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Posts Tagged ‘prevention’

Prisons and the supersize solutions

Friday, March 24th, 2017

“We try to remove whatever it was that caused the crime”

News this week of plans to build four new “supersized” prisons in England and Wales contrasts miserably with progress in the Netherlands where nineteen prisons have closed in recent years, five in the last year alone.

Jan Roelof van der Spoel, deputy governor of Norgerhaven, a high-security prison in the north-east of the Netherlands offers this explanation for the difference.

“In the Dutch service we look at the individual …If somebody has a drug problem we treat their addiction, if they are aggressive we provide anger management, if they have got money problems we give them debt counselling. We try to remove whatever it was that caused the crime. The inmate himself or herself must be willing to change but our method has been very effective. Over the last 10 years, our work has improved more and more.”

Justice Secretary, Liz Truss, justified her expansion plans with this analysis: “We cannot hope to reduce reoffending until we build prisons that are places of reform where hard work and self-improvement flourish”. Is she really saying that the only way to close prisons is to first build more?

It is certainly never too late to “try to remove whatever it was that caused the crime” but the prevention of first time offending is even better than preventing reoffending. It can be done and it should be: Speaking about creating an  “early action culture” in the police service at our Insight event last year  Andy Rhodes of the Lancashire Constabulary told us that “to prevent crime”, not to arrest more, is the first “Peelian principle”, it should be a police officer’s  primary goal.

Andy embarked on a mission to shift the emphasis after reading our Triple Dividend  report in 2011. Now he says early action is part of our language, it’s referenced on the crime plan, it’s in our recruitment, promotion and Learning and Development with a masters in Early Action at UCLAN and tons of frontline toolkits.”

At the start of his quest Andy was the deputy chief constable and there were a lot of sceptics. Now, not everyone gets it but we are getting there” and Andy is the new Chief Constable , promoted just last week to the top job in the Lancashire Constabulary.

And if Andy is right and we can reduce crime, what might become of our prisons? Again the Netherlands are setting us a shining example: Part of Amsterdam’s Bijlmerbajes prison has become a cultural hub called Lola Lik and part of it is now the Wenckebachweg refugee centre. Here activities for up to 1,000 refugees are aimed at “accelerated integration” – the so called “Amsterdam approach”. The Refugee Company is launching a coffee shop on the site, there’ll be a solar-powered cinema, and The Startup Kitchen, will host food start-ups from around the world.

It’s a remarkable transformation and vivid testimony to the idea that supersizing prevention is altogether better for us all than supersizing prisons.

Is mental illness the “Great Stink” of our times?

Monday, October 10th, 2016

Last week, we argued that investment in social infrastructure is equally important as investing in physical infrastructure for our economy. Today, on World Mental Health Day, it seems appropriate to explore how early action can be applied to mental health – and how this can create better outcomes and deliver significant savings too.

The ‘Great Stink’ of London. Image by David Holt.

Since the 19th century, the government has recognised the benefit of investing in public health. The “Great Stink” of 1858 led Victorian reformers to make the case for investing in public sewage systems – physical infrastructure that enabled healthier lifestyles and reduced the significant costs of disease. These reformers recognised that poor public health not only had a terrible human cost, it was also bad for the economy as people were less able to work.

Today, we are facing a comparable situation in mental health. Mental health problems represent the largest single cause of disability in the UK, affecting one in four adults and costing the economy around £105 billion a year – roughly the cost of the entire NHS. Yet mental health budgets in the NHS and Public Health remain low, and despite mental health gaining increasing prominence in the public realm there still seems to be little recognition from other sectors that mental health is also their concern.

We’re making the argument for society to act earlier – by acting before mental illness occurs and stepping in quickly when problems arise – ensuring people are ready to both deal with setbacks and seize opportunities for flourishing lives. We’ve realised that many of the broad tenets of early action can be applied specifically to mental health, some of which are outlined below.

Make mental health everyone’s responsibility

A key ingredient for effective early action is breaking down siloes and promoting ‘joined-up’ services. To ensure that support is provided at the right time it is crucial that mental health is seen as everyone’s responsibility – embedded at every scale and in every activity. Whether it’s by placing talking therapies within the community like Haringey Thinking Space, taking mental health into schools like Mancroft Advice Project, or addressing mental health in the workplace like happier@work, it is clear that extending mental health beyond the health sector enables earlier action to support people’s positive mental wellbeing. We are not arguing here that all service professionals, for example, should be experts in mental illness and therefore able to deal with acute mental distress: that is the remit of referral routes and specialist services. However, we are saying that everyone should have some understanding of good mental health, ensuring that those who don’t qualify for specialist support aren’t neglected until they reach the point of crisis.

