Westminster Rough Sleepers Strategy by wulinqing

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									Rough Sleepers and Street Culture Strategy June 2002
Westminster City Council



Table of contents                                       Page

1. Introduction                                         3-4

2. Executive Summary                                    5-9

3. Rough sleeping                                       10-12
    Size of the problem
    What we have achieved
    What we need to do
4. Supporting People                                    13


5. Hostel Management and bed Supply                     13 - 14

6. Strategic implications for hostels and day centres   14-16


7. Day Centres                                          16-18


8. Substance Misuse                                     18-24
     Size of the problem
 9 What we have achieved
10 What we need to do
11 DAAT
12 Treatment options
13 Street Drinking

14   Begging
     Size of the problem                                23-25
     What we have achieved
15   What we need to do
16   Strategic implications


17   Street Out Reach                                   24 - 26


18   One Stop Assessment Project                        26 - 27




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19   Soup Runs and Hand Outs                                  28
      Soups runs cont.
     Size of the problem
     What has been achieved
     What we need to do
20    Health Issues                                           29-30

21    Partnership between Metropolitan Police Safer Streets   30 - 32
                 Unit and the City Council

22   Financial Implications                                   32


23   Management Structure                                     33-35


24    Summary and Recommendations                             36-38




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Introduction

The problems faced by the City Council in relation to rough sleeping and
street culture are unique in terms of their scale and complexity. These include
the large number of people who collectively form Westminster’s ‘street
culture’ only a proportion of whom actually sleep rough.

The term street culture is used to define individuals who are engaged in any
of the following in a sustained way:

         Sleeping on the streets either on a regular basis or spasmodically
         Street drinkers, who may or may not be homeless
         Those addicted to/or users of illegal substances and who buy to
          feed their habits on the streets
         Dealers who peddle drugs on the streets
         Sex workers
         Beggars
         Transients who may come into the City for a short while and engage
          in any of the above
         Those who regularly come onto the streets to receive ‘handouts’
          from soup runs or who continue to use services in spite of their
          being accommodated either short or long term
         Those who are accommodated in hostels but spill out onto the
          streets and form social groups to engage in any of the above
          activity



Under the framework of Civic Renewal the City Council is developing a
strategy that will successfully reduce the numbers of people sleeping rough,
drinking, begging, using drugs and behaving in an anti social way on the
streets. The strategy must also encompass the Council’s duty to protect and
offer appropriate services to those who are assessed as vulnerable through
mental or physical illness, age or addiction.

It is clear the above represent complex problems that demand complex
solutions. It will involve the City Council forming new and sustained
partnerships with the Homelessness Directorate, police, health, voluntary
agencies, residents, the business community, visitors and street users them
selves. Some of the solutions will be acceptable to some street users but not
to others and enforcement may be deemed as an attack on the rights of those
engaged and/or sustained by the street culture.

The size and complexity of the problems demand decisive measures if
improvements are to be made and sustained. The following represents a
strategy for bringing some of the identified problems and conflicts under
control. The proposed measures depend upon the strength and commitment
of our partners as well as the efforts of the City Council. It has to be




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recognised that rough sleeping is not simply an accommodation issue, though
the right mix of available accommodation is a prerequisite to success.
We have made progress in bringing down the number of rough sleepers and
have plans to reduce the number further. Attention must be paid to cross
borough issues particularly with Lambeth, Camden and the Corporation of
London. We also need to extend our activity into the whole area of street
activity and to integrate the City Council response into the City Council’s new
Community Protection Directorate. The latter will ensure that residents and
the business community receive a response that reflects improved co-
ordination.

The government sent targets for a 2/3 reduction in rough sleeping in national
terms this was achieved. In Central London the rate of reduction has not
been so successful and a new more assertive approach is now required to
deliver safer streets for our residents and visitors.




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Executive Summary

Introduction

This document outlines the forward plan and long term strategy to reduce the
number of rough sleepers in Westminster to double figures by March 2003
and then to as near zero as we can reasonably be expected to achieve. It
illuminates the complexity of the issues surrounding street culture and the
associated and unacceptable problems created for residents, visitors and the
business community. The message from residents and local businesses is
clear. They expect the City Council to provide effective co-ordination of all the
key agencies involved, including the statutory and voluntary sector, in order to
ensure lasting solutions. Co-ordinated city wide initiatives will offer protection
to those perceived as vulnerable whilst employing enforcement to dislodge
those who are not. The five main challenges are:

          To achieve the reduction in rough sleepers to double figures by
           March 2003 whilst ensuring that those assessed as vulnerable are
           protected and enabled to accept appropriate services and
           accommodation. Managing the tension between social care and
           enforcement.

          To strengthen and sustain key interagency partnerships to deliver
           the targets.

          To convince local residents and businesses that we are striving to
           make Westminster streets cleaner and safer and to harness their
           support to ensure success.

          To respond in a meaningful way to the changing demands of a 24hr
           city. There is a need to improve co-ordination at Chief Officer level
           between City Council Departments to harness all the Council’s
           resources in a more systematic approach.

          To identify and secure funding streams as a matter of urgency.



Rough Sleeping

There are currently between 150 –170 sleeping rough each night in
Westminster – a significant reduction, but still a serious problem for residents,
businesses, visitors and the rough sleepers themselves. We now need to :-


          Review current use and management of hostels and day centres to
           ensure needs and management of most vulnerable rough sleepers
           can be met and sustained. Improve co-ordination of all agencies
           and council services working on the streets of the City.


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          Strengthen the statutory mental health (JHT) and substance
           misuse teams to ensure the council meets its duty of care to those
           who are vulnerable.

          Develop a more assertive enforcement led approach to those who
           beg, drink, and cause nuisance and/or refuse all offers of support
           or accommodation.

          Extend police powers by using bye-laws and controlled drinking
           zones more widely.

          Focus on prevention and early intervention to sustain the reduction
           in numbers.

          Continue to develop services off the streets and discourage
           services being delivered on the streets.

          Regularly monitor and evaluate the impact these initiatives and
           share good practice.

          Implement a communication strategy to increase public confidence.



Hostels and Day Centres

There is need to audit the management of hostel beds and the occupancy
levels, by user, length of stay and care plan initiatives. There is also a need to
introduce protocols across all providers to minimise banning and eviction back
onto the streets. Westminster has agreed to undertake this in partnership with
the Homelessness Directorate a timetable is being negotiated.

There are four key day centres in Westminster which should be subject to
improved co-ordination to ensure they are complementing the efforts of other
service providers and that they are working toward the overall objective of
reducing rough sleeping and street activity.

More responsibility needs to be accepted by some providers for ‘good
neighbourliness’. This might involve keeping the surrounding area clean and
ensuring hostel and day care centre residents or users do not spill onto the
streets causing nuisance and distress within the local community. We would
also like to see providers thinking imaginatively about the premises they
occupy and whether they could work more closely with the City Council to
provide local solutions to local problems. For example, a space in a centre or
hostel for a small group of street drinkers to be given refuge whilst being
encouraged to move toward treatment or more controlled drinking.




