A housing-led system that gives homeless people a permanent home with intensive support is being tested across four English local authorities to measure whether it actually improves their health. This matters because the current approach often requires people to prove they are "housing ready" before getting a home, leaving those with chronic or repeat homelessness stuck in temporary accommodation. The researchers will track 25,000 people through linked health and housing records, conduct ethnographic studies in four areas, and analyse 18 detailed case histories to understand what works, for whom, and under what circumstances. If successful, the study will produce a practical "road map" and toolkit for policymakers and local planners across England. This could shift how public services invest in housing-led systems, potentially reducing emergency hospital visits and secondary care use among a population that currently cycles through hostels, A&E departments, and temporary accommodation. The economic modelling will also show whether these systems save money for wider public services beyond housing alone.
View original technical description
Research Question: What are the health impacts of housing-led systems that provide housing plus intensive forms of support for people with histories of chronic/repeat homelessness? Background: Housing-led systems are based on the simple proposition that rapid access to a permanent home with ‘wrap around’ support can improve health and wellbeing for people experiencing homelessness. Within housing-led systems, Housing First targets those with the most complex needs, providing flexible long-term support for as long as needed. Due to housing shortages, hostels and other types of temporary/emergency accommodation will also be utilised within a housing-led system. The expectation is that people will move on from these as quickly as possible. The concept of ‘housing readiness’ is redundant in the housing-led system. Aims and objectives: The overall aim of this realist evaluation is to provide policy makers and planners in England with an evidence informed ‘road map’ that will aid the design of housing-led systems, focussing on the complex set of factors that will need to be considered to maximise health impacts for people with histories of chronic/repeat homelessness. The objectives are: (1) To understand the contexts that promote/hinder the integration of different housing models as a single system to deliver rapid rehousing and improvements in health and wellbeing; (2) To understand the mechanisms through which housing-led systems achieve changes in health and wellbeing (what works for whom, under what circumstances and how?); (3) To undertake an economic modelling exercise to understand the impacts of housing-led systems on wider public services; and (4) To establish the outcomes of housing-led systems on health and wellbeing. Methods: This three-year realist evaluation will employ mixed methods. It has three interconnected work-packages. WP 1 - Is a multisite ethnographic study that will provide ‘rich descriptions’ of housing-led systems across four local authority areas in England; their proposed mechanisms of action, the realities of their implementation and outcomes from service user (n=40) and provider perspectives (n=40) (Objective 1 and 2). WP2 - is an economic deep dive into illustrative case histories (n=18), encompassing different housing-led systems and individuals with differing complexity of need (Objective 3). WP3 - is an analysis of linked homeless, housing and health datasets that will look at health outcomes for 25,000+ people (Objective 4). This will analyse (i) What is the impact of different housing models (including Housing First) on morbidity and mortality outcomes; and on emergency and secondary care usage; and (ii) What is the population-level effect of local policies and investments in housing-led systems on healthcare use and health outcomes (i.e. do areas with higher levels of investment in Housing First deliver better health and wellbeing outcomes?) Impact: We will use coproduction to work with people with lived experience of homelessness, service providers and policy makers to design and deliver the study. We will produce a journal report for the NIHR series and academic journals. The conceptual ‘road map’ for policy makers and planners will be disseminated as a ‘tool kit’ and shared widely via regional roadshows and partnership working (e.g. with the Local Government Association). The anticipated impact of the study will be housing-led systems that improve housing, health and wellbeing outcomes.
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know