that we keep a very close eye on those arrears and bring in alternative payments as soon as necessary.

Kevin Hollinrake

In terms of the removal of housing benefits for 18-to-21-year-olds, what assessment have you made on the impact of that on homelessness?

Peter Searle

We are still working through the detail of that policy, which, strictly speaking, is the removal of housing support within universal credit because it does not come in through housing benefit itself. We have committed to protecting vulnerable young people from any negative impacts of that. That is something we are working through in detail with stakeholders at the moment. We will come forward with proposals in due course but we recognise there is a risk for some vulnerable individuals where they cannot find alternative accommodation. Housing costs would then be covered by universal credits.

Kevin Hollinrake

Again, we heard clear evidence from a Birmingham housing provider in this would really exacerbate the problem of entrenched homelessness, certainly in their region. This is something that clearly must be a concern.

Peter Searle

It is something that would be a concern but, again, understandably a lot of commentators, when they talk about this policy, talk about a stark version without the exemptions that we are talking about. That is very much what we are trying to work through with stakeholders and experts such as the person you are talking about to understand what sort of protections need to be put in place to ensure those negative impacts do not come about.

Helen Hayes

I have met with many housing associations and specialist providers of supported housing in my constituency who are very worried about the proposal to cap the local housing allowance and to implement that for supported housing as well. The Government announced a review of that decision some months ago. I met with one of those providers on Friday, who told me that the delay in having a decision is now starting to affect the ability of their trustees to plan for their long-term future and they continue to be very worried about the impact of that decision. I just wondered whether you might be able to confirm when the Government will announce the outcome of that review.

Peter Searle

We have no precise date, but shortly—over the next few weeks, I would expect. We are very committed to protecting that really important sector providing protection to some really vulnerable people. We have heard loud and clear the messages that the people, such as those you have talked to, have come back with. I personally visited 10 or 15 different providers around the country to get a personal feel for the impact. We are working very closely with colleagues across Government, first to get that sense of the picture, the evidence and the data around this. We are involving Department of Health officials, as well as DCLG, Treasury and others. We are getting a first draft of that report as we speak, and getting a better sense of what the position is, and are now looking to come up with some policy ideas about what an alternative future model might be and how we might provide the appropriate action that the Ministers have committed to providing. I would expect that work to be complete before the summer, but there is no precise date as yet.

Mr Prisk

Just following on, having held a ministerial office I am aware of the definition of “summer” being broad. Do you expect to publish the outcome of that? The decision-making that my colleague has described is a critical issue, and the clock is ticking. Do you expect to publish this before the end of the summer term?

Peter Searle

As I said, this is not a firm plan, but the intention is to publish the evidence review and policy conclusions before the summer recess. That is the timetable we are currently working to. We very much recognise the urgency and the need to free up plans.

Jim McMahon

Mr Searle, do you try to ensure that the local housing allowance keeps up with changes in rent at a local level.

Peter Searle

Do we try to do that?

Jim McMahon

Yes, actively try to do it.

Peter Searle

The Government’s policy has been to freeze the local housing allowance for the next four years. In many areas rents will be going up above 0%, so naturally that will mathematically mean that in many areas it will be falling behind relative to rents. The Government have committed to taking 30% of the potential savings from that freeze, and, from 2017-18, to feed that into a targeted affordability fund, which is something that we had in place up until last year. That would target additional support at those areas where rents and the local housing allowance have moved most out of kilter, to try to keep local housing allowances as close as we can to local rent levels.

Jim McMahon

We have heard evidence from a number of parties that even before the freeze the disparity between the two were significant because, as the annual review period showed, some housing markets were changing very rapidly over that 12 months and by the time it was actually implemented it could be significantly behind where the local housing market was, and with the freeze on top of that some areas have seen very significant increases. What do you think will be the practical result of that policy?

Peter Searle

Inevitably, as has been the case over a number of years, the relationship between local housing allowances and rents for individual, particular local authority areas is not consistent across the country. Now there are some areas where local housing allowances are quite low relative to the distribution of rents. Generally, in a local area, there will be something more affordable somewhere relatively close by.

Jim McMahon

When we talk about the local area, we have heard evidence from Birmingham in particular, where they have concerns about just how broad their rental market area is. Do you think there is a case for having more localised allowances that take into account very varied local housing markets?

Peter Searle

It is something we think about every now and again. How broad should those areas be? You could make them very narrow, but then you end up with a very complex system with a multitude of different rates. Government think at the moment that the balance is about right, with a broad, relatively simple system. There are some people who say the areas should perhaps be broader still; there are others who say they should be narrower. The Government have no plans to change that at the moment.