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Supporting people

The progress already made within Westminster under the new Supporting
People agenda has begun to strengthen partnerships and has potential in the
longer term to prevent to-morrows rough sleepers.


Street Drinking

The success of the Controlled Drinking Zone introduced in the Victoria area is
being evaluated with the aim of extending the Area across the City. The City
Council is seeking to introduce ‘wet’ day provision and is seeking the
assistance of existing day centre and hostel providers to secure small units
within existing premises.


Substance misuse

Westminster’s Drug and Alcohol Action Team has developed a co-ordinated
response to combat drug use and the potential for dealing. Access to detox
and treatment partnerships are well established. The Homelessness
Directorate is reviewing the role of specialist workers funded by them in the
voluntary sector as initial evaluation suggests this has not been an effective
model of intervention. The Westminster Substance Misuse Team needs to be
strengthened if the voluntary sector resource is to be reduced. The question
of providing a needle exchange is being tackled by the DAAT but there will
need to be careful cross borough agreements to avoid critics who claim
services within Westminster are acting as a magnet. Well managed needle
exchanges remain a vital complement to the strategy


Begging

Research suggests that the majority of beggars are engaged in this activity to
feed their addiction to drugs and/or alcohol. A concerted and sustained effort
is needed by the CST and the Metropolitan Police to tackle the problem. The
City Council is currently running a communications strategy a ‘Hand Up not a
Hand Out’ and this should assist in helping the public to resist denoting a
beggars.


Street outreach

The Homelessness Directorate is reviewing its funding of street outreach that
covers all street activity. One agency covering the whole City and working
very closely with both the City and the police Safer Streets Team would be a
welcome step forward. The team could be integrated and managed within the
City Council or commissioned from the voluntary sector. Either way the
outreach provided must be assertive and ensure those new to the streets do
not become settled there. The workers need to be skilled enough to operate a


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‘primary list’ of clients who are vulnerable and need access to social care
whilst also supporting disruptive techniques and enforcement with the police
with those who have no social care needs. If this team is commissioned
Westminster envisages that they would co-ordinate a 24hr telephone
‘Helpline’ and have provision for a response capability 24/ 7. The workers
would be strategically attached to the Day Centres across the City but not all
street users attend day centres and are highly mobile so there will remain a
need for a street based outreach team.


One stop assessment Centre Project (Formerly Rolling Shelter)

In order to sustain the reduction in numbers of rough sleepers and to stop the
flow we welcome the Homelessness Directorate piloting a One Stop
Residential Assessment Unit in Camden where the length of stay will be time
limited and assessment of need very thorough. We will be interested to see
how this pilot develops since there is the opportunity to build on the success
of the Rolling Shelter model.

Soup runs and hand outs

Soup runs constantly undermine the work of the outreach and assessment
teams who are trying to get people off the streets. Soup runs help to sustain
life on the streets or they drag people back who have been accommodated.
A video will be produced highlighting good and bad practice and will
demonstrate what an outmoded and degrading process street food provision
has become. The video will also include CCTV footage that demonstrates the
risks faced by those engaged in street activity as well as behaviour that
causes fear and distress to the community.


Health issues

For those caught up in street life and street culture access to primary health
care is the gate way to receiving appropriate preventative and treatment
interventions. A discussion with the new PCT has begun and the potential to
extend the Health Support Team to include outreach nursing services will be
raised. A proportion of those on the streets are acknowledged to have mental
health problems. Amongst these are a number of vulnerable people who do
not have a severe or enduring mental illness but are nevertheless disabled by
mental health problems. These street users are at risk and cause alarm to the
general public yet they are the least served because they fall outside the
safety net of the legislative framework. More needs to be done to both reach
and support this group and an additional layer of intervention could be located
within the existing JHT. Appropriate and effective responses to dual diagnosis
(mental health and substance misuse) are currently subject to debate at both
local and central government levels. It is recommended in this strategy that
thought be given to combining the specialist workers within the SMT and JHT
since both work with those carrying a dual diagnosis on the streets.




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Partnership between the Metropolitan Safer Streets Unit (SSU) and the
City Council

The introduction of the SSU funded by the Homelessness Directorate has
been very successful both in tackling crime and reducing rough sleeping and
there should be an extension across the City. The SSU have also greatly
assisted the JHT and health colleagues to carry out assessments under the
Mental Act. The team has had direct results in reducing street crime and
improving quality of life issues. The City Council’s enforcement initiatives now
need to be more integrated with the SSU to improve co-ordination and reduce
duplication.


Financial Implications

There are significant financial implications currently subject to negotiation with
the Homelessness Directorate.

Management Structure

Implementation of this strategy involves several departments within the City
Council and the project needs to be overseen by a nominated Chief Officer
who can intervene and ensure efficient cross departmental working. There
needs to be a clear shift toward integrating the Social Care agenda and
enforcement. The newly created Community Protection Directorate presents
an ideal vehicle to take this forward and to convene a more appropriate and
representative Steering Group to manage the initiatives in the future.

Monitoring and Evaluation

Regular street counts will need to continue to ensure numbers are properly
audited. The City Council will take over responsibility for this from the
Homelessness Directorate.

Communication Strategy
A communication strategy has been implemented which aims to manage the
message and ensure that reducing the number of rough sleepers is in part a
shared responsibility. Residents, visitors and the business community need to
be discouraged from giving to beggars and to work with the City Council to
offer a hand up and not a hand out.

Summary and recommendations

A brief recapitulation of the recommendations and the difficulties that have to
be surmounted are detailed in this section. Linking together the final pieces of
the complex jigsaw of provision and partnership to achieve the over all
objective, to reduce street activity and to make Westminster streets cleaner
and safer.




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      STRATEGY for CONTROLLING ROUGH SLEEPING and
               TACKLING STREET CULTURE

1. ROUGH SLEEPING
1.1    Size of the Problem:

       No other LA has to face the volume of rough sleepers that Westminster
       is addressing and this is compounded by the constant ‘recycling’ from
       hostel to streets to hostel to streets again. The consequence of this is
       that the flow onto the streets is not made up entirely of people new to
       the streets but contains a high percentage of those who have either
       been banned, evicted or have abandoned accommodation.

1.2    The last full street count across the UK, November 2001, identifies 120
       rough sleepers in Westminster that met the Rough Sleepers Unit
       definition. Numerically 120 could be described as minimal but this
       figure does not reflect the activity levels nor that rough sleepers
       represent one of the most socially excluded groups in our society.

1.3    There are a group within the rough sleeping population who are known
       to the Joint Homelessness Team (JHT) and Contact and Assessment
       Teams (CATs) who are deemed to be extremely vulnerable through
       mental or physical ill health, age or substance misuse. These remain
       our ‘primary list’ clients. They are constantly targeted and encouraged
       to accept suitable offers of accommodation and or treatment.

