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The purpose of this paper is to understand the lived experience of people who have experienced homelessness and street activity, and professional stakeholders’ views about the challenges faced by this client group. The study sought to identify measures to improve the current situation for both individuals experiencing homelessness and professionals working with them.

Peer researchers with lived experience of multiple and complex needs conducted semi-structured interviews/surveys with 18 participants (eight individuals experiencing homelessness and street activity and ten professional stakeholders). The authors of the paper conducted a thematic analysis of the data.

This paper offers insights into both the current challenges and assets for people who are or have been homeless in an urban setting. Key findings include the need for a coordinated partnership approach to address pathways to support, and the importance of developing opportunities for meaningful activity and building on local resources including giving homeless people a voice. These findings are discussed within the context of current policy (Housing First) and legislation (Homelessness Reduction Act 2017) and the impact on integrated care for people who have experienced homelessness.

The views explored in this study are specific to one city centre in the West Midlands; thus, generalisability may be limited.

This study presents a participatory research approach with peer researchers exploring the perspective of individuals experiencing homelessness and wider stakeholders. The findings of this research are considered with reference to the provisions of the HRA 2017.

This paper – the first of three – aims to explore some of the complex physical and mental health needs of those experiencing homelessness. It will act as a leader to the other articles by establishing the nature of the problem and offer a rationale for carrying out a service user needs assessment as part of a review of local service provision in the North West of England against the backdrop of the current COVID-19 epidemic.

There are a number of complex social and health inequalities often experienced by those who are homeless. Effectively tackling these requires a co-ordinated multi-agency response to both prevent and tackle the harms associated with being and becoming homeless.

Partnership working offers the best opportunity to meet the complex needs of those experiencing homelessness. The current delivery model being actioned in the North West of England highlights the importance of the links between statutory and non-statutory services. An ongoing service user needs assessment will further help to highlight contemporary issues faced by those experiencing homelessness and those providing services in the context of the COVID-19 epidemic.

Future papers as part of this series of three will consider the implications of social exclusion and barriers to accessing services faced on a day-to-day basis by those experiencing homelessness.

The opportunity to reflect on established views in relation to the nature and scope of homelessness. It will consider the implications exclusion from society and service provision that this group face on a day-to-day basis. The paper will describe a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 epidemic.

Social impact bonds (SIBs) have become a favoured way to fund public services, including housing, prison and homelessness projects, in an era of austerity. In a growing critical literature on SIBs, a largely absent voice is that of the link worker. This paper aims to focus on the views of link workers in a SIB funded project which works with long-term entrenched rough sleepers in the East of England.

Interviews with link workers were conducted with a thematic analysis echoing many of the views expressed in the critical literature not only about the problems but also some of the advantages that SIBs offer to this type of project.

Three key themes were discomfort with the funding mechanism; flexible and innovative interventions that SIBs make possible; and problems with the outcome measures that trigger payments. This study concludes that if SIBs are to achieve their promise of providing funding which leads to effective solutions to deeply ingrained social problems, there needs to be more careful evaluation of their true benefits in comparison to publicly funded projects, adoption of more appropriate and project-specific outcome measures and a much clearer explanation and justification of the way in which SIB funding works.

Few studies have specifically explored the perceptions of front-line link workers in the homelessness sector. This study highlights not only the concerns but also the benefits associated with the use of SIB as a funding mechanism within the homelessness sector.

Trusting and empathic relationships between project workers and people experiencing homelessness (PEH) form the cornerstone for their needs to be met. However, under the UK austerity agenda project workers practice in a context of increasing pressure and limited resources; with relationships often characterised by conditionality and disconnection. The purpose of this paper is to report on a study investigating project workers’ experiences of building relationships with PEH living in supported housing projects.

A qualitative design was employed in which focus groups were carried out in six projects, using an opportunity sample of 22 project workers. Data were analysed using thematic analysis, within a social constructionist epistemology.

Three main themes were identified: “Working hard to build connection”, “Supporting each other within an unsupportive context” and “Draining but sustaining”. Project workers acted out of strong value systems in building relationships with residents against a backdrop of systemic disconnection.