Focus on transitions throughout the life course

In our previous early action work, we’ve talked about the need to focus on transitions throughout the life course. Some of these transitions are universal, such as starting school or work, or facing retirement, whilst others are experienced by particular groups, such as leaving care, having a child, or leaving prison. People can be particularly vulnerable at these transition points if they are not prepared for them, and this can negatively affect their mental health. Ensuring people are prepared to face these transitions not only means they are resilient to such shocks, but also that they are ready to seize opportunities when they arise. Not only can this deliver savings as people are less likely to suffer mental health problems, it can also stimulate growth in the economy – as Cliff Prior argued in our blog series, a Question of Growth, with regards to supporting people back into work.

Make ‘deep value’ relationships central to delivering services

Whilst researching for our case study gallery, we have constantly been hearing about the importance of long-term, trusting, and compassionate relationships between service providers and recipients – what we call ‘deep value’ relationships. This can take a variety of forms, such as the peer-mentoring undertaken by SOS Project or the long-term relationships that Includem builds with young people. It appears that these type of relationships make interventions more effective because they have the underlying benefit of improving people’s mental wellbeing, often relating to their confidence and self-esteem. Tellingly, the standards for ‘enabling environments’ created by the Royal College of Psychiatrists to promote positive mental wellbeing in any setting, including schools, hospitals and prisons, state that the ‘nature and quality of relationships are of primary importance’.

The case for early action on mental health

It appears that we are facing our own version of the “Great Stink” today, as the public increasingly recognises the crucial importance of positive mental health and the current crisis in mental health care. We believe that an early action perspective on mental health presents the moral and economic case for investment, and the themes above indicate the beginnings of what our social infrastructure could look like.

We’ll be building on this work in our upcoming themed paper on mental health, following on from ‘Secure and Ready’ and ‘Looking Forward to Later Life’. The series aims to provoke new ways of thinking and acting earlier, beyond just the realm of experts already working in and around the topic. To support this aim, we are exploring mental health through the settings of education, work, money, housing, communities, and criminal justice. If you would like to discuss the report further with us, or you have any interesting case studies you think we should feature, please do get in touch.

Going beyond the food banks

Friday, July 22nd, 2016

“To search for solutions to hunger means to act within the principle that the status of a citizen surpasses that of a mere consumer.” City of Belo Horizonte, Brazil.

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At Tuesday’s report launch from the Trussell Tust, the Q&A focused on what can be done to prevent the rise in foodbanks. Currently, according to the findings of the report, our welfare system not only fails to prevent problems before they arise, it also struggles to deal with crisis. At Community Links we see this every day, with clients often needing food parcels due to benefit delays or some other crisis. The use of foodbanks continues to rise despite a reduction in sanctions, and it appears that foodbanks are increasingly being incorporated into the welfare system, as we previously feared.

Quite rightly, the discussion covered the need for the DWP to improve the benefits system as well as the expansion of foodbanks remits to include wider support and advice on debts, budgeting, and developing coping strategies. Yet I couldn’t help but feel that calls for central government to improve our welfare system are somewhat undermined by other crisis-causing policies. So what would an early action framework for food look like?

The city that ended hunger

The Brazilian city of Belo Horizonte, known as the ‘city that ended hunger’, declared food a ‘right of citizenship’ in 1993. A city agency involving local people was established to devise solutions to end food poverty, including directly linking up farmers and consumers, establishing low-cost, high-quality ‘people’s restaurants’, and enabling extensive community and school gardens as well as nutrition classes.

In only ten years, Belo Horizonte cut its infant death rate—widely used as evidence of hunger—by more than half, and today the initiatives benefit almost 40 percent of the city’s 2.5 million population. In the same ten years, Belo Horizonte was the only locality in Brazil which saw a rise in the consumption of fresh fruit and veg and local small scale producers increased their revenue despite farmers in the rest of the country seeing incomes drop by almost 50%. The cost of these efforts? Around $10 million annually, or less than 2 percent of the city budget. That’s about a penny a day per Belo resident.

Reasons to be hopeful?

A differing economic and agricultural context means that the Belo Horizonte model may be difficult to directly replicate in the UK. Yet it demonstrates that significant action can be taken to reduce food poverty despite an unfavourable national context.

In the UK, the burgeoning ‘food sovereignty’ movement is equipping communities with the means of producing their own food, thereby reducing barriers to fresh fruit and veg in spite of spiralling food prices, and simultaneously delivering multiple social, emotional and health benefits. For example, the Women’s Environmental Network is running a number of projects in Tower Hamlets which are empowering local women to work together to access affordable fresh food, whilst improving their physical and mental wellbeing and combating social exclusion.

Of course, such projects are generally small-scale and the structural conditions in which they operate, such as deprivation and job insecurity, also need to be addressed to achieve lasting change. Sustain’s campaign, ‘Beyond the Foodbank’, calls on central government to improve the benefits system, but also advocates for local living wages and city-level partnerships to address the root causes of food poverty in their locality.

