Tackling homelessness in the age of COVID-19

1 October 2020

By Dr Lígia Teixeira (Chief Executive of the Centre for Homelessness Impact)

When the COVID-19 pandemic erupted in the UK, policymakers, practitioners and campaigners alike feared a catastrophic coronavirus outbreak among people experiencing homelessness. Estimates suggest that in 2019 there were around 280,000 people experiencing homelessness in England – with a further 220,000 people threatened with homelessness. Many of them live under very poor conditions, with health problems that predispose them to severe illness.

As the pandemic spread, it seemed almost inevitable that without effective intervention, people experiencing homelessness would succumb in high numbers to the disease. An influential early study had estimated the numbers were likely to go as high as 21,092 infections, 1,164 hospital admissions and 266 deaths in England’s homeless population alone unless action was taken. But as the pandemic has unfolded, there has been very little spread of the novel coronavirus amongst the homeless population. Of the recorded cases among people experiencing homelessness, fatalities by June stood at 16.

Though seldom talked about, social science played a considerable role in this success story. Thanks to our rich knowledge base in the UK, two things were clear from the beginning:

  1. The immediate effects and long-term impacts of the pandemic would not be evenly distributed. From the outset, we knew that people from deprived backgrounds and especially those experiencing homelessness were more likely to have pre-existing health conditions that put them at higher risk of suffering a severe case of COVID-19.
  2. The pandemic was not just a public health crisis. COVID-19 would have huge economic implications, and a myriad of direct and indirect adverse social consequences not only for people who are street homeless, but for children and families living in temporary or insecure accommodation (for example, staying with friends or family, sofa surfing, or in B&Bs). A whole-of-government, whole-of-society approach would be required, built around a comprehensive strategy to prevent infection, save lives and minimise impact.

 

A PARADIGM SHIFT

Governments, both local and national, and the wider homelessness sector listened to the evidence and responded to the pandemic at speed. A raft of emergency measures were also introduced to strengthen the welfare safety net in light of COVID-19, including the ending the freeze on Local Housing Allowance rates, and a ban on evictions. And on March 27, with the Ministry of Housing  call for all people who were street homeless to be housed by that weekend, and an ambition long-held by the entire homelessness sector was achieved almost overnight. Governments housed 15,000 individuals in hotels and other types of emergency accommodation.

This feat was deemed ‘impossible’ before the pandemic hit. It helped to reduce the number of people with long histories of street homelessness who were rough sleeping, by about 30% in London between April-June 2019 and the same period this year, whilst also helping to contain the number of infections and deaths linked to COVID-19. As Geoff Mulgan remarked at our recent Impact Festival, ‘’One of the most interesting questions in the next period is ‘does this crisis shift what we think is possible, conceivable or ‘normal’?”

However, the crisis is almost certainly still deepening around us. Levels of homelessness have started to rise in many parts of the UK, with increases likely to create formidable obstacles to the Government’s ambitions around ‘levelling up’ – it is near impossible to take advantage of economic opportunity without a home. It seems very likely that the number of people experiencing homelessness will get a lot worse in a year’s time unless decisive, evidence-informed action by Governments at local and national levels continue.

 

MOVING FORWARD

Before the pandemic, English local authorities spent over £3bn on homelessness in 2018/19 – an 6% increase from 2017/18. A third of this – some £1.1bn – was spent by councils on temporary accommodation.[1] This is over five times as much as they spent on homelessness prevention and support. £650m of this expenditure was on nightly-paid, privately-managed accommodation and emergency B&Bs.These are the most expensive types of temporary accommodation, and often are poor quality.

In most cases, we do not understand how effective this spending is. Performance is seldom evaluated, and measurement tends to track the number of people reached and the volume of services delivered, rather than the outcomes achieved. Tight budgets cause us to under-invest in upstream, early and preventative policies, even though we know that doing so will result in greater spending on remediation down the road.

This fiscal predicament may also be stifling innovation and creativity. How can we set aside the time, energy and resources to look at old problems in new ways and test promising ideas when we’re struggling to pay for what we are doing already? We lack proven, cost-effective, scalable strategies.