Clear clinical implications are put forward with in a Psychologically Informed Environment framework. Services supporting PEH need to be psychologically informed and organisations need to embed reflection within their policies and every day practice. In developing services for PEH interdependence not in/dependence needs to be the aim. Finally, the responsibility for improving the lives of PEH should be placed back on society to provide a context in which PEH can thrive.

With the temporary housing of rough sleepers in response to the Covid-19 emergency, some commentators have been tempted to believe that the rising population of rough sleepers in the UK has finally been reversed. This paper aims to examine the choices made by persistent rough sleepers and how far they are influenced by the perverse incentives of social policies, in order to challenge the view that they sleep rough out of choice.

Evidence for this paper is derived from two teams of frontline service providers with routine familiarity with the rough sleeping population: a street outreach team and a team of support workers working with adults with multiple and complex needs. Primary data from focus groups were combined with the secondary analysis of both numerical and narrative accounts routinely recorded by both teams.

The exercise of agency by persistent rough sleepers is constrained by a mixed baggage of complex needs, past negative risk assessments, limited resources and regulatory deterrents to generate choices to reject help that appear irrational. These need to be understood if recent policy initiatives to end rough sleeping are to be effective.

The paper draws on the experience and comprehensive records of practitioners with intimate knowledge of the rough sleeping population. It extends narrative accounts of causes by focusing on key choices to show how the perverse incentives of policy combine with personal factors to incline rough sleeping to persist.

This study aims to explore homeless-support workers’ perceptions of homeless welfare recipients and their experiences of navigating new conditions placed upon them by UK welfare reform. It examines support workers’ views of the most punitive feature of the welfare system, sanctions, on those recipients.In 2012, the Conservative and Liberal Democrat Coalition Government introduced the largest and most radical overhaul of the UK benefit system, significantly increasing the level of conditionality and sanctions for non-compliance, part of a shift in welfare, suggesting that rights must be balanced by responsibility and the “culture of worklessness” and “benefit dependency” should be addressed.

Welfare reforms in the UK and the increased use of sanctions as part of welfare conditionality are reviewed. Data are collected from eight semi-structured interviews taking place in five housing support groups in the South East and South West of England in 2019–2020. The interviews followed an approach from interpretive phenomenological analysis.

Findings from this study indicate that the government’s reforms serve as a disciplinary measure for the poor, reinforcing inequality and social marginalization. To mitigate the effects would require a comprehensive review of universal credit prior to its full rollout to claimants. Data are analyzed thematically.

Welfare conditionality and welfare reform is well-researched in the UK. There is also a significant volume of research concerning homelessness. This paper, however, fills a gap in research concerning the experiences of those working in housing support agencies working with homeless people in the UK.

The purpose of this paper is to set out the similarities and differences between the legal frameworks for safeguarding children and adults. It presents the case for developing a Transitional Safeguarding approach to create an integrated paradigm for safeguarding young people that better meets their developmental needs and better reflects the nature of harms young people face.

This paper draws on the key principles of the Children Act 1989 and the Care Act 2014 and discusses their similarities and differences. It then introduces two approaches to safeguarding: Making Safeguarding Personal (MSP); and transitional safeguarding; that can inform safeguarding work with young people. Other legal frameworks that influence safeguarding practices, such as the Mental Capacity Act 2005 and the Human Rights Act 1998, are also discussed.

Safeguarding practice still operates within a child/adult binary; neither safeguarding system adequately meets the needs of young people. Transitional Safeguarding advocates an approach to working with young people that is relational, developmental and contextual. MSP focuses on the wishes of the person at risk from abuse or neglect and their desired outcomes. This is also central to a Transitional Safeguarding approach, which is participative, evidence informed and promotes equalities, diversity and inclusion.

Building a case for developing MSP for young people means that local partnerships could create the type of service that best meets local needs, whilst ensuring their services are participative and responsive to the specific safeguarding needs of individual young people.

