Homelessness prevention by Moray Council

Co-located Occupational Therapist in housing team

The context

As evidence of the relationship between housing problems, homelessness and health inequalities becomes ever clearer, calls for partnership working between health and housing are heard more loudly. Whilst GPs, hospitals and community mental health are often cited as teams housing agencies should collaborate with more effectively, the role of Occupational Therapists (OTs) – a naturally preventative, person-centred, community-based profession working across all areas of health and social care – can sometimes get overlooked. Moray Council’s co-located housing OT has been playing a key role in preventing homelessness since 2015.

The intervention

In 2015, homelessness and Health and Social Care (H&SC) teams in Moray realised customers of both services could benefit from them working together at an earlier point. People applying for health-related moves were waiting months for an OT assessment, with health points awarded on a ‘medical model’. In some cases, a person’s health had deteriorated to the point homelessness was the only option by the time they received an assessment. Hospital patients whose health issues had made their home unsuitable were often discharged into temporary accommodation.

The Council’s housing team and Integrated Joint Board (IJB) got together to jointly fund (and line manage) an OT post, based in housing. The OT engaged a range of health teams (community OTs, GPs, mental health and learning disability services) to shift the focus of housing assessment from a medical to functional one: how does a home undermine or support a person’s health? (rather than how many points is a medical condition worth on a housing list?) This included training for H&SC professionals on completing applications with relevant health details from a housing perspective.

All housing applications (from people in any tenure) with a health issue or disability cited go to the OT for assessment. Given their specialised housing focus, the OT can act quickly and flexibly, with knowledge of options and processes gained from being embedded in the housing team. The OT takes a person-centred approach, trying to elucidate what, if anything, could be done in the present home to reduce barriers, including aids and adaptations. The OT has good links with community teams across health and wider services, with an ability to plug people into support.

In a hospital setting, the housing OT effectively contributes to multi-agency discharge meetings. They also sit on the lettings panel, and work with planning colleagues to flag up housing types most needed from the affordable supply programme - especially ground floor, fully adapted homes.

The outcome

Since introducing a housing OT, the number of households who become homeless and/or require temporary accommodation on grounds of health has substantially reduced in Moray. The number of appeals received against medical points for housing has decreased. The wait for OT assessment has significantly declined for housing applicants, with some people able to move through earlier OT input, bypassing the need for a homelessness application and temporary accommodation. The OT post has been made permanent, and continues to be jointly funded by both the IJB and housing.

Key insights

embedding a member of staff generates insight and opportunity for improvements in processes for both host and home services, but inter-agency training/awareness-raising remains a constant task
a housing OT feels like a 50/50 role: it took being permanently based in a housing team to grasp how to complete an OT assessment which could really make a difference to a person in housing terms
not everyone can cope with a 50/50 type role: an embedded worker needs to be confident enough to cope with what can feel like a ‘blurring’ of professional identity, and genuinely enjoy partnership working

Find out more…

Gordon McCluskey, Housing Needs Manager, Moray Council
gordon.mccluskey@moray.gov.uk

Andrew Warman, Occupational Therapist, Moray Council
andrew.warman@moray.gov.uk