This kind of systems change is already ongoing at Brighton & Hove City Council, who have relatively recently adopted a Food Poverty Strategy and Action Plan, co-produced with the local population and delivered by a wide range of local agencies. The plan has a distinct flavour of early action, recognising that the city needs to address food poverty now to save major costs later on arising from poor mental and physical health, poor educational attainment, obesity and malnutrition. Promisingly, a number of other councils have since replicated the model.

From passive recipients to active citizens

Evidently, whilst central government continues to deny any link between issues with benefits and the rise in food banks, there are still actions we can undertake to reduce food poverty; building people’s resilience and enabling them to lead thriving lives. Services shouldn’t reduce people to passive recipients but enable them to have active control over their own lives so they’re prepared to deal with setbacks and seize opportunities as they arise. And emergency food aid should remain just that.

Sending out an SOS: how early action can break the cycle of reoffending

Wednesday, June 8th, 2016

The Early Action Task Force is currently building on its latest report, ‘A Rough Guide to Early Action’, by creating an early action case study online gallery. Below is a sneak peek into one of our new case studies, the St Giles Trust SOS Project… 

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Junior Smart, Founder of SOS Project. (Image by Emmanuelle Purdon.)

St Giles Trust’s SOS project was founded by Junior Smart in 2006, an ex-offender working for the trust who had experienced the destructive cycle of gangs, violence and crime. The project is designed to help vulnerable young people caught up in criminal lifestyles – often gang related – to enable them to realise their aspirations in education, training or employment and ultimately reduce violent and weapons crime.

 Why is this early action?

According to the National Audit Office it costs nearly £250 million each year to detain young offenders, with 73% of them re-offending within a year. Gang crime is also hugely costly, both in terms of destroying the lives of gang members, their family members, and their victims, and of policing, prosecuting, and incarcerating offenders. The Government estimates that 50% of shootings and 22% of violent crime in London are perpetrated by gang members.

Preventing violent crime by breaking people’s involvement allows them to contribute to society, improves their family’s prospects, and makes their communities safer by reducing the likelihood that their peers are drawn into crime. SOS does so through an emphasis on shared experience and building relationships, training ex-offenders as caseworkers to work with gang members providing one-to-one holistic support tailored to the individual’s needs.

 How does it work?

Initially piloted in Southwark, SOS is now the largest gang exit service in London, operating in 14 boroughs and funded by local authorities, corporates, philanthropists, and charitable trusts. It operates through St. Giles Trust’s Peer Advisor model, using ex-offenders as frontline caseworkers and training them whilst in prison to give high-level advice and guidance. Not only is this experience powerful in breaking down barriers with gang members, it also provides caseworkers with a meaningful qualification to find well paid employment upon release.

SOS develops one-to-one relationships that are available 24/7 to build trust and encourage individuals to turn their lives around. Caseworkers provide support in family mediation, finding solutions to housing needs, enabling them to break ties with destructive friendships and move towards education or employment. SOS is about implementing pragmatic solutions that lead to behaviour change.

SOS also works in schools through SOS+, using ex-offenders to inform at risk young people about the dangers of gang involvement, de-glamorising the lifestyle, and raising awareness about how they can stay safe. One-to-one support is given to particularly vulnerable young people. SOS is also delivered through Expect Respect which works exclusively with young women, offering one-to-one support to those at risk of sexual and violent exploitation associated with gang involvement.

What has it achieved?

SOS ultimately aims to prevent gang crime by helping clients end gang involvement and getting them into work and decent housing. An evaluation by The Social Innovation Partnership found that 87% of SOS clients interviewed changed their attitude to offending. Over 75% of clients move into employment or training, and 75% into decent housing. Mainly, though, it was clients’ relationship with caseworkers that had the greatest effect in changing behaviour as caseworkers’ experience allowed them to challenge clients whilst ultimately giving support.

According to a cost benefit analysis of its work with high risk prison leavers, St. Giles Trust reduces reoffending by an additional 40% compared to the national average. It’s testament to St. Giles Trust’s transformative effect, not just among its clients but staff as well; of 23 SOS caseworkers who left school without any qualifications, eight now hold degrees. It demonstrates St. Giles Trust’s ethos of not dismissing individual’s capabilities because of their past, and caseworkers’ great determination to improve their clients’ lives, as well as their own.

 What can we learn?

The intensive, empathetic and 1:1 relation-building between caseworkers and clients is key to SOS’s success. 75% of clients said that their caseworker being an ex-offender was crucial in making them want to change their lives. Having a team of caseworkers who’ve experienced the hardships their clients face makes them particularly determined to persist in maintaining the relationship for as long as it takes, whilst also showing clients that they have to want to change for themselves. What’s significant about the SOS project and St. Giles Trust’s work more generally is in showing that changing behaviours of the most entrenched, challenging and complex clients only works through relation-building because people who are disengaged from all other services need a consistent, flexible and personal source of support.