1.4    There are also street users who are not deemed to be vulnerable who
       are refusing services and accommodation and chose instead to sleep
       out. The reasons for this are complex and are addressed below.

1.5    There is a further group who sleep out during the day because they are
       leading nocturnal life styles and our intelligence and knowledge of this
       group is weak. The above groups swell when street drinkers, some
       hostel residents and beggars who use the streets to behave in an anti
       social way are added. The number then becomes significantly higher
       than the starting figure of 120.

1.6    It is difficult for residents to distinguish between these groups and all
       are referred to as rough sleepers or vagrants. Thus, Westminster has a
       significant problem of high visibility leading to a feeling that the streets
       are not safe and disbelief that the problems associated with rough
       sleeping are being effectively tackled. The findings of the Vision 21
       research, ‘Streets of London, A study of Street Culture in Westminster’,
       confirms that there are two clear populations of rough sleepers to
       concentrate upon – those who are within the four week window and the
       longer term more entrenched rough sleeper.



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2.    What have we achieved so far

2.1   The number of people sleeping on the streets on any one night has
      been reduced from a base figure of 237 in June 1998 to 120 in
      November 2001. This reduction is not as great as we had hoped but
      important lessons have been learned and achievements made. For
      example, the number of those vulnerable through mental illness has
      been reduced as has the numbers of those vulnerable through age
      (both the young and the old). Some very entrenched rough sleepers
      have been enabled to come indoors by the CAT workers whilst other
      more transient people who have no connection to Westminster have
      been connected with services in their home town or reunited with their
      family.

3     What we need to do now

      We need to develop a strategy that includes the eight components
      listed below:

1     A multi agency response to ensure that issues of social exclusion and
      diversity are fully addressed and effectively tackled. Vision 21
      confirmed that rough sleepers need a great deal of help to obtain and
      retain a permanent home. Part of this task is tenancy sustainment,
      securing a paid employment or meaningful occupation and to obtain
      access to benefits so that choices and options become real.

2     Stop the flow by prevention of to-morrows rough sleepers. This
      includes, help on the night and requires 24/7 assertive street out reach
      teams to cover the City and where appropriate to work across borough
      borders. There is a view that Westminster, particularly Victoria,
      represents the golden road to rough sleeping and street activity.
      Between May 2000 and May 2001 1625 referrals for accommodation
      were made by street outreach workers and this resulted in a reduction
      in the street count of a mere 70. There are rough sleepers recycling in
      and out of accommodation and there are those who sleep out for the
      odd weekend or night and make the situation much more fluid and
      difficult, though not impossible, to manage and control. This situation is
      made more difficult during the summer months.

3     The creation of the Community Protection Directorate provides a
      unique opportunity for an integrated City Council response that crosses
      several departments and is corporately managed. All working to the
      same agenda to reduce the number of rough sleepers and make the
      streets cleaner and safer via a co-ordinated and integrated strategy.

4     A balance between enforcement and social care has to be maintained,
      where enforcement is employed great care needs to be taken to protect
      those deemed to be vulnerable




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5         Strengthen the Joint Homelessness Team (JHT) and the Substance
          Misuse Team (SMT). The two teams are tasked with meeting the
          needs of the most vulnerable rough sleepers and it is an established
          fact that the high incidence of mental health problems has stretched the
          dedicated JHT and the increased availability of drugs and usage on
          Westminster Streets is likewise stretching the SMT.

6         An appropriate mix of available accommodation to meet the varying
          needs of individual rough sleepers including the need to rebuild lives
          away from the streets

7         Zero tolerance of begging and street drinking schools these activities
          represent the most resented aspects of street culture

3.2       Outlined below are the key areas of activity that the City Council will
          seek to influence and to secure change compatible with the objectives
          of this strategy, to reduce rough sleeping, eradicate street drinking and
          begging and protect the vulnerable. There are key areas of service that
          are not addressed in great detail. This is because the central
          government funding held by the Homelessness Directorate is to be
          used by the Directorate to commission services directly from the
          voluntary sector. In the future it is anticipated that Westminster will be
          allocated funding to commission services directly and when this
          happens a more detailed commissioning strategy will be produced.

3.4       The flow onto the streets is recognised to come from four main
          sources:
           Young people leaving the Care system
           Those released from prison with no home to go to
           Those leaving the armed forces
           Those fleeing sexual abuse and broken relationships
          Westminster can add another category to this namely, those, banned,
          evicted or who have abandoned their hostel place because it failed to
          meet their needs.



         We aim to reduce the flow onto the streets and to reduce the
          number of rough sleepers to double figures by March 2003
         We will protect the vulnerable and in partnership with the police we
          will use enforcement techniques to disrupt and dissuade other street
          users.
         The City Council will ensure integrated departmental responses to
          ensure the streets become cleaner and safer for residents, visitors
          and the business community
         Begging and street drinking will not be tolerated
         Active consideration is being given to extending the Controlled
          Drinking Area City Wide
         The increasing use of Byelaws is also under consideration to reduce
          rough sleeping and extend long term powers of enforcement to the
          police.

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4     Westminster Housing and Supporting People

4.1   The City Council’s Supporting Peoples Strategy represents a
      mechanism which facilitates important partnerships with the PCT,
      Probation Service, RSL’s, the voluntary sector and users.

4.2   The City Council’s Homelessness strategy will include plans to prevent
      homelessness, secure accommodation for people who are or may
      become homeless and provide satisfactory support for people who are
      or may become homeless, or who need support to prevent them
      becoming homeless again. This approach is intended to dramatically
      strengthen the efforts to prevent the growth of to-morrows rough
      sleepers. The first strategy will be published in accordance with central
      government guidelines in July 2003.


4.3   A unique opportunity is presented to co-ordinate and deliver statutory
      and voluntary provision that meets the complex needs of users. The
      Supporting People agenda also promotes quality of life issues including
      the needs and aspirations of residents who want to tackle crime and
      nuisance within their community. The outcomes of these initiatives will
      add to prevention strategies. (see also 9.3 )

4.4   A Joint Commissioning Manager for Mental Health Funded by the
      Housing Department and the PCT and Social Services has been
      appointed and located within the Supporting People Team. The post
      holder will seek to improve the range and quality of temporary and
      permanent accommodation in Westminster for the mentally ill.