Based on our work at the Centre for Homelessness Impact (CHI), social scientists can maximise their contribution to this mission at this time by focusing efforts in three ways:

  • Enable smarter decision making by building evidence about the policies and interventions that will achieve the most effective and efficient results. Policymakers must have good information on which to base their decisions. Today, there is surprisingly little rigorous evidence on homelessness policy and programmes. Examples of evaluation using experimental and quasi-experimental methods, such as the new UKRI-funded trial that CHI and Cardiff University are running to test the effectiveness of different housing options on housing stability, health (particularly COVID-19 infection rates) and wellbeing, are still rare.Eight-five percent of the studies in CHI’s Evidence and Gap Map of Effectiveness studies are from the US and fewer than four percent  are from the UK. These shortcomings need to be addressed: we need more UK experiments to identify which interventions are effective and cost-effective in addressing homelessness, and we also need more – and better – systematic syntheses of those findings.
  • Help reorient resources to the most promising interventions and drive prevention          Work by CHI suggests there are significant opportunities to reduce expenditure in certain areas, thereby freeing resources within homelessness budgets for more preventive priorities. For instance, local authorities in England are spending an average of £12,500 per year/person or £240 per week per year/person in Temporary Accommodation (TA). Using our Housing Cost Calculator we estimate that moving 25% of temporarily accommodated households in the 15 local authorities with the highest rates of TA use to ‘settled’ PRS with support could produce savings of up to £500 million over a 5-year period, even when considering additional costs incurred, including management costs (e.g. voids, rent collection), move-in and incentives paid to landlords, and additional costs of providing floating support for those who require it. Wider health gains (including lower COVID-19 infection rates) and societal benefits are also likely to be higher if people achieve better outcomes than when placed into TA.

Trialling this and other promising interventions, such as individual placement and support (a model of supported employment) or family mediation, in a range of UK settings would both enrich our domestic evidence base, and help identify which variations of these interventions would allow a more effective and cost-effective response to the needs of particular parts of the homeless population.

Crucially, as part of ‘building back better’, and stopping the flow of people who experience homelessness, we also need to address the larger, systemic housing affordability issues, and ensure welfare support and wages are adequate.

  • Help local authorities use data and data analysis more effectively – as a management tool to generate innovation, systems re-engineering, and continuous improvement. All local authorities in the UK produce a large volume of performance data, but many of the performance metrics are highly imperfect, and users find it very challenging to go beyond performance reporting to using data to drive performance improvement. This needs to change if they are to improve outcomes for the whole homelessness population, rather than focusing solely on those who arrive at the council’s front door.

We also know from our work with our What Works Community partners, that the hardest thing is making sure there are leaders across all levels of local authorities, and key local agencies who are capable of looking at numbers and asking the right operational questions about them. They need support, and this needs to be delivered in such a way that allows local areas to continue doing whatever the support enables, even after the support ends.

 

FINAL WORDS

While social scientists cannot cure the coronavirus, they have a vital role to play in helping understand how we can reshape our society for the better as we react to COVID-19. To succeed we will need to instigate cultural change to ensure we are acting quickly on the best available knowledge, evaluating which interventions work, and (re)directing budget allocations towards “proven” interventions. We should combine that with an approach that uses better data more often to improve the impact of government-funded homelessness programmes.

2020 could mark a definitive turning point in homelessness, but only if we use the pandemic to step up our shared ambition to end rough sleeping and embrace the opportunity to tackle all forms of homelessness more effectively.  At the Centre, we make the data and evidence on homelessness more accessible, and support that evidence to be applied in practice. But at this moment of great change, we’re also aiming to mobilise a growing chorus of ‘what works’ champions – from local councils, to central government – to ensure that, as part of aiming to end homelessness for good, we use this opportunity to understand how to end it effectively. How to end it sustainably. And, most importantly, how to end it with evidence.

[1] CHI Analysis of Revenue Account Outrun for Housing Services.

Visit the hub of the social science community’s response to COVID-19.

Dr Lígia Teixeira is the founding Chief Executive of the Centre for Homelessness Impact.  The Centre is an independent organisation that supports the use of data and evidence in bringing about a sustainable end to homelessness. As a member of the What Works Network, we support organisations in the field of homelessness and beyond to make evidence-led decisions and adopt evidence-led practices. We launched to act as a catalyst for evidence-led change to enable breakthrough results. We believe that homelessness is an issue that can be solved sustainably. We know that this is an ambitious goal and that lasting change will require collective efforts across a complex system and addressing root causes, not just symptoms. To break the cycle of homelessness, we need to start with the end goal in mind. We need to foster a learning culture in which data and evidence helps policymakers, practitioners and commissioners everywhere make better decisions to improve outcomes on an ongoing basis.

The perspectives expressed in these commentary pieces represent the independent views of the authors, and as such they do not represent the views of the Academy or its Campaign for Social Science.

This article may be republished provided you place the following statement and link at the top of the article: This article was originally commissioned and published by the Campaign for Social Science as part of its COVID-19 programme.