 

Find out more

Further information on SOS can be found here.

Watch a film about the SOS Project here.

Displacement is not prevention: acting earlier to prevent homelessness

Tuesday, June 7th, 2016

Homelessness is a problem that has often been met with strange solutions. Take the so-called ‘homelessness prevention spikes’ that we’ve written about before, in which spikes are fitted near buildings to prevent rough sleeping. Rather than deal with the causes of that person’s homelessness and enable them to take steps towards finding a home, it merely displaces them somewhere else to be somebody else’s problem.

It is no wonder that many individuals find it hard to escape homelessness when such approaches not only exist, but are deemed suitable ways to address the issue. I was reminded of this ‘prevention’ technique when reading about Bournemouth Council’s homelessness strategy, which claims to be putting £200,000 towards “assertive techniques and procedures”. Part of this involves buying rough sleepers one-way train tickets to move them out of the area. As with the spikes, rather than dealing with causes of homelessness this strategy deals with their consequences; rendering rough sleepers invisible (to the residents of Bournemouth) and foisting their problems on somebody else. By this logic as long as rough sleepers are not in ‘our’ area then they are no longer ‘our’ problem.

A different approach

Over the past six months we’ve been collecting stories of early action, exploring how individuals and organisations are acting one step earlier in order to solve the root causes of social and economic problems such as homelessness.

To be fair to Bournemouth, their Housing Strategy does go into a bit more detail about their use of the central government Homelessness Prevention Grant (although, slightly worryingly, that has now been absorbed into general council funding) and provide some additional services for those experiencing or at risk of homelessness. Information is scant, however, and other areas seem to be taking a much more proactive, systemic and partnership based approach.

Most recently we heard about the Active Inclusion project in Newcastle (AIN). By working in partnership, AIN enables people to avoid homelessness wherever possible by making advice, information, and support from a range of organisations far easier to access. It works primarily on three levels, from primary prevention (‘information and support for all to identify risks and prevent crises’), through secondary prevention (‘specialist support, accommodation and advice for those at risk’), to crisis activities (‘for people who are literally homeless’). As a result of activities – which can be anything from welfare and debt advice to emergency accommodation – AIN has helped prevent 4,192 potential cases of homelessness in 2014/15.

Another example is Dundee City Council’s Homeless Service Unit. This unit runs a range of services targeted at those at risk of homelessness, from raising awareness among 16 year olds about planning for independent living, to giving people leaving care or prison support through a key worker. They make between 1,000 and 1,500 homelessness assessments each year and it adapts services to reflect need; for example one of the fastest growing reasons for homelessness is insecurity within the private rented sector (stay tuned for our private rented sector briefing that will be published in the coming weeks).

The Passage – a London based charity highlighted in our latest report – have also taken an explicitly preventative approach (whilst also maintaining essential crisis-oriented services). Most notably their Hospital Discharge Service identifies homeless patients (or those at risk of homelessness) who repeatedly present at A&E and refers them to more appropriate services that deal with their underlying crisis. After working with 300 people last year through this service, 70% of them ended up going into accommodation after leaving hospital. They also run a Home for Good service that enables formerly homeless people to connect with local voluntary and community sector organisations, with 97% of the people they worked with retaining their homes after 12 months (as opposed to 84% without this intervention).

Prevention is about more than displacement

These three examples – by no means the only ones to exist across the UK – highlight that homelessness prevention can (and indeed should) be about more than displacement. Early action at its core is about enabling people to flourish, rather than merely preventing them from experiencing negative outcomes (or, in some cases, simply displacing their problems elsewhere).

It also raises an important point about what we measure and how this drives activity. In much the same way as certain types of policing – traditionally driven by the enforcement model (i.e. charging around under blue flashing lights, making arrests, and ‘kicking down doors’) – can drive up arrest statistics, Bournemouth’s attempt to reduce levels of rough sleeping may well ‘work’ when we look at the statistics in a year’s time. But will their ‘assertive’ train-ticket buying ‘techniques’ have actually achieved anything positive for those at risk of or experiencing homelessness? Will they be securely housed and leading happier, healthier and more productive lives? Unless they catch a train to Newcastle or Dundee, I’d guess probably not.

From public benches to posties: how early action can change our approach to later life

Saturday, May 28th, 2016

Faced with an ageing population and cuts to public spending, early action can provide an alternative way forward for local authorities and the NHS

Yesterday, the National Audit Office (NAO) published a report calling for radical action to tackle delays in discharging older patients from hospital and stop the costs adding further strain to the financial sustainability of both the NHS and local government. The spending watchdog estimates that the gross annual cost to the NHS of treating older patients in hospital who no longer need to receive acute clinical care is in the region of £820 million. Delayed discharge also has a huge personal cost as people that are delayed more than 72 hours are far more likely to fall ill again, lose independence or mobility and be admitted to residential care.