This paper promotes applying the principles of MSP to safeguarding practice with young people. It argues that the differences between the children and adult legislative frameworks are not so great that they would inhibit this approach to safeguarding young people.

The authors’ interest in the discharge of patients with no fixed abode (NFA) arose through repeatedly seeing patients discharged back to the streets. In 2017, the Royal United Hospital (RUH) treated 155 separate individuals with NFA, making up 194 admissions. Given these numbers, the best practice according to Inclusion Health’s tiered approach to secondary care services suggests that the hospital should be providing a dedicated housing officer and a coordinated discharge pathway. As this is currently lacking, the purpose of this paper is to establish a Homeless Healthcare Team (HHT) and design a hospital protocol for the discharge of NFA patients with strong links into community support.

The literature review identified six elements that make up a successful HHT, which has provided the structure for the implementation of the authors’ model at the RUH.

Along the way, the authors have faced a number of challenges whilst attempting to transform the model into a reality, including: securing funding; allocating responsibility; balancing conflicting priorities; coordinating schedules; developing staff knowledge and challenging prejudice. The authors are now working collaboratively with invested parties from the third sector, specialist primary and secondary care health services and local government to overcome these barriers and work towards the long-term goals.

Scarce literature exists on the practicalities of attempting to set up an HHT in a District General Hospital. The authors hope that the documentation of the authors’ experience will encourage others to broaden their horizons and persist through the challenges that arise.

This paper reports the use of situational analysis as a systems methodology to evaluate the voices of independence change and empowerment in the Stoke-on-Trent (VOICES) partnership project.

Using situational analysis and drawing on a range of secondary data sources, a three-stage conceptual mapping process provided a detailed picture of both the non-linear interlinkage and complexity of the local system that VOICES was working to influence, as well as the processes that shaped the experiences of those who act within the situation.

Data highlighted the systemic challenges facing VOICES customers (e.g. stigma and marginalisation and lack of legal literacy), progress made by VOICES in each of their priority areas and an overarching theme of VOICES promoting equity (rather than equality) to address failure demand in the system of support for people with multiple needs and disadvantage.

The authors present the novel application of situational analysis to demonstrate a substantial impact of VOICES while demonstrating the value of this methodology for complex systems thinking research and evaluation.

The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. The initial data set was published in this journal in 2015 and has since been updated annually. The complete data set is available from the author. The second purpose is to reflect on the narratives about adult safeguarding and self-neglect by focusing on the stories that are told and untold in the reviews.

Further published reviews are added to the core data set, drawn from the national SAR library and the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the domains used previously, direct work, the team around the person, organisational support and governance. SAR findings and recommendations are also critiqued using three further domains: knowledge production, explanation and aesthetics.

Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. SAR findings emphasise the knowledge domain, namely, what is actually found, rather than the explanatory domain that seeks to answer the question “why?” Findings and recommendations appear to assume that learning can be implemented within the existing architecture of services rather than challenging taken-for-granted assumptions about the context within which adult safeguarding is situated.

A national database of reviews completed by SABs has been established (www.nationalnetwork.org.uk), but this data set remains incomplete. Drawing together the findings from the reviews nonetheless reinforces what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Although individual reviews might comment on good practice alongside shortfalls, there is little analysis that seeks to explain rather than just report findings.

Answering the question “why?” remains a significant challenge for SARs, where concerns about how agencies worked together prompted review but also where positive outcomes have been achieved. The findings confirm the relevance of the evidence-base for effective practice, but SARs are limited in their analysis of what enables and what obstructs the components of best practice. The challenge for SAR authors and for partners within SABs is to reflect on the stories that are told and those that remain untold or untellable. This is an exercise of power and of ethical and political decision-making.

The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence base for practice. The paper analyses the degree to which SARs answer the question “why?” as opposed simply to answering the question “what?” It also explores the degree to which SARs appear to accept or challenge the context for adult safeguarding. The paper suggests that SABs and SAR authors should focus explicitly on what enables and what obstructs the realisation of best practice, and on the choices they make about the stories that are told.