5.    HOSTEL MANAGEMENT and BED SUPPLY

5.1   If on any one night we have 120 people sleeping on the streets then
      technically we need 120 units of accommodation. It has been
      established that almost half of all moves off the streets are into hostels.
      However, there is a major problem created by the large number who
      either abandon places or who are evicted and/or banned. This is made
      worse by the fact that the CATs have made 50% of referrals to just 10
      hostels out of the 42 London hostels funded by the RSU. The
      implication that is being drawn from this is that some hostel providers
      are not equipped to deal with the demands made by rough sleepers
      and that the 10 most used hostels should be targeted for future
      Homelessness Directorate funding and further improvement. The
      Homelessness Directorate (HD) has pledged to improve hostel
      management and to closely monitor ‘evictions and banning’. The HD is
      aiming to target funding on key strategic providers who offer the most
      beds or /and specialist services. Specialist hostels include those for
      both young and older people, and for those with mental health and
      substance misuse problems. There are over 1400 hostel places in


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      Westminster and an audit of these places is being conducted under the
      Supporting People initiative. The Rolling Shelter program has produced
      some good results but such shelters are no more than a safety net with
      a limited life span as other provisions improve.

6     STRATEGIC IMPLICATIONS FOR HOSTEL and DAY CENTRE
      MANAGEMENT AND PROVISION:

6.1   HOSTELS

      Working in partnership the Homelessness Directorate, the Out Reach
      and Assessment Management Team and Westminster should audit
      provision within the City and ensure that best practice and best value
      principles are being employed consistently. The intelligence and
      knowledge of the Westminster Supporting People Team should be a
      major contributor to this exercise and would include all hostel provision,
      not just those financially supported by the Directorate. This will ensure
      that planned legislative changes are incorporated and hostel providers
      are left in no doubt of the partnership between the Directorate and the
      commissioning and monitoring arm of the City Council.

6.2   A review of the processes of banning, eviction, and abandonment
      should be implemented as soon as possible. This should be coupled
      with a robust monitoring system driven by targets to reduce the
      numbers involved. This should also incorporate agreed best practice
      and the planning around supporting people initiatives so that
      consistency is applied across all hostel provision.

6.3   The mix of provision needs to be revisited and the voice of users made
      stronger so that provision matches more closely with both manifest and
      latent need. This would entail a review of staffing levels and their mix
      of skills and ability to meet the expressed need of potential residents.
      To get the mix right, either, staffing levels may be required to go up or
      resident levels down, whichever, provided the consequence is that a
      break through occurs in the recycling patterns that have become the
      established norm.

6.4   A consequence of the above would mean that there would be an
      emphasis on matching rough sleepers to particular accommodation
      units which may cut across attempts to get people off the streets ‘on
      the night’ into wherever vacancies happen to be. However, this
      problem might be resolved with the introduction of an assessment
      facility modelled on the current safe stop for younger people. This
      would facilitate diversion, reconciliation, mediation and matching to
      appropriate accommodation that would be tightly managed and time
      limited.

6.5   The present arrangements for CAT priority over hostel vacancies
      should be modified. The new strategy recommended is that a
      proportion of vacancies should be ring fenced for the CATs and day


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      centre workers for verified rough sleepers only, leaving the remaining
      vacancies to be accessed by other referrers. This recommendation has
      the benefit of catching those new to the streets as well as long term
      rough sleepers.

6.6   Mixed sex hostels and those making provision for dogs seem hard to
      come by and yet they are in demand. Underused hostels in
      Westminster should be targeted to either facilitate a wider or more
      specialist use. A change in either direction might make them more
      effective and efficient.

6.7   The increasing drug use in London has penetrated the rough sleeping
      population. Often users exhibit ‘chaotic behaviour’ which requires
      containment only available from specialist staff. The idea of hostels
      with well staffed Drugs Units, housed in the same building as general
      units needs rethinking and reorganising. The reason being the
      specialist unit workers get drawn into the general facilities which are
      also trying to contain chaotic users but without the appropriate
      resources or skill mix. The remaining residents who are often in the
      minority of none drug users are prone to leave because they cannot
      cope in such a strained environment. It may be cost effective to have
      dual purpose provision within one building but in practice it appears to
      act as a contrary indicator for successful outcomes.

6.8   Hostel management must involve managing the locality and liaising
      with neighbours and local businesses. Partnerships with the police
      need to be established to deal with unacceptable behaviour of
      residents or ex residents outside of the hostel. Managers should hold
      meetings with the local community and have community resident and
      user group meetings.

6.9   The availability of move on accommodation and any strings attached
      needs to be much more transparent and closely monitored.
      Westminster City Council and the Homelessness Directorate need to
      agree protocols and processes for regular data collection so that
      blockages in the system can be quickly identified and rectified.

6.10 The thorny question of whether there should be a special residential
     resource for dual diagnosis or complex needs is in urgent need of
     debate. Certainly there are a number of people on the streets who have
     borderline mental health problems and/or serious forensic histories.
     Such that they cannot be contained within main stream provision. They
     are small in number but currently are not catered for. Westminster is
     preparing a proposal to present to the Homelessness Directorate to
     address these issues.

6.11 Hostel management needs to respond to the changing nature of their
     client group which demands a multi disciplinary response so that rough
     sleepers with challenging behaviour can access hostel provision.



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6.12 All hostel staff should receive some form of basic training in relation to
     drug and alcohol abuse

6.13 Entrenched hostel residents need a new resource that will facilitate
     their move on to a more permanent type of hostel accommodation that
     can cater for their institutionalised life style whilst encouraging
     expression of individuality. Hostel managers should then ensure that a
     new group of institutionalised hostel residents is not created.

6.14 The referral process by CATs and other agencies needs to be
     examined so that unhelpful practices such as having set times for
     referrals becomes more flexible to need and coincides for example with
     the early morning closure of the night shelter. Hostel spaces should be
     efficiently managed with increased access to spaces at night when the
     temperature is falling. Out reach workers need to make more night time
     referrals and make better use of transport at their disposal to get
     people into appropriate vacancies with maximum haste.

6.15 Westminster has agreed to pilot a Rolling Shelter. This decision is
     based on a short term need to target those sleeping rough who are
     resisting all other offers of help.


6.16 We would welcome the introduction of an Assessment Centre to
     provide a thorough time limited needs assessment. The potential
     outcome of the assessment could involve referral to Westminster’s
     proposed Mediation Project managed by the Housing Department,
     diversion, referral to Assessment and Advice Centre or to a hostel most
     appropriate to need etc. Camden have requested funding to pilot this
     model and Westminster would welcome the opportunity to operate a
     pilot within existing hostel provision.

         Westminster S&CS department will with the Homelessness Directorate
          conduct a major and thorough audit of existing hostel provision
         Potential sites for a suitable Rolling Shelter are being explored
         Point of and time of entry into hostels will become more flexible.
          A small but specialist unit for dual diagnosis is needed in the interim
          whilst current hostel managers negotiate increased staffing and
          training to cater more effectively for their current and potential resident
          population and reduce current recycling
         Westminster would welcome the introduction of an Assessment Centre
          which would represent the first and only point of entry for those new to
          the streets.