The evidence clearly indicates that the care system needs to be transformed. We believe that adopting early action is a common-sense approach for the NHS and local authorities who face the worrying combination of an ageing population and cuts to public spending.

When considering the problem of delayed discharges, an early action approach encourages us to ask the question ‘where could we intervene earlier?’

The ideal solution to reducing delays in discharge is to reduce the need for admissions altogether by focusing on primary or secondary prevention. Primary prevention enabling older people to lead thriving lives could focus on adapting our society to be more ‘age-friendly’ through a myriad of relatively small, innovative interventions, for example by installing grab rails in homes to prevent falls or providing more public benches. There is also a considerable amount of evidence that interventions throughout a generation’s lifespan, not just in the early and later years, will help reduce pressure on health and social services from an ageing population.

Secondary prevention to reduce hospital admission would target individuals with more clearly identified needs. A good example of a simple intervention that does just this is the Call & Check Service based in Jersey. Postmen ‘call and check’ on older people, reminding them of medical appointments / prescriptions and connecting them with other support services. It prevents social isolation and enables them to live independently for as long as possible. This simple concept demonstrates that communicating and linking people with existing services is an effective way of using resources to act earlier. It also shows the strength of combining normally disparate sectors by using an existing service to increase the efficiency and quality of health and social care. [1]

Emergency hospital admission rates are correlated with chronic illnesses, so secondary interventions should also focus on enabling people with chronic illnesses to manage their own care. The US Veterans Health Administration ‘Health Buddy’ uses innovative yet simple technology to produce dramatic outcomes – an evaluative study showed savings of $3,506 on average per patient, hospital admissions reduced by 66% and bed days reduced by 71%.[2]

Of course, even with the best of care some older people will need to be admitted to hospital, so early action is also about considering how services can be improved to ensure that older people can be discharged quickly and safely as soon as they no longer need acute care. The NAO report highlights that financial incentives for the NHS to reduce delayed discharges are not matched with incentives for local authorities to speed up receiving older people back into the community. One possible solution is to integrate health and social care, by pooling budgets in order to reduce departmental silos and encourage information sharing. The cost benefits accrued through improved efficiency could then also be shared.

The Government has shown some appetite for integration through the establishment of the ‘Better Care Fund’, designed to support local areas to plan and implement unified health and social care services. However, in a survey of local authority care directors, almost half (43%) said they believe the Better Care Fund has had little or no impact on care budgets and service quality. This is perhaps a somewhat negative outlook given the BCF is still in its infancy, but it does demonstrate that there is still a lot of work to do on integration. Different funding streams remain a major barrier and more must be done to bring them together.

Furthermore, integration alone is not enough. It is essential that services are designed with the involvement of both those who deliver the service and those who receive it to ensure buy-in to the new approach. ‘Co-production’ leads to a person-centred approach which focuses on the older person’s needs, rather than organisational targets. Hospital to Home, featured below, is one initiative which has adopted a co-production approach to redesigning integrated health and social care services in Scotland. The project is still ongoing, but practitioners from the working group report that the project has “greatly improved communication” with one respondent estimating that they have “reduced care home admissions from our hospital by about 50%”. Equally as important, interviews with older people and their carers evidenced positive relationships with staff but also helped to identify gaps in their care that still remained.

There is recognition amongst councils of the importance and benefits of investing in prevention – and the spirit of prevention is now embedded in the Care Act. However, overall funding pressures resulted in local authorities’ planned spend on preventative measures dropping from £937 million in 2014/15 to £880 million in 2015/16 – a 6 per cent reduction in real terms. If the government is serious about prevention, it needs to translate words into action – backed up with hard cash.

How can integrated services be designed whilst improving older people’s care experience?

Hospital to Home is an initiative aimed at improving the care experience of older people being discharged from hospital in the Tayside region of Scotland. Delivered by Iriss, the project worked with local health and social care practitioners, older people and their carers. This group shared their own experiences with each other and co-designed issues to be addressed. This resulted in three broad recommendations which have been adapted and embedded locally with partners from the case study areas of South Angus and Dundee over the past year.

Hospital to Home’s starting point is improving the experience of the person receiving care, yet its effect is increasing the efficiency of hospital discharge and improving community based care, with an aim to minimise hospital admissions in the first place. It demonstrates the process of redesigning services for early action, highlighting an approach that removes departmental silos by focusing on the desired outcomes of the person. Strengthening communication between practitioners, patients and their families and coordination between acute and community services is key in tailoring health and social care around patients’ needs and improving care and efficiency in hospital discharge.

We will be publishing a more detailed case study of Hospital to Home on our website soon. In the meantime, you can find out more about the project here.