Jim McMahon

On hostel accommodation, we have heard evidence during the course of the review that residents of hostels are actively discouraged from getting employment, because it is a restriction that the hostel places on them. Are the Government doing anything to tackle that? It does seem quite counterintuitive, does it not? The idea of getting somebody into supported living is for them to get back on track and re‑establish themselves, and employment is an important part of that. For that barrier to be in place seems odd. Are there plans to look at that?

Peter Searle

It is something that I have not personally heard a great deal about. It would alarm my Department, and I am sure Ministers across Government. Lord Freud would be very concerned and want to know more about that. From our point of view, we want to make sure that the incentives are right, and that, in hostel accommodation or any other sort of accommodation, everything is geared towards helping someone progress, and you should not be incentivised, effectively, to not progress just to keep that accommodation. With some of the YMCA accommodation recently, for example, they have been very good at having a system where you are earning points so that you can move up to this next stage of accommodation. Getting points and getting a job is not something that means you immediately have to—

Jim McMahon

It was more the relationship between the amount of money that they can charge for those on benefits and the amount of money that person in that situation can be reasonably expected to earn in employment to then cover the rent that the hostel charges. It is that transitional support that was highlighted as the issue.

Peter Searle

You are saying that the issue is that they need that person to be on benefits because there is more money to them through the housing benefit system.

Jim McMahon

Yes. Some of the cases that we heard involved people who had been excluded from the job market for a long time, if they had even ever had a job at all in a meaningful way. The type of work that they can get and the amount of money they can be realistically expected to earn in that employment does not cover the loss of benefit payments for the accommodation.

Peter Searle

Universal credit, as the Minister said, can help with that, because it means a smooth transition into in-work support from out-of-work support. The issue potentially there again is you need to make sure that the incentives are right so that people are not encouraged to stay in accommodation. Generally, hostel accommodation, I would imagine, is there for people at a particular time of need. There has to come some point at which someone who has progressed moves on from there and frees up the accommodation for someone else. It is about the balance of when that time is right.

Kevin Hollinrake

On that specific point, in a hostel in York, which serves some of my constituents, the cost of that accommodation was £275 per week. If they had to pay for themselves they would have to pay about £250 per week. To get into work in order to be able to pay that is just not possible. Even though the people I met were perfectly capable of getting a job, just practically and financially it would not work. There was no accommodation that they could move to that was cheaper and that would make all of that stack up. They are locked into a supported housing environment, when there would be opportunities for them to work if they did not have to pay this huge amount of money in terms of rent.

Peter Searle

I cannot talk about the York market or particular markets. Generally, there will be people on relatively low earnings in work who are living nearby and renting. There will be some properties not too far away from there. For people living in hostel accommodation, it is not unreasonable to at some point expect them to move on. The key is for hostels, Departments like my own and local authorities to try to have a plan to help that person to progress in a way that is affordable for them.

Kevin Hollinrake

That is definitely correct. There do not seem to be stepping stones to get out of that. It is very difficult to see a way through of going from that position to one where they can sustain themselves, which makes perfect sense to us all of course.

Peter Searle

I am always very happy to look at those sorts of issues. Anything that creates a disincentive to progress would concern my Ministers.

Chair

This is a really important issue. We heard a lot of evidence on it. The problem is that people are in supported housing because they need support. There is a reasonable level for the charities and voluntary organisations to provide to make ends meet. Those costs of £300 a week are something that somebody in work cannot afford. You therefore have to be on housing benefit, because housing benefit currently covers the costs. That is the problem. The Government are doing a review about this whole issue. As part of that review—and I asked the Housing Minister the other week and he agreed that it was the case—can you have a look across Government at how you can resolve this problem? It clearly is a problem.

Peter Searle

Yes, I am certainly very happy to include, as part of the review that we have been talking about, that transition from out of work to in work and how someone can deal with the rent cost.

Jim McMahon

I just want to build on some of the evidence that was given. We have talked a lot about the transition from being out of work to getting a job, and to getting a well paid job. However, it was more than that. From what the individuals were talking about, they still require a great deal of support to function in society full stop. It is not just that the hostel provides a roof over their heads. It provides an all-in cost. They do not have to worry about additional bills that you would have if you had your own property. There is a danger that, with that support being taken away too early, if they were to get a private tenancy somewhere else they would immediately fall into trouble when the bills start to come in. As such, it could end up being a false economy if it is not got a grip of very quickly.

