“I’m really glad you helped me ... I trust you and I know you have my best intentions at heart where I’ve been let down by others in the past”.
(Alex, Routes to Roots (R2R) project service user)
Providence Row, the East London based charity, offers a range of support services to those affected by homelessness, including a day centre and advice and advocacy services. ‘Routes to Roots’ (R2R) is a specific project for homeless patients in two East London hospitals, helping them to prepare for discharge. It is designed to prevent patients from returning to the streets, which will usually worsen health conditions and ultimately lead to a future hospital re-admission. ‘R2R’ aims to break this cycle by providing the vulnerable homeless person with an opportunity of a new beginning at the critical point of discharge. ‘Routes to Roots’, as the project name indicates, tries to bring some stability by offering ongoing support for the patient for as long as possible to prevent repeat homelessness.
As the ‘R2R’ case worker, funded by CPT, explained to Bishop Paul:
“Working directly with vulnerable patients and spending time with them prior to discharge is essential. The person often does not have any local connections where the hospital is, and so my job is to identify which local authority has responsibility for the person and establish what support services they can actually provide. Top of the list of priorities is sourcing safe accommodation”
‘R2R’ employs a holistic approach, and besides offering practical and material resources, the caseworker ensures that each individual can also access local health services and community support groups. Once housed, caseworkers maintain ongoing support with regular contact for at least six months, and they ensure that much needed financial support is in place too. In short, every strategy is deployed to try to prevent a reoccurrence of homelessness.
The story of ‘Alex’ illustrates the kind of support offered by the R2R caseworker.
‘Alex’ had been homeless for many years, surviving mainly by sofa-surfing with friends. He was referred to the R2R caseworker following admission to the Royal London Hospital after a serious accident. During his time in hospital, the caseworker made contact with various multi-disciplinary teams to enable Alex to approach his own Local Authority with a homeless application. Eventually, a phone assessment was secured with the relevant Housing Department where R2R advocated for Alex to ensure all the correct information about Alex’s situation was presented. Simultaneously, R2R spoke with the Community Mental Health Team (CMHT) about the future risks for Alex due to his poor mental health, including occurrences of self-harm. Despite pressures to move Alex on from hospital, between the efforts of the R2R caseworker and the CMHT, Alex was able to remain in hospital for a little longer until Temporary Accommodation (TA) was found. Unfortunately, the initial accommodation that was offered wasn’t suitable for Alex, who was still non-weight bearing, and meant he was forced to stand up to get through the front-door, dragging his wheel chair behind him and causing him severe pain. Faced with this initial setback, the R2R Worker persisted and eventually managed to find more suitable accommodation for Alex. They also got him registered with a GP so he could receive District Nurse visits to help change his dressings regularly and prevent infections. The R2R caseworker is returning to see Alex soon to advocate with him during a mental health assessment. The net result of this support is that Social Care have now accepted that Alex is vulnerable and have agreed to provide ongoing support around Alex’s enduring mental and physical health needs.
Alex’s story is far from unique. The R2R team have received 109 referrals from hospitals in the first year of the project, and 58 of these are now actively receiving the support of the R2R caseworker. So far, 48 reconnections have been made in year one, where a vulnerable patient has secured Local Authority accommodation across forty different local areas. The R2R team monitors whether or not service users remain in the accommodation six months after moving on from the R2R service. To date, they have established that 26 service users had maintained their accommodation after six months which means the project is clearly working for many, helping to break the vicious cycle of homelessness for these individuals.
But it’s not all plain sailing. The R2R team have faced a much larger proportion of patients with complex needs this year resulting in them doing a lot more work with clients post hospital discharge, reducing the number of new referrals they could consequently work with. There have also not been enough ‘step-down’ accommodation options, especially for wheel-chair users, which means more clients have been placed in Bed and Breakfast accommodation (B&Bs) temporarily with no support. The step-down option normally forms part of the immediate move-on accommodation (a form of supported temporary accommodation) available to our R2R team when service users approach the point of being ready for discharge from hospital but before more suitable, longer-term accommodation has been found to move in to. Moreover, several Local Authorities have been trying to close their client cases once people have been moved into B&Bs which is not an acceptable option for many service users. Therefore, the R2R team have been busy ensuring that LAs know they still have a duty to house service users and that B&Bs aren’t a suitable option. Meanwhile the waiting times to access community health services increased (to between six and 12 weeks) once patients are discharged from hospital. This again resulted in the R2R team needing to offer more intensive support once patients moved out of hospital.
Despite some of these challenges, the R2R team have continued working well with the Hospital Pathways Team at the Royal London Hospital (RLH) to ensure referrals keep coming through and that the patients receive the support they desperately need to prevent homelessness. There are plans to move the R2R referral process online to simplify and speed up referrals and ensure the correct information is shared with the R2R Team from the outset.
As Bishop Paul McAleenan reflected after his visit:
“At CPT, we know that it is only through valued partners like Providence Row that the Church can play its part to change some of the entrenched social injustices of our day. We stand in solidarity with all the homeless ‘Alex’s’ out there. Homelessness figures are up 10% in the last year alone and there are now record numbers of people living in temporary accommodation. The need to tackle homelessness and to start building the social homes we need has never been more urgent.”
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