 

[1] You can read more about Call & Check in our ‘Rough Guide to Early Action’

[2] Coye, M. (2009) Transformation in chronic disease management through technology: improving productivity and quality in the shift from acute to home based settings. San Francisco (CA), Health Technology Center

Early action on homelessness in Wales

Thursday, May 19th, 2016

The Welsh government has recently introduced a Housing Act with a new focus on early action to prevent homelessness. This post explores further how such a model can help people to lead thriving lives, while contributing more and costing less.

At Bow County Court in Newham, not far from Community Links, a young couple were recently handed down an eviction notice. The Shelter Housing Advisor at hand advised them that the bailiffs would not come for a few weeks and they should stay in their property until that time. As the article they were featured in described; “such is the madness and complexity of the UK’s housing rules that if you leave your property a moment before the bailiffs come to evict you, you’re “voluntarily” homeless and ineligible for support.”

This is just one example of the flaws in the social security system that Community Links’ Early Action Force is trying to transform. The idea is to build “fences at the top of the cliff, rather than waiting for the ambulance at the bottom”.

It is a welcome announcement then, that the English government has begun to consider the possibility of introducing an additional ‘prevention duty’ for local authorities working on homelessness. This additional duty was inspired by the new approach that the Welsh government has taken towards homelessness, as outlined in the Housing (Wales) Act 2014.

The new Act revolutionises the Welsh government’s approach to homelessness, focusing on preventing the problem, rather than waiting for it to occur and then dealing with the consequences. It is a new, inclusive system designed to help everyone at risk rather than just those in priority groups. The significant early action elements are new preventative duties to help anyone threatened with homelessness within the following 56 days by preventing situations from escalating and to enable any homeless person to secure a home.

Of course, this approach is extremely new so it is difficult to fully evaluate the success of the model. However, reviews so far describe the “overall picture [of the Welsh approach as] an encouraging start with homelessness being successfully prevented for the majority of households.”

Enabling people to lead thriving lives

A major strength of the Welsh approach to homelessness is the focus on earlier action; assisting anyone at risk of homelessness before they lose their home. This means the very real impact of ensuring that people do not have to go through the traumatic experience of eviction and homelessness. Although some of this prevention work was being carried out previously by local authorities, the new legislation now gives people a legal duty to assistance and ensures this is measured. Between July and December 2015 3,605 households were assisted under the new prevention duty with a success rate of 64.8 per cent.

The new legislation also requires local authorities to take a person-centred approach through the use of Personal Housing Plans which are jointly developed with the client. These plans don’t just evaluate immediate housing problems but also consider underlying issues, with the intention that resolving these issues should help reduce any future possibility of facing the risk of homelessness again.

Contributing more

Evidence from Shelter Cymru highlights that despite an increase in people facing homelessness, their caseworkers are achieving better prevention rates than ever before. They credit the new Act for assisting them in achieving a prevention rate of 93% – a new record for the charity.

Data from the Welsh Government also indicates that single people are benefitting more from the new legislation. Between July and December 2015 the success rate for single households was 57.6 per cent, only slightly lower than the figure for all households. This is a significant achievement for Welsh local authorities given the shortage of single accommodation in Wales; demonstrating that they are embracing the duty to help households prevent homelessness on an equal basis, despite single households previously having few rights to homelessness assistance.

Source: Shelter (April 2016)

Costing Less

It is clear that the transition to a preventative approach towards homeless would need additional funding at the outset. In Wales, the Welsh Government has provided an extra £5.6 million in funding to local authorities, with the money to be spent at the authorities’ discretion, provided it prevents or relieves homelessness.

It may initially appear that the early action approach comes at a higher price; however, the significant direct and indirect costs of homelessness must be considered. The staffing and legal costs required to carry out evictions are huge. There are also the indirect costs caused by homelessness on the NHS, the police and justice system, and social services. A government evidence review on the cost of homelessness in 2012 put the figure at around £1bn (gross) annually and this is only likely to have increased given the rise in homelessness over the past four years.

There has not yet been any research conducted on the financial impact of the Welsh homelessness model but as with other preventative action and given the high costs of homelessness, it is likely to prove more cost effective than acute spending in the longer term.

A preventative model that works(?)

The Housing (Wales) Act 2014 is certainly a trailblazer in homelessness prevention, and the early feedback seems positive.

There has been some criticism of elements of the Act such as the removal of priority need for prison leavers, and the introduction of the ability to discharge duty once tenants have been in private sector accommodation for more than 6 months or if they ‘fail to cooperate’ with their Personal Housing Plans. There is also evidence that local authorities are not adopting the legislation in a consistent manner. It remains to be seen if these issues will prevent the Act from providing a sustainable solution to homelessness in Wales.

