Addressing homelessness through holistic care: East Sussex Wellbeing and Employment Service

Multiple NIHR PHIRST teams operate across the UK, providing rapid evaluations of public health
interventions in local authorities. This evaluation was conducted by PHIRST Light – a team of researchers from the Universities of Nottingham and Lincoln and Loughborough University.

The East Sussex Wellbeing and Employment ESWE service (ESWE) is funded equally by East Sussex County Council Public Health and by Eastbourne Borough and Lewes District Councils. It launched in June 2021 to address the increasing homelessness crisis in the UK. Evolving from a pilot project, ESWE is a housing and wellbeing initiative focused on delivering holistic and personalised care to individuals experiencing and/or facing homelessness. The service integrates physical and mental health support, social connectivity, and employability coaching through the efforts of Housing and Wellbeing Coordinators (HWCs) working alongside housing officers, in collaboration with other providers.

Priority area addressed

People who are homeless or at risk of becoming homeless have reported significantly poorer health
outcomes, with many reporting chronic illnesses and/or poor mental wellbeing. Mean age at death for individuals experiencing homelessness in England and Wales has been estimated at 45 years for men and 43 years for women. Factors such as connection to society, safety, and a sense of purpose, in addition to physical health, are critical to wellbeing. Cumulatively these highlight the need for holistic approaches to support this population.

Service objectives are to:

• 
  Fill a gap in the provision of wellbeing support using a holistic perspective to address peoples’
  wellbeing, housing and employment needs.
• Address the lack of wellbeing coaching support to guide people at risk of or currently homeless
  throughout the system.
• Improve tailored case worker support.
• Address the significant economic burden to health care and emergency and temporary
  accommodation housing services.

Budget

Source: Evaluation funded by the National Institute for Health and Care Research Public Health
Interventions Responsive Studies Programme.
 

Timeframe to completion

Evaluation October 2022 – September 2024 (with service commencing 2001 and continuing postevaluation).

What came out

The evaluation demonstrated that the ESWE service is likely to be an effective and economically viable initiative that is addressing essential gaps in support for vulnerable populations. Its holistic, flexible approach has shown positive impacts on wellbeing. For long-term sustainability, improvements in service consistency, including goal setting and data collection, are recommended to enhance the service’s scalability and impact on community health and social outcomes. 

Key findings are included below:

Wellbeing impact

The ESWE service appeared to positively affect customer wellbeing, particularly in
the areas of mental and physical health, social isolation, lifestyle behaviours, and employability.
Personalised support from HWCs was an important contributor to these outcomes.

Implementation and delivery

The evaluation highlighted the service was able to be highly adaptable, with the co-location of WBCs and housing officers enhancing delivery. However, inconsistencies in goal-setting and structured support were identified as areas needing improvement.

Economic evaluation

The service is likely to present value for money, with costs per outcome unit within efficient service thresholds. Economic evaluation indicated ESWE’s effectiveness and financial viability, including established cost of delivery of the services and a favourable analysis of value for money and housing cost avoided.

Read full evaluation report

The primary objective of this NIHR funded research was to evaluate the effectiveness, fidelity,
implementation, and economic value of the ESWE Service, launched in June 2021. 

The service provides individualised support to residents at risk of homelessness or those who submitted a homelessness application within the past 12 months. The service aims to fill gaps in wellbeing support, as well as improving case worker provision of care and reduce the associated economic burden on healthcare and housing services by addressing

In the UK there was a reported 169 per cent rise in rough sleeping between 2010 and 2022. Alongside the national rise in rough sleeping has been significantly escalating costs of local authorities using temporary accommodation in parts of East Sussex for those at risk of homelessness or presenting as homeless. As highlighted elsewhere in this case study, people experiencing these issues have potentially significantly poorer health and wellbeing outcomes. Locally an initial pilot project was developed to address gaps in joined-up provision and provide holistic person-centred approaches. The Service comprises of behaviour-change utilising Motivational Interviewing and other techniques, as well as providing practical and emotional support.

The evaluation of ESWE took place alongside national and county issues of resource pressures and, in some coastal contexts such as Eastbourne, significantly rising temporary accommodation costs.
However, dedicated resource to facilitate the service and specifically colocation of Housing and Wellbeing Coordinators with local authority housing officers has been instrumental in providing local and county-wide perspectives that promote place-based understanding of factors that contribute to the risk of homelessness.

How did you go about setting the project up/getting it running and getting people on board with it?