Peter Searle

I agree. In north-west London there was a YMCA model that, on the face of it, seemed to be very good. They moved someone on into nearby accommodation that was still connected to them, so it was not a case of one day you were in and the next day you were out. Actually, it was gradually helping people to progress.

Alison Thewliss

I have a few initial points around 18-to -21-year-olds. We decided in Scotland, with the powers we are getting, we are going to maintain that because we think it is important to support that group. I just wanted to take your views on whether you think removing that entitlement would make it more difficult for young people, who are perhaps in a situation where their family is breaking down or where they have perhaps suffered abuse or something in their family situation, to leave in such circumstances?

Peter Searle

Those are the sort of things that we will be looking to talk to stakeholders about and how we can make allowance for that. If someone is suffering abuse and if the family relationship has really broken down, then those vulnerable people will need support. How to make that work in practice is the key thing. There will be other people for whom that relationship has not broken down, and the Government’s view is that the parental house is available. People who are in work cannot necessarily afford higher rents, so they often need to live with their parents. Where it is possible, that should be the course of action.

Alison Thewliss

If the person is then in a situation where they almost have to declare themselves as vulnerable, does that not present a barrier in itself? Perhaps you do not want to tell anybody about that. Perhaps you are embarrassed by it. Perhaps you do not know your rights. If you put barriers in place where you have to go and declare yourself vulnerable, does that not then make it more difficult for people to move on and to escape from those circumstances?

Peter Searle

We want to try to make sure that our staff who were talking to them and working with local authority staff are as sensitive as possible to those sorts of situations and are fully trained to be able to pick up those issues. Again, this is something that we will be talking to experts and stakeholders in the field around to make sure that we get the system right, so that it does protect the taxpayer but also protects those vulnerable young people you are talking about.

Alison Thewliss

We did hear evidence that young people felt as though they were dismissed by the housing officers and that they did not see the seriousness of that situation and thought that the young people could just go back home, but that has not been the case for them. I also wanted to pick up on another issue: my understanding is that there is an exemption within the rules whereby if you have a child you are exempt from that. I wanted to ask Jane Ellison whether she thought that perhaps that exemption may in turn drive behaviour of young people, where they may go to a situation where they become pregnant in order to get that exemption.

Jane Ellison

I can honestly say that I have not formed a view on that. It is beyond my portfolio. Where, as a Health Minister, I would be particularly interested in that group is the money we put around something like the Family Nurse Partnership, for example, which you are familiar with and has just announced an expansion in Scotland. It involves specific, very highly trained resource to support young parents, especially teenage mums. That would be the angle I would come to it from. I have not got a view about that interaction with the benefits system.

Alison Thewliss

I am just concerned that one policy perhaps undermines the good work that is trying to be done to reduce teenage pregnancies.

Jane Ellison

We would always look to ensure that we try to be joined up across Government, and that is one of the reasons why, for example, my officials are involved in the piece of work that is going on in this review. For anything like that, we would always look to be involved. Judging by the number of policies that we are asked for a view on and that we have an input on, and judging by the number of inter-ministerial groups that I am on, I would say that the Department of Health is being very well engaged right across Government on a lot of things. We are right at the heart of the Government’s new life chances strategy. We are doing the work, as I say, particularly looking at vulnerable younger mothers. Just today, in fact, I have hosted an expert roundtable on pre-conception health, with a specific focus on what we could do to support young women who have unplanned pregnancies. We have a maternity and stillbirth strategy, for example, which has a focus on perhaps some of the most vulnerable young mothers who have a disproportionate chance of having problems for their baby in early years. That is really the angle that we come at it from. We are involved in lots of different discussions, and one of the things that I have noticed since 2013, when I first became a Minister, is we are doing better. I would not say that we have cracked it yet. This is common to all Governments. You can sometimes end up in silos, but we are doing so much less silo working and so much more trying to do cross-cutting work and cross-cutting strategies, where we understand that the solutions to a particular group of individuals’ challenges do not lie in any one Department’s remit. We all instead look to what we can bring to contributing to tackling the challenges. I am encouraged by what I have seen, both from the national Government but also, in particular, we have seen some fantastic working at the local government level along those lines.

Peter Searle

The new DWP-DH Work and Health Unit is a really good example of that, where two Departments with historically different views about things are coming together to try to bring those views together to help achieve better outcomes for people with health conditions and disabilities.

Alison Thewliss

We took evidence from Katharine Sacks-Jones of Agenda about women’s experience of homelessness. She said that the drivers for homelessness were quite different for women than the drivers for men’s homelessness. She also said that women who are homeless are far more likely to have experienced domestic abuse. Can I ask a bit more about what DWP’s take is on that specifically?