However, the paradigm shift in thinking by the Welsh government should be welcomed and it is very encouraging to see this early action approach adopted at a systemic level. We hope that the new Act will further influence the English government to consider a homelessness prevention duty, to ensure that our housing system allows people to lead thriving lives, contributes more, and costs less.

No Other Way: the story of the Early Action Task Force so far

Thursday, December 17th, 2015

They went because their open eyes could see no other wayWalking along the South Bank to the Southwark and Lambeth Early Action Commission event last month I passed the elegant memorial to the volunteers who fought in the Spanish Civil war. It contains the striking lines from C. D. Lewis’s ode to the volunteers of the International Brigade “they went because their open eyes could see no other way”.

The line has come back to me several times over the last couple of weeks as we have reflected on what the Task Force has and hasn’t achieved in the last three years and how we might think about the future.

Look at the desperate financial projections for hospitals across the UK, in the news again this week, and consider the one in five beds in the huge London Hospital just down the road from us here in Newham currently occupied by patients whose condition is caused by or complicated by avoidable diabetes. Listen to Lord Porter, the Conservative chairman of the Local Government Association, talking in November about the “difficult decisions” for local authority leaders: “Even if councils stopped filling in potholes, maintaining parks, closed all children’s centres, libraries, museums, leisure centres and turned off every street light they will not have saved enough money to plug the financial black hole they face by 2020.” Speak to people in the queue downstairs at Community Links. Across the public realm we are locked into trajectories that are simply unsustainable. We have argued for a more preventative approach, for a “need reduction strategy” because with open eyes we can see no other way.

In this end of term report written for the Task Force we consider the progress so far. Early next year we will be sharing our plans for the next stage.

We need an early action approach to later life more than ever

Tuesday, December 8th, 2015

It’s a universal truth that we get older. According to the ONS, average life expectancy at birth has increased since the 1980s by about 10 weeks every year for women and 13.5 for men. This means that 1 in 3 babies born this year will be centenarians. More than a demographic change, an ageing population is a social challenge as more people depend on public services paid for by fewer people of working-age.

In response the government is supporting the Centre for Ageing Better as part of the What Works Network, which aims to improve the way government and other organisations create, share and use high-quality evidence for decision making. With £50m Big Lottery funding over the next decade, its programme ‘Fulfilling Lives: Ageing Better’ plans to improve the lives of older people by helping them feel more prepared for later life, more in control and more active and connected. photo Ageing_zpsbxiixrko.png

Last Wednesday the research findings underpinning these priorities were announced. Along with Ipsos MORI, it conducted a major study into the wellbeing of over 50s, interviewing almost 1,400 people. It shows that social connectedness, financial security and health are the main determiners of wellbeing. More tellingly, perhaps, it shows that people with high social connectedness are able to overcome the negative effects of poor health and financial worries, suggesting that it’s the most significant indication of wellbeing.

It follows, then, that having more opportunity to be with people is the major aspiration among over 50s. Those with high social connectedness are more than twice as happy as the average older person. Over 50s also want to be fitter, more active and connected through better access to societies and volunteering.

This means there’s a huge potential for early action in later life. Building relationships and resourcefulness within communities is one of its core principles, and enabling older people to become part of social groups and engaged with their communities not only improves individual’s wellbeing but also contributes more to society as a whole.

Too often the preventative thrust of early action is only associated with early years, but these findings show that it’s important throughout the life-cycle, enabling people to maximise quality of life in older age. As Anna Dixon, the Centre’s CEO said, it’s not about living longer but putting life back into living.

This means enabling older people to meaningfully participate by promoting fitness classes, offering accessible financial advice and planning, and more social and volunteering opportunities to name but a few. This is so important in changing the perception of ageing to one of ‘resourcefulness’: as chronological age rises it is not inevitable that people should suffer decline. At the moment it’s a self-fulfilling prophecy that people who look upon ageing negatively die 7.5 years earlier than their more positive peers. Society has a huge role to play in proactively supporting older people view ageing as positively as possible.

We’re pleased that the Centre for Ageing is committed to a preventative, proactive and asset-based approach to ageing. Last Wednesday it felt as though there’s genuine enthusiasm for sharing what’s most effective in enabling older people to lead thriving lives, costing less and contributing more. Last year we set out our vision for early action in later life, showing that longer-term planning, integrating and locally providing services has the potential to increase wellbeing and social connectedness among older people.

With our collective age on the up, it’s no good for government to continue its piecemeal and reactive policies on ageing, tinkering at social care and pension reform. It’s unsustainable on public finances and underutilises the huge contribution older people can make through their time, resources and experiences. Restructuring the labour market to enable older people reduce their hours and change roles, tailoring social care towards the individual and introducing services to signpost over 50s to age-friendly local employers, charities and societies are among many of our recommendations for transforming older people’s opportunities for participation.