7.        DAY CENTRE PROVISION

7.1       There is an urgent need to rationalise the services provided by the day
          centres serving Westminster. The Passage has recently introduced


                                                                                   16
      major innovations following an extensive review of their service
      provision. The other Day Centres could benefit from the experience
      gained by the Passage in implementing these important changes which
      places emphasis on the most vulnerable and hard to reach rough
      sleepers. There is now a working group chaired by the Passage to
      promote best practice and achieve consistency.

7.2   There is a view that street outreach workers should operate in three
      teams and work in close partnership with one of three day centre
      providers. There are clear advantages to this provided the Day Centre
      Management accept there is a need to extend their own outreach and
      accept responsibility for the local community outside of the centre. This
      would include ensuring the area is not strewn with litter and any anti
      social behaviour is minimised. It is also proposed that groups of Hostel
      and Day Centre Managers could work together to provide a co-
      ordinated response to nuisance caused to the local community by their
      current users or the ex-users of their services.

7.3   The Vision 21 research identified that the Day Centres were in a unique
      position to strengthen and improve provision to rough sleepers but that
      in some instances this was not being utilised. There needs to be tighter
      gate keeping to ensure that the users are in deed the most vulnerable
      because of homelessness or potential homelessness. The needs of
      those who are accommodated but are nonetheless isolated and acutely
      lonely need to be met by a more appropriate resource.

7.4   We would like to see a more seamless provision so that as one
      provision closes, another appropriate resource opens. For example
      from day to night provision with clear information sharing on client need
      and care plan. Always the shared objective should be to get people off
      the streets and accommodated. The introduction of a street rescue
      vehicle attending the day centres to escort users to hostel
      accommodation is very welcomed and should ensure that users don’t
      fall at the first hurdle. Moving into accommodation should become the
      established norm for users not sustaining a life on the streets.

7.5   There will always be a need for day centres to provide meaningful
      occupation opportunities but this should be evaluated and effectiveness
      monitored to ensure the right mix of provision and not an over
      emphasis on IT projects. The City Council should consider creative
      ways of expanding employment opportunities via local businesses.

7.6   Unless there is a preparedness for hostel, day centre and CAT
      managers to work together then none of the above can be achieved. It
      is imperative that managers look beyond their own service provision to
      ensure a seamless service for their users.

7.7   The need for cross borough working and liaison needs to be agreed
      between the key providers with protocols and agreements on how this
      will be facilitated and managed.


                                                                             17
7.8      The Managers of Day Centres will have to be given referral rights to
         specialist services and hostels if the model proposed of integrated
         outreach is adopted. There is also a need for the day centres to be
         linked to CHAIN to prevent duplication and assist communication.


       Day centre management will occupy a more strategic role and key staff
        will be given referral rights to hostels and other services.
       CHAIN data base should extend to the sites
       Managers in both Hostels and Day Centres must engage with the local
        community and ensure no over spill onto the streets
       Users should be those assessed to be the most vulnerable to rough
        sleeping and managers need to identify good practice and introduce
        procedures to manage more effectively banning and eviction.
       Existing premises need to be explored to identify the possible introduction
        of a ‘wet’ area
       .Day centres will co-ordinate hours of operation to ensure a seamless
        service.


8        STREET DRINKING and DRUG ABUSE

         Size of the Problem:
8.1      There are street drinking schools within Westminster as well as areas
         where street drinking is a regular occurrence. There is the problem of
         drunkenness involving those leaving pubs and clubs particularly in the
         West End as well as drinking schools. A street drinking school can act
         like a magnet to other members of the street culture for example, rough
         sleepers, residents from near by hostels and drug users and dealers.
         Consequently finding solutions to street drinking and drunkenness
         represents a complex problem that demands complex solutions. Failure
         to effectively co-ordinate a response to the problem(s) may result in
         shifting the problem(s) from one part of the city to another. It is also
         important to recognise that raising the expectations of the local
         community has to be balanced with what can realistically be achieved
         within a 24 hour City.

8.2      The 24hr City also attracts drug dealers and users and there is much
         dual abuse of both alcohol and drugs. The existence of what can only
         be described as international drug markets operating on the
         Westminster/Camden borders can only be tackled by the police but the
         off shoot of this activity has to involve a local authority response. Drug
         debris, including discarded syringes and other potentially contaminated
         waste have to be speedily and safely cleaned away. The young and
         vulnerable need to be diverted away from the dealers and prevention
         programmes established. This is happening within our schools assisted
         by DAT funding and there are several projects aimed at vulnerable
         young people.




                                                                                 18
8.3   Zero tolerance to attempts to make areas ‘no go areas’ should be firmly
      applied by the police and City Council.

9.    What have we achieved so far

9.1   Early signs suggest that by designating a Controlled Drinking Area
      under the Police and Criminal Justice Act quick wins can be achieved
      to combat established street drinking. Victoria and the environs were
      Designated on March 4th 2002 with dramatic immediate effect. The risk
      of extending the area too quickly relates to the need for police
      resources and their willingness to enforce the order. However, the
      Metropolitan Police, Safer Streets Units remain committed to enforcing
      the Victoria area and are themselves requesting that Westminster
      makes application for a City wide extension of the Order.

9.2   The SMT have engaged and enabled rough sleepers with addictions to
      drugs and/or alcohol to access appropriate services and rehabilitation
      but there is a week link around securing appropriate pre tenancy
      support as rehabilitation draws to a close in units outside of London.
      The SMT have found their work to be assisted by the Soho Rapid
      Access to Treatment Project and the Westminster DAAT has confirmed
      Project will continue to receive funding in 2002/3.

9.3   The Housing Department has secured funding via the Communities
      Against Drugs initiative to work with residents and community groups to
      gather information about drugs supply and anti social behaviour and to
      fast track referrals to appropriate agencies. Funding has also been
      secured from the Neighbourhood Renewal Fund for a worker to work
      with people with substance misuse problems on the Lisson Green and
      Church Street estates.

10    What we need to do now

10.2 Ensure rapid access to detox and treatment. Identify and provide safe,
     in door, areas where street drinkers with a local connection can drink
     whilst accessing appropriate services and receive encouragement to
     rebuild their lives. The main resource available to the City Council is
     Hopkinson House, what is needed is an additional small day time wet
     facility. The latter will need to have an holistic approach ensuring that
     primary health care, housing and benefits issues can be dealt with as
     well as a discrete out reach to enable people to move towards
     abstinence. Achieving a local solution to local problems suggests that
     we should attempt to have small but multiple, wet day, provision
     housed within existing resources. Discussions are taking place with
     hostel and day centre managers along these lines. If these were to be
     located within the designated controlled drinking area then local
     opposition should be minimised because there would be no opportunity
     for drinkers to congregate outside the wet areas. Entry would be tightly
     controlled by a restricted referral process involving, Day Centres, the
     Cats and the police.


                                                                            19
10.3    Much of this strategy is dependent upon our partnership with the police
        particularly the Safer Streets Unit and their commitment to ensure a
        truly City wide response.