Peter Searle

We want our work coaches and our people who are providing support on the ground to take account of all of the circumstances of someone they see before them, to be sensitive to the potential issues that someone who has suffered abuse might be experiencing, and to take full account of that within the rules.

Alison Thewliss

That is not particularly expansive, but that is fine.

Bob Blackman

Minister, turning to the issue of the provision of health services for people that are homeless or are rough sleepers, how satisfied are you with the ability of providers to meet the needs of those people who are homeless or sleeping rough?

Jane Ellison

There has been improvement, but there is still work to do. A lot of the work I described for the inclusion health board was about looking at what the barriers were in the system and how you can overcome them. Some of that very much sits on the commissioning side. NHS England is now taking forward the work around embedding within GP contracts and within commissioning and primary care better services particularly for homeless people and rough sleepers. There has been significant progress. Even some of the homeless charities would say that, although there is a distance yet to travel, we have begun to make an impact on that. We are starting to try to get under the bonnet of some of the persistent problems like, as I said, the revolving door in A&E for many rough sleepers. We are starting to look at what we can do to make sure when they are discharged they stay discharged and have a chance to better recover. The parity that we have announced around mental health and physical health is important. Beyond that, there is the additional money that has been announced around mental health and some of the work that has been done around things like street triage. There is going to be more investment in acute assessment in hospital emergency departments and mental health liaison services. It is pretty obvious that all of those things will disproportionately benefit some of the people who find themselves with those regular acute needs. We are also watching very carefully the investment in drugs and alcohol services. We currently have very high levels of access. I double-checked the statistics; I thought you might be interested. At the moment the average waiting time for all individuals is 3.3 days, and that ranges from 2.4 days for people who have been admitted for opiate treatment, to just over four days for alcohol-only clients. We know homeless people are massively disproportionately susceptible to multiple health needs—essentially drug and alcohol challenges and mental health needs—and obviously often have a poor level of physical health. We know that homeless rough sleepers have a much lower life expectancy, tragically, than the population as a whole. Making sure that we get good access to some of those key services and maintain that access, as well as looking to improve and target all of the time, are ways we can serve the needs particularly of homeless rough sleepers.

Bob Blackman

Given the fact that people that sleep rough or are homeless are likely to have mental health problems, and also challenges to their physical health, and equally, because they have no fixed abode, they often find it almost impossible to get on a GP register, for example, they therefore are likely to turn up at A&E when they are ill or believe they need treatment, what further action can you take as a Department to actually assist those people, given that in earlier evidence we heard from the Minister that we do not have stats on the number of people sleeping rough and people that are challenged in this way?

Jane Ellison

One thing I should say is that, for people who are homeless but not sleeping rough, the occurrence of mental health problems is broadly in line with the nation as a whole. You are quite right that it is both a cause and effect in terms of people who are rough sleepers. So it is much more disproportionate there. We are starting to tackle some of those problems. They are difficult. It has always been difficult. I asked, in preparation for this hearing, to look at the situation going back a few years. It has always been challenging to look after people with no fixed abode and people who have multiple problems in primary care. Actually, the work we did—this inclusion health programme—was not just about identifying problems. It was also about identifying some of the commissioning solutions and embedding them throughout the NHS. NHS England is taking that work forward. They published the patient standard operating principles for primary care at the end of 2015, and that was to clarify the rules around access to services for vulnerable groups and GP registration. Those principles have now been embedded within the GP standard contract. That is not to say that overnight it is going to become perfect, but it is now actually embedded within the contract. Obviously, PHE are doing a piece of work, which will come after your Committee is looking to do its report, that is due in July this year. It is looking at the extent to which the health system is supporting homelessness health prevention and the health of homeless people. It is not that we are saying, “We have done that. We have changed the contract,” and we will rest on our laurels and move on. We are actually actively monitoring how that is working and what more can be done to take that forward and make sure it is a system-wide response. We had a really good conversation when we launched some of the £40 million fund I described at the Passage in Victoria, in December last year. One of the conversations I had there with a frontline health worker was about his frustrations at some of the people he was supporting struggling to register. We are constantly talking to people on the ground and looking at how we can overcome those problems. We are trying to embed it within the system, and I think we are making some progress. Separate to that, there are other things that we are doing, investing in and making a priority, such as the work we are doing around TB. Again, that is obviously going to disproportionately benefit homeless people. There has been additional investment in find-and-treat services, and significant additional investment in reducing the TB level in London and England beyond. There are a number of areas in which we are looking to tackle some of the most intractable health problems that affect homeless people.