Now, more than ever, is the time for doing so. With foresight around enablement and prevention, the Centre for Ageing has scope to institute early action in later life and deliver systemic change. It’s difficult at this stage to say any more than watch this space, but with ten years secure funding it really does have the resources to make later life a transformative platform for early action.

New research echoes the principles of early action

Tuesday, December 1st, 2015

Early action’s core principle of prevention has rippled right to the top, foregrounded in a new report commissioned by the charity chief executives body Acevo. It’s caught my attention because it echoes the principles of early action the Early Action Task Force are keenly promoting through our work. I should say that it doesn’t uses the term ‘early action’ as such, and this lack of shared language is one thing hindering the sector as a whole galvanise support for common-sense principles. Still, I’m optimistic because it shows that the principles of early action are gaining ever wider support. photo Acevo_zpsddazu9wh.png

Redesigning public services

Remaking the State, produced by the Commission on Delivering Better Public Services, received attention in the Guardian last week as its co-author Rob Owen, CEO of the St. Giles Trust, highlighted that increasing government spending on prevention would greatly increase the effectiveness of public services.

Campaigning under ‘Five for the Future’, the report ambitiously challenges government to allocate 5% of overall government spending to preventative services across health, welfare, justice, education and the Home Office. While this may appear fanciful, the report notes that in absolute terms this would only get spending back to where it was in 2010. Far from fanciful, then, it demonstrates the frightful effects of spending cuts on preventative services, which have fallen by 45% in local government according to the National Audit Office, calling it a “moral and social catastrophe”. By 2020, the report wants 10% of total government spending to go towards prevention and a proper plan for how these services would be delivered across government through longer-term social programmes and government accounting cycles.

We endorse longer-term government spending, recommending Ten Year Spending Plans reviewed every two or three years to shift planning and budgeting beyond the current short-term outlook. The government should see early action as an investment, increasing its spending on preventative services whilst doing so incrementally to continue supporting acute services until the need lessens.

Empowering citizen-centred reform

The report also emphasises making community central to commissioning and delivering effective public services, echoing the principle of building ‘resourceful communities‘ recently highlighted by Southwark and Lambeth Early Action Commission. One size does not fit all, as everyone knows, so government should wise up to the need for tailoring services to the communities they serve. Yet over the past four years, public services have increasingly been delivered by a few large companies as effectiveness is overlooked for delivery cost-savings. In the case of the Work Programme, 25% of the total value was awarded to one company. This is shutting community organisations out who are often so effective in offering personal, localised and holistic support―it’s little wonder that the number of people on employment support is rising. Private sector public service contracts can be valuable, although they tend to be more effective when embedded alongside organisations in the community.

The report goes on to argue that there is a need for “a new relational compact between the state and the individual… [to] empower them and their communities”. Key to this is calling for a Public Services Constitution that would strengthen people’s power to complain for failed service delivery, enabling them to hold government to account on the right to choose and access good services. It wants to see reform in public services being driven by those who use them, enabling people to have more control over their own lives and, ultimately, ensuring that problems are tackled and harm prevented before doing more damage later down the line.

Taking the failure of public services as its starting point―even questioning whether our most vulnerable citizens are experiencing “a breakdown in the social contract”―Remaking the State, reemphasises that cutting preventative services for short-term cost savings is damaging lives and storing up more demands on the exchequer. It highlights Action for Children’s estimate that prevention for looked after children would save £486 billion over the next 20 years and anywhere between £104 and £616 for prevention in homelessness according to Shelter.

The report sets out six “virtues” of the third sector explaining why its services have “stickability”, pre-dating and enduring beyond government. It suggests that the third sector is best placed to deliver preventative services, made effective by its ability to provide personalised, innovative, collaborative, integrated, and participatory services. As government spending looks set to chip away at preventative services over the next five years following last week’s spending review, it’s perhaps more important than ever for the third sector to start thinking seriously about how it can take up the undeniably challenging task of delivering frontline preventative services.

Mobilising senior leadership buy-in is key to implementing early action on the frontline

This challenge is made harder through dwindling government investment, making bold and foresighted leadership crucial in driving the early action agenda. For my part, I’m encouraged by Acevo’s report because it confirms what practitioners and community workers are telling me that preventative services are effective in enabling people to make sustainable life changes. These same frontline workers are also saying that positive changes are primarily achieved by organisations heavily embedded in the community; whose workers have been there too, whose help doesn’t exclude any aspect of a person’s life and who’re able to give extra support through their long-standing relationships with other local services. These are key aspects of effective public services that Acevo is highlighting. And I sincerely hope that the senior leaders it represents are taking note because their buy-in is key to making early action happen on the frontline.

Rob Owen and Will Hutton, Remaking the State: Remaking the Social Contract between
Public Services and Our Most Vulnerable Citizens, ACEVO, (19 November 2015). Read the full report here.