10.4    The Community Safety Team will under the new Community Protection
        Directorate take a more proactive role emphasising that street drinking
        and drunkenness cause much distress to residents, affects businesses,
        and adds to litter and fouling of the environment. It is a quality of life
        issue that increases fear among residents. The City Council and Police
        enforcement needs to be strengthened to successfully prosecute rogue
        off licenses who sell liquor to drunks, take electrical goods in lou of
        payment and hold benefit books until giro day. The City Council will
        ensure that there will be a more effectively co-ordinated cross
        departmental response that encompasses enforcement, environment
        issues, and prevention. Liaison with CPS and Magistrates will also be
        given increased attention so that prosecutions intended to deter do not
        fall at the first hurdle and lower motivation.

10.5    No application has been made for ASBOs in relation to persistent street
        drinkers and drug users who cause regular nuisance and who behave
        in an anti social way. Given that other authorities have successfully
        used ASBOs consideration for targeted use should be explored. The
        police are very interested in the extended use of ASBOs and the City
        Council will not hesitate to consider any appropriate application.

     The use of anti social behaviour orders will be considered for those who
      cause distress to residents and refuse all offers of assistance
     ‘Wet’ facilities should be introduced to support those prepared to work toward
      abstinence
     Consideration is being given to extend the controlled drinking area City wide
     We will promote greater access to primary health care
     Continued joint initiatives to be carried out by the Police and the City Council
     Inter departmental working will be strengthened leading to a more joined up
      City Council response


11.     DAAT co-ordination and integration into the strategy, treatment
        options for homeless substance misusers

11.1    Introduction: The Rough Sleepers Project Manager and the DAAT
        Strategy and Commissioning Manager are clear that their strategies
        must complement one with the other to achieve successful outcomes.
        Hence the views of the DAAT Strategy and Commissioning Manager
        are incorporated into this document. The DAAT will continue to review
        operational services to ensure delivery and drive numbers down whilst
        identifying what needs to be expanded. The DAAT will make known
        requirements and be involved in the overall review of borough wide
        service requirements pre the tendering process in September 2002.


                                                                                20
11.2   Westminster has been in the forefront of providing flexible, accessible
       treatment options for homeless individuals. The Westminster DAAT
       has promoted the use of interagency solutions to a consistent
       population of chaotic substance misusers who, due to the ready
       availability of illicit drugs are able to maintain their habits, obtain access
       to money to support their habit, and find shelter all within a relatively
       small area. While the sale of drugs might appear to be a borough-
       based concern the central London area has proved fertile ground for
       the spread of a highly mobile group of dealers that now covers most of
       the central London boroughs.

11.3   Many of those who are homeless have criminal records (predominantly
       for begging, shoplifting and theft as well as violating bail conditions)
       may have mental health histories and tend to cycle in and out of
       hostels (in – when they need a rest, and out when they wish to use
       drugs) as well as treatment. Effective engagement with this group has
       been a consistent problem.

11.4   What is known about this group: Until recently the problems of this
       group tended to be assumed but little was known about them. Project
       Lilac (a multi-agency, cross-border Targeted Policing Initiative funded
       by the Home Office) was able through registering users at a mobile
       needle exchange van to register individuals as well as begin the
       process of engagement. Project Lilac came into existence after
       community residents became incensed at the problems being created
       in their area due to the presence of discarded needles, anti-social
       behaviour and a perceived lack of response from their local police.
       Camden and Westminster DAAT in partnership with the Metropolitan
       Police developed a project that worked cross-border to deal with the
       substance misuse problem locally.

11.5   Table 1 shows the breakdown of those registered at the van:
                   Table 1: Demographic breakdown of needle exchange clients

       Demographics                        CAMDEN                              WESTMINSTER
                                  Frequency         Percentage         Frequency       Percentage
  Gender     Male                    444               85.2               556             88.0
             Female                   77               14.8                76             12.0
           Total                     521               100.0              632            100.0
Age Groups 15 - 25                    33                7.2               139             22.0
             26 - 35                 288               62.7               307             48.7
             36 - 45                 110               24.0               156             24.7
             45+                      28                6.1                29             4.6
             Total                   459               100.0              631            100.0
 Ethnicity   Asian                    5                 1.0                3              0.5
             Black                    24                4.6                31             4.9
             White                   473               90.8               558             88.3
             Other                    19                3.6                40             6.3
             Total                   521               100.0              632            100.0



                                                                                        21
 Housing    Fixed Address       155             30.2             174             27.7
            NFA                 359             69.8             455             72.3
            Total               514             100.0            629            100.0



11.6   Clearly, the first thing that was noted about the registration was the
       sheer numbers of individuals involved in purchasing drugs in the West
       End of London. It should be noted that these figures represent
       individuals who inject their drugs and does not include a further
       population that potentially smoke their drugs and never inject.

11.7   Over two-thirds are unstably housed, predominantly white and male
       between the ages of 26 and 35 years of age. In short a common
       picture of opiate usage.

11.8   While Table 1 does not show those who are based outside the two
       boroughs, consistently, the proportion of individuals has been 30%
       from Westminster, 30% from Camden, and 40% from surrounding
       boroughs or further afield. Discussions are underway between
       Camden and Westminster to develop and pursue an appropriate
       response to the out of borough problem.

12     Treatment Options

12.1   The provision of needle exchange has been central to Westminster’s
       strategy for working with homeless substance misusers. From a public
       health perspective, needle exchange is an ethical necessity. From a
       treatment perspective it is an effective means of engaging with injecting
       drug users. Central to that engagement are two things:

       a.      registration (to both inform our understanding of the target group
               and to inform service development)
       b.      pathways from engagement into evidence based treatment
               options.

12.2   While needle exchange and a decrease in the rate of discards in the
       Project Lilac area has been achieved, the provision of services from a
       small van is not the most effective approach to take. The priority for
       this service in the coming year is to find a permanent location with
       additional space to provide an adequate and managed service. A
       potential site is under consideration but development will require
       investment.

12.3   The Soho Rapid Access Clinic which received funding from the RSU
       after evaluation had shown that the pilot project funded by Westminster
       had been effective at stabilising substance misuse and decreasing
       offending, it is located in a hostel in the West End. It has a capacity of
       120 clients per year but has consistently exceeded its targets. It was
       gate kept by specialist CAT workers and designated hostel managers
       which has created a managed service that can provide effective follow-


                                                                                22
         up on clients who fail to turn up for appointments as well as a service
         that the clients want. Linked with the specialist unit at the hostel the
         clinic has been successful at engaging and retaining clients.