Bob Blackman

Are there any specific initiatives in centres where there are clearly large numbers of homeless people, either rough sleepers or people that are sofa‑sleeping, etc?

Jane Ellison

There are some initiatives. Perhaps I can write to you with some examples.

Bob Blackman

That would be very helpful, because one of the other things I would like to know about is best practice, so that other people can learn from it, and equally what monitoring you are doing as a Department, to see whether specific things are working somewhere and could be used somewhere else.

Jane Ellison

Some of that work is the work that Public Health England is doing. As I say, it is working towards reporting in the summer. Although it would be after your inquiry, I am very happy to make sure that it sends you a copy of that work when it is published, because I think it will be of general interest to the Committee.

David Mackintosh

Do providers always co-ordinate the service delivery effectively—mental health teams, hospitals, adult social care, the voluntary sector, for example?

Jane Ellison

Not always, but again it is an improving picture. Multi-disciplinary teams having a single view of the patient, the person who you are trying to care for, is one of the most important things we can get right, and it is obviously more difficult if people are, for example, moving around a lot or rough sleeping. So there is more that we can do, but in some areas you can see it working very well. As I say, I am happy to write with some examples of that. Particularly, we have seen in local government how people have brought together different statutory services to try to take a single view of what is going on with an individual. Actually, in 2016-17, Public Health England is working on a resource to support just that integrated commissioning for better health right across the pathway. Work is underway to look at how we can do better in that regard.

David Mackintosh

In relation to those vulnerable people who are seen by the health services, what advice is available to them on housing and benefits?

Peter Searle

Generally we try to make sure that GPs are aware, but often GPs have other things to worry about, to be honest, than benefit rules, first and foremost. Increasingly this Work and Health Unit that I talked about, between the Department of Health and DWP, will be trying to get at those links between the two systems, so that as far as possible people in one system understand the issues in the other, and can try to make those connections for patients and claimants and so on, moving forwards.

David Mackintosh

Thank you. I think it is important to follow that up and look at it.

Jane Ellison

I would say, as well, that if you go to some of the excellent supported accommodation that I have visited—and I have not visited an extensive number, but a number both as a constituency Member and in this job—you do see that what they do brilliantly is that wrap-around service around all of those pieces of advice. There is no doubt that is absolutely critical. What is also quite interesting is that I have noticed as well, in the time I have been doing this job, how often they use people who have been previously clients of particular services to actually become an advocate for other homeless people. Regularly I meet people, when I go to homeless accommodation and supported housing, who have themselves come through the system, have understood its failings and its possibilities, but actually are then redeployed very, very proactively and very effectively to be a source of advice for other people, because if you can catch people before they fall, clearly that is so much better.

David Mackintosh

In terms of homeless people when they are discharged from hospital, what support is given to them specifically?

Jane Ellison

As I say, we invested this money a couple of years ago. We looked at a number of different models of what could work to support people. Clearly, anybody who is discharged from hospital will be discharged with an aftercare plan, but it is about how easy or otherwise it is to follow through with that plan, depending on your circumstances. We went to see St Mungo’s Broadway and one of the investments they had made in homeless hospital discharge from the homeless hospital discharge fund, and they were talking to me about things like helping people to get into the habit of taking drugs post-treatment, about understanding how to get dressings changed and things like that. They were quite simple things; this is not sophisticated stuff. It is just basics that a lot of people in a stable environment would take for granted, but it is much harder if you do not have that environment. That sort of thing, at the rough sleeping end of things, is where we have invested in expertise, and now the challenge is to embed that across the system. That is something that NHS England is taking forward. We are finding that in places like London, often big A&Es that see a disproportionate number of people in this particularly vulnerable group, will have very good relationships with some of the local supported housing and some of the local expert charities, to understand what more they can do to stop somebody from coming back through the other side of the door.

David Mackintosh

Finally, it would be very helpful if you could write to us and let us know whether there are any scenarios where people have trouble, when they are discharged from hospital when they are homeless, accessing benefits. We often hear about the lead-in time, particularly for homeless people. It would be helpful to see particularly how both Departments work closely on that.

Peter Searle

Yes, we are very happy to do that.

Chair

Thank you both very much for coming and giving evidence this afternoon.

Jane Ellison

Thank you, and I will follow up with the examples, Mr Betts.

Chair

Thank you; that is really helpful. Oral evidence: Homelessness, HC 40 38