Not that many years ago, seeing a commissioner’s name come up on my phone was inevitably followed by a deep breath to compose myself, an unconvincingly cheery greeting and mentally scanning through potential reasons for a cold call. Lately, I’ve more often been the one calling our commissioners, asking if they have time for a quick chat, cheery greeting 100 per cent organic.
In March, we began mobilising the RhEST team, a brand-new service that was commissioned as part of the new pan-London substance misuse rough sleeper pathway. Its remit is to engage with people who are or have been rough sleeping and require support from substance use services, with a view to supporting them into those services and, in particular, to help them access inpatient treatment. The vital importance of this is reinforced by the latest ONS figures, which show that two-in-five deaths of homeless people are drug-related (see news, page 4).
One exciting element of the specification for the service was the clear expectation that the service feed back to the commissioner around the experiences of the team and the people we work with when trying to access services. During our regular catch-ups and contract monitoring meetings we’ve had opportunities to discuss anecdotal examples of some of the work we get to see as a pan-London team, including common practices that pose a barrier to people accessing support as well as innovations that have opened services up to them.
These conversations don’t feel like frustrated rants – they feel optimistic because there’s a real drive from all involved to ensure the best possible outcomes for the people we work with, backed up with a strategic capacity/potential to actually enact/influence change on a city-wide scale, and that’s a hugely motivating feeling.
For example, in our first few weeks we saw that many services would book appointments via text and mobile, and if the person didn’t turn up their attempts to re-engage would again be limited to attempted phone contact, which if unsuccessful would often mean the case was discharged.
We know that owning, topping up and keeping a phone is extremely difficult for a lot of people who are rough sleeping, so we’ve begun speaking to partners internally and externally about how services which are already so stretched can develop joint-working plans with outreach teams to make contact with their rough sleeping clients to increase longer term engagement and reduce the amount of time spent texting and calling a number that’s probably no longer in use.
We aim to collect and develop examples of smart approaches that services that are already so stretched can adopt to make sure they’re as accessible to our cohort as possible.
As well as the general sense of collegiality in our partnership with our commissioner at City of London, some of the other things that have felt like game changers are incredibly simple. For example, having case studies form a part of our reporting has allowed us to have much more nuanced conversations around the work the service is doing for the people we work with on an individual basis, moving away from the sometimes dehumanising act of reducing performance to numbers, and also giving space for us to discuss some of the complexities we are responding to instead of purely using the space to prove performance. Anecdotal evidence around trends also allows us to use the meetings to inform joint strategies to target specific areas and issues, for example boroughs with low referral rates or under-represented demographic groups.
In our Essex service, this kind of relationship with their commissioners directly resulted in genuine system change. Phoenix’s Changing Futures team raised concerns with their commissioners about a gap that was consistently identified in the delivery of all the projects – namely the fact that individuals with mental health needs who did not meet secondary mental health services criteria but were in need of lower-level interventions to support their wellbeing had no real options for the necessary support. Through continued discussions with commissioners Full Circle were able to bridge this gap with the mental health wellbeing team (MHWBT).
This service has been invaluable to the work Phoenix are delivering in the region, as the MHWBT are able to provide a range of swift interventions to stabilise and support clients, while in turn alleviating pressure on other agencies who don’t have the necessary clinical expertise or capacity. Due to the positive outcomes of the work the MHWBT are completing alongside Phoenix, commissioners are exploring how this provision can continue to be funded and mainstreamed as part of their Essex drug and alcohol commissioning plan.
While we’re still facing the same huge challenges – recruitment, increasing complexity, high demand – this way of working together with our commissioners, being able to share actions, reflect together, and strategise as one team with a common goal, as well as being held to account, feels essential if we hope to achieve our shared ambition to end drug related deaths in the rough sleeping population.
Ellie Grieg is Phoenix Futures regional housing manager south.