12.4 Where we have had less success has been in placing individuals for
     detoxification. Westminster had funded in 2001-02 one bed for
     homeless substance misusers at Florence Nightingale. This was not a
     successful initiative for a number of reasons:

        the population tend to be long-term, chaotic, polydrug users and a
          successful move away from a street life will take longer and require
          concentrated service provision
        the move from 4 months of stabilisation to detox is too sharp and people
          drop out
        for polydrug users the relinquishing of all illicit substances at once is an
          unrealistic goal
        the detox unit as currently structured does not allow for the
          management of staged detox for polydrug users

12.5 Westminster DAAT are considering undertaking a pilot in 2002-03 a
     separate small unit for staged detoxification which would allow clients
     to maintain a link with Soho Rapid Access Clinic (being maintained on
     opiates) while receiving a detox for other substances they might use.
     This wing could also provide access to a crisis bed while maintaining
     links with SRAC.

12.6     At the far end of the cycle the provision of housing for those who have
         successfully completed detox and rehab is limited. Stable housing with
         links to possible employment and other support that is not based in an
         area associated with drug use is hard to find. Westminster DAAT is
         currently exploring how the Supporting People framework could assist
         with developing this resource.

12.7     In short, Westminster has been able to demonstrate, through the use of
         its skill base and experience of working with chaotic and unstably
         housed substance misusers, the development of new and efficacious
         services for this population. Currently it has been able to put in place
         through a mix of funding sources a number of pieces of the jigsaw that
         would create a system of service provision for this population. In
         partnership the DAAT, the Rough Sleepers Project, and Supporting
         People Westminster aims to provide co-ordinated and integrated
         provision.


13       Strategic implications involved in reducing the problem of street
         drinking and associated anti-social behaviour

13.1     It is acknowledged that there is an urgent need to review cross
         departmental working within the City Council, to ensure a joined up
         response to all the anti social activity related to street drinking and


                                                                                    23
       drunkenness and begging. The public are looking for a 24hr response
       and are not interested which department an officer works in, nor
       whether a particular service has been contracted out. They need
       assistance to deal with debris left behind by drinkers including vomit
       and urine, empty bottles, cans and other rubbish. The introduction of
       the Community Protection Directorate will address many of these
       issues.

13.2   In view of the Homelessness Directorates review of funding for
       specialist workers in the voluntary sector, Social and Community
       Services need to ensure the vulnerable are targeted via a strengthened
       SMT and that services are matching the needs of users. This would
       include more rapid access to detox and subsequent rehabilitation.

13.3   There should be one point of entry for the public to express their
       concerns and they will be offered a co-ordinated and seamless City
       Council response.

13.4   There is a need to have a day time CAT to concentrate on identifying
       vulnerable substance abusers and ensuring they are referred onto
       appropriate specialist supports including the SMT, for access to detox
       and treatment. There will also be matched police and City Council
       activity concentrating on appropriate enforcement, be that against a
       person or a business.

13.5   A central London Day Services Strategy Group has been established to
       promote good practice and to ensure that the role of Day Centres
       corresponds to both the City Council and the Homelessness
       Directorate’s forward plans. This will entail dovetailing street outreach
       and managing the interface between accommodation and primary
       health needs. It will also address cross border issues with Camden and
       Lambeth.


14     BEGGING

14.1   Size of the problem:
       There is a clear link between drug use, begging, and crime. There are
       also links with drug use and rough sleeping both sporadic and long
       term. Therefore there is no one easy solution. In the West End dealing
       is on an international scale, other areas of Westminster such as
       Victoria has a persistent crack and heroin supply. In order to obtain and
       pay for drugs users frequently beg and commit criminal acts.

14.2   What have we achieved so far including services available: The
       Westminster Substance Misuse Team (SMT) with the support of CAT
       specialist workers and day centre staff has targeted large numbers of
       street users who have successfully completed treatment and
       rehabilitation programs. Specialist services such as Soho Rapid



                                                                                24
       Access to Treatment have also reduced the number of chaotic street
       users.


15     WHAT NEEDS TO BE ACHIEVED

       Cutting off the supply is an obvious need and the police have to be the
       lead agency in this battle. However, the City Council still has an
       important role to play in improving lighting, providing CCTV, designing
       out and clearing away drug debris. Targeting particular begging ‘hot
       spots’ has produced good results, for example, Victoria Street.
       However, unless this effort is sustained City wide then the beggars
       migrate to another part of the City. There needs to be a public
       awareness exercise to inform those that are giving money to beggars
       what use their lose change is being put to. A communications strategy,
       with the slogan a hand up, not a hand out’ is currently being promoted
       by a supporting poster campaign.



16     STRATEGIC IMPLICATIONS

16.1   We need to review both our own and local provision in the light of the
       Directorates spending revue which will be complete in June

16.2   Fast access to treatment must be sustained and continued to be
       facilitated by the SMT with the lead coming from the commissioning
       activity of the DAAT.

16.3   Targeted PTS and ongoing TS should be maintained to prevent those
       who have been successfully treated sliding back into drug abuse during
       times of crisis.

16.4   The arrest and reach out team needs to be strengthened to cover the
       whole of Westminster. This team is able to break into the cycle of short
       term prison sentences and exposure to the drug culture with good
       effect. They offer containment and minimise chaotic behaviour so that
       access to treatment becomes a viable option. Westminster made a
       successful bid for two additional Arrest and Reach Out workers to be
       attached to Safer Streets Police Team based at Belgravia Police
       Station.

16.5   The City Council will work in a more joined up way with clear corporate
       co-ordination. This would lead to firmer partnerships with key agencies
       such as the metropolitan and transport police. The new Community
       protection Directorate will promote this and take an active and strategic
       role.

16.6   There is a need to have clear and understood social care and
       enforcement agendas and that complement each other.



                                                                                25
16.7       With a combined communication strategy and enforcement begging
           could become zero tolerated. This may involve introducing local
           ‘diverted giving schemes’.


           Rapid access to treatment needs to be assured along with
            persistent encouragement for those not yet ready to take this step
           Pathways to treatment need to be clearly understood
           The social care agenda needs to be appropriately supported by
            police enforcement
           The City Council will promote a joined up response promoted by the
            Community Protection Directorate
           Begging will not be tolerated
           The City Council has secured CAD funding for two additional Arrest
            and Reach Out workers to be based at Belgravia police station and
            Substance Misuse outreach for the Passage Day Centre
           The City Council has developed a communications strategy to
            promote all of the above


17         STREET OUTREACH


17.1       It is previously stated that we would like to see more emphasis on
           street outreach from the central day centres. There remains however, a
           need for street outreach that extends across the City taking place
           during anti social hours. Thus ensuring the 24/7 response. We would
           prefer one provider to undertake this role and to work in close
           partnership with the day centres and the police. With weekly
           communications identifying who is on the streets, why, and what plans
           there are to get them in doors.

17.2       Street outreach in whatever form the Homelessness Directorate
           determines needs to be pro active, highly visible, and work in close
           partnership with the Safer Streets Unit. This would involve signing up to
           information sharing protocols. The objective should be to ensure that
           the target of reducing the number of rough sleepers to double figures
           by March 2003 is achieved.