Between October 2022 and March 2023, a series of co-production stakeholder events between Local Authority, ESWE staff and wider stakeholders, including public contributors and the PHIRST-Light team, took place to develop the evaluation protocol. The evaluation took place within the context of a LA and involved people: a) directly linked to the LA and ESWE service (such as HWCs, housing officers and customers) and b) people from multi-agency settings and third-party organisations, such as the Rough Sleeper Initiative and mental health services. Participants were recruited on voluntary basis.

Did you face any challenges at this stage? How were they managed?

Given that the service was undergoing continued development and expansion, it was decided that the evaluation should be informed by a developmental, but ultimately pragmatic approach. A Learning and Development Working Group was established to support the study. Initially, the group engaged in regular discussions to refine the aims of the study and the service activities of interest. Further input was sought from a wider stakeholder group (including representatives from across the five districts and people with lived experience during three stakeholder events and series of meetings with members who made up an East Sussex Public Advisory Group.

What were the key stages to delivering the project outcomes?

Key evaluation milestones included:

• A core output of the collaborative work was a logic model which set out the inputs, resources,
  activities of interest, barriers and facilitators, and expected impacts of the ESWE service in the
  short, medium and long-term.
• Descriptive review of the LA’s Annual Performance Report (APR) 2023/2024 for the service, providing insight into customers’ demography and risk information. Data provided in the APR is aggregated and it is used to provide a snapshot of the service as a whole.
• Online survey, conducted in December 2023 via the JISC Online Surveys platform, aimed to capture the perspectives of a broad range of ESWE stakeholders through a snowball sampling
  approach.
• Semi-structured interviews with customers recruited through Housing and Wellbeing Coordinators, subsequently contacted by a member of the research team.
• A semi-structured group interview with six Housing and Wellbeing Coordinators to explore
  perceptions of the core features of the service, including goal setting, techniques and skills
  (including MI) used to support customers, the types of contact delivered, and whether there have been changes to the scope of their roles since the inception of the service.
• A semi-structured group interview with twelve wider ESWE stakeholders. Their recruitment was facilitated by a senior member from the Lewes District and Eastbourne Borough Council.
• Additional supplementary informal data collection methods to supplement the formal data collection were used to capture changes to the implementation environment for ESWE. These methods included: researcher notes, notes from meetings with stakeholders and HWCs,
  document reviews and feedback from a stakeholder workshop event.
• Stakeholder workshop. A presentation of formative findings workshop was held on 4 April 2024 to review and confirm interim results with a broader range of stakeholders not reached through the survey. The event also used an open-ended survey and question and answer sessions that facilitated further qualitative feedback, incorporated into the report alongside data from semi-structured interviews.
• Economic evaluation utilising data of workforce costings alongside the creation of economic
  indicators for the service. The evaluation considered staff costs for the first 12 months of the scheme, which formed the majority of overall expenses (one Team Leader and six HWCs) and
  used data from 2023/24 APR to measure outcomes.

What has been the wider impact of the programme?

The ESWE service is a seemingly effective and economically viable initiative addressing essential gaps in support for vulnerable populations. Its holistic, flexible approach has links with positive impacts on wellbeing. Our economic analysis presents a conservative cost avoided in relation to housing of £162,787.03.

What have you learnt because of the programme?

What will you change, or what has changed as a result of its success?

For long-term sustainability, improvements in service consistency, specifically goal setting, and data
collection are recommended to enhance the service’s scalability and impact on community health and social outcomes. The logic model developed of the service evaluation has been utilised by ESCC to
secure additional funding for housing services in the county. The evaluation report can be used maximally to inform the design and development of other holistic housing and wellbeing support services.

Contact name

Email Hayden Bird, Post-Doctoral Research Associate, Lincoln Institute for Rural and Coastal Health, University of Lincoln.

Author names

• Dr Hayden Bird (University of Lincoln)
• Dr Veronica Varela-Mato (Loughborough University)
• Dr Holly Knight (University of Nottingham)
• Dr Luisa Vargas (Loughborough University)
• Professor Elizabeth Orton (University of Nottingham)
• Professor Mark Gussy (University of Lincoln)
• Professor Darrin Baines (University of Lincoln)
• Pam Rees (University of Nottingham)

Collaborating authors

• Jo Bernhaut (Consultant in Public Health, East Sussex County Council)
• Daniel Eade (Operations Manager-Partnerships & Prevention Services, Lewes & Eastbourne
  Councils)
• Katie Dawkins (Housing Options and Wellbeing Strategic Lead, Eastbourne and Lewes Councils)
• Hollie Gerrish (Team Lead East Sussex Wellbeing and Employment Service)
• Michael Courts (East Sussex Housing Partnership Lead, East Sussex County Council)

NIHR Funding acknowledgement 

This study is funded by the NIHR [Public Health Research programme (NIHR 135758)/PHIRST Light). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.