we listened to the people using our service – instead of asking them to fit the system, we made the system work around them. The flexibility built into the pathway meant we could respond to the realities of homelessness – we saw people previously considered‘ unsuitable’ for residential treatment flourish when finally given the opportunity.
The project also highlighted how easily people can be excluded through assumptions about‘ lack of engagement’. For example, some participants faced barriers that made standard
As a sector we often talk about holistic and person-centred care, and this work has shown clearly that flexibility must be part of that.
preparation groups inaccessible. In one instance, a person with neurodivergent needs was unable to attend these sessions, yet this was misinterpreted as‘ low motivation’. In other cases, people in coercive or unsafe relationships who struggled to attend appointments were similarly judged as disengaged. The pathway created space to understand these barriers and respond appropriately.
RhEST’ s involvement was about more than referrals, however. It was about building trust in a system where it has often been lost. Many of the people we engaged would previously have remained on the periphery of services because the pace and structure of traditional pathways don’ t align with the realities of rough sleeping. A trauma-informed, motivational approach was vital to the pathway’ s success.
MAINTAINING ENGAGEMENT This short-term funding showed what’ s possible when commissioning frameworks allow for flexibility. People experiencing homelessness often require more time, more consistency and a more personalised approach than standard services can currently offer. A pan-London model has proved highly effective in maintaining engagement for those who frequently move boroughs, and it highlights the need for greater discretion in decision-making around residential treatment.
We fully appreciate that funding for placements is a major consideration for commissioners. However, we would welcome a shift that allows teams greater latitude where conventional engagement expectations are unrealistic. People experiencing homelessness deserve the same access to treatment as those in stable housing, and achieving equity requires systems that reflect the complexity of their lives.
Once trust is established and people begin to engage, opportunities should be genuinely equal. As a sector we often talk about holistic and person-centred care, and this work has shown clearly that flexibility must be part of that. Embracing the differences in people’ s circumstances and widening the door for those facing the greatest challenges is essential if we’ re serious about improving access. The rough sleeper pathway proved that, with understanding and adaptability, treatment can be accessible and transformative for people experiencing homelessness.
Chris Annison is head of services, London, at Phoenix Futures
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