17.3       The current Contact and Assessment Team model has much to
           commend it not least the protection and targeting of vulnerable rough
           sleepers. Whilst the latter should not be changed we would like to see
           additional emphasis on other street users including street drinkers and
           those accommodated but who come onto the streets and increase the
           nuisance level for the business community and residents. They also
           contribute to the high visibility problem that is particularly acute in
           Westminster. This in turn leaves residents feeling Westminster streets
           are not safe and increases their fear of crime.




                                                                                  26
17.4   We would like to see the out reach workers taking a robust assertive
       stance in partnership with the police with all street users including
       rough sleepers who refuse assistance and/or have no connection to
       Westminster. This would involve, diversion, disruption strategies, use of
       the Vagrancy Act, anti social behaviour orders, enforcement of byelaws
       and controlled street drinking.

17.5   Controversially we would like these workers to be identifiable. This
       does not mean that they should wear uniforms but they do need to be
       able to be identified by members of the public to counteract the
       perception that nothing is being done. Clearly there are issues of
       health and safety that will need to be addressed.

17.6   It would be appropriate to resource and locate the 24 hr help line within
       this team but the City Council would wish to have a major role in
       monitoring and evaluating the use made of the line.



          We would welcome the commissioning of an outreach team that
           has a capacity for a 24hr response, 7 days a week and covers the
           whole City.
          The outreach offered would be assertive and respond to all street
           activity, the workers would in the main be attached to strategic day
           centres offering a co-ordinated service to the most vulnerable
           whilst supporting enforcement against those who are not
           vulnerable and who refuse all offers of accommodation and
           assistance
          A robust partnership between the outreach team(s) and the Safer
           Streets Police Unit is essential
          The introduction of a 24hr Help line that is advertised for the
           general public to raise concerns regarding rough sleepers and
           street activity would be welcomed by residents




18     ONE STOP ASSESSMENT


18.1   The City Council will be very interested to monitor the outcome of the
       Camden pilot project involving the provision of a residential
       assessment facility located within existing hostel provision.

18.2   A one stop assessment facility would provide help on the night to those
       new to rough sleeping and facilitate diversion and mediation. It would
       also eliminate the need for ‘rolling shelter’. For these reasons we hope
       to learn from the pilot project and if appropriate consider the
       advantages for Westminster.




                                                                                27
19     SOUP RUNS/HAND OUTS

19.1   Size of the problem: no other local authority has the volume of soup
       runs operating than that faced by the City of Westminster. There are in
       the region of 80 to 100 runs active, in the main faith groups, who are
       convinced that without their individual efforts death by starvation would
       occur on Westminster streets. The runs attract groups of individuals
       who are not homeless but who may be residing in hostels and they also
       sustain the life style of some street users. The City Council would like
       to see street users helped off the streets not assisted to sustain a street
       life style by well intentioned but misguided groups.


19.2   What has been achieved:
       The Salvation Army were commissioned by the RSU to co-ordinate and
       reduce the number of soup and clothing runs. They have had some
       success but the number of runs remains between 80 and a hundred
       though some have reduced the sites visited. Two meetings have been
       convened within City Hall with soup run organisers with limited
       success. One major soup run organised by Thames Reach Bondway
       has stopped and changed to street rescue, targeting the most
       entrenched rough sleepers to encourage them to come in doors and to
       ensure that primary health care is made available to those in most
       need.


19.3   What we need to do now
       Strategy: A video will be produced to demonstrate that soup runs are
       out moded and undermine the work of the Contact and Assessment
       Teams. It will also highlight how vulnerable people are when they first
       leave the streets and how the soup runs can in fact draw people back
       to a life on the streets and do little to assist people to adapt to a new
       life style. Alternative more helpful ways of volunteering to help the
       homeless will be highlighted. A poster campaign with the slogan ‘A
       hand up not a hand out’ is being introduced.

19.4   Westminster will work in partnership with Camden to agree a strategy
       for cross borough co-ordination. We would welcome particular
       emphasis being placed on the Lincoln Inns field site.



          A Communications Strategy is currently running to educate the
           public and gain support in minimising street food and the giving of
           money which together sustain life on the streets
          A video is to be produced that will demonstrate good and bad
           practice amongst soup runs and distinguish fact from myth.




                                                                                   28
20     HEALTH ISSUES

20.1   Health issues amongst the rough sleeping population cluster around:
        Mental Health
        Access to primary health care
        Tailored substance misuse services
        Dual diagnosis or complex needs

20.2   The Vision 21 research has demonstrated the high incidence of self
       reporting of mental health problems suffered by those involved in the
       street culture and it is also recognised that TB is prevalent within the
       street community. The Great Chapel Street Medical Centre and
       Wytham Hall do much to design their service around the needs of
       homeless patients. Workers at Great Chapel Street have confirmed
       that the number of rough sleepers is falling but that those who are
       presenting for assistance now present with multiple needs, a mixture of
       physical, mental health and dependency problems. However, they also
       report that the highest number of new patients presenting fell into three
       categories, drug, alcohol and mental health.

20.3   Although rough sleepers report that they are happy with the above
       services and the out reach offered, it is also the case that a sizeable
       group do not access the services at all for a variety of reasons.
       Therefore access to primary care in a variety of settings is vital. The
       concept of a Mobile Primary Care Service is being developed in some
       areas with the aim of enabling the most hard to reach rough sleepers to
       access primary care and main line services. Given Westminster has
       amongst its population of rough sleepers some who are reluctant to
       access primary care through present available routes a mobile service
       should be considered.

20.4   A Mobile Health Unit did operate between 1987 and 1989 and although
       it ceased because of violent incidents the evaluation was positive. The
       objective was to make contact with those who were not accessing
       services and introduce them to more targeted day centre/medical
       centre model services. Waterloo and Lincoln Inn Field were the main
       sites visited. The mobile surgery bridged the gap for those sleeping
       rough and gave access to formal medical care. Since this initiative
       several targeted nursing outreach sessions have been held but
       success is dependent upon voluntary sector commitment.

20.5   The Westminster Primary Care Trust, Health Support Team consists of
       Community Practitioners (nurses with a health visiting or district nursing
       qualification), community nurses, a welfare advice worker and support
       workers. The key principle of the team is to provide additional health
       support for vulnerable groups with gradual integration into key services.
       In the main their users are asylum seekers and refugees and families in
       temporary accommodation. However, with imagination it would be


                                                                               29
       possible if this team were given an extended brief and resources that
       they could pilot the outreach model. This would involve uniformed
       nurses providing street outreach to hard to engage vulnerable rough
       sleepers who do not access current provision. This service would
       complement the work of Great Chapel Street. Care would need to be
       taken to ensure that the service did not become another means of
       sustaining a street life style.

20.6   Currently negotiations are under way between the Passage, St Martin
       in the Field and West London Day Centres and the Primary Care Trust
       to co-ordinate health care between voluntary sector providers. The
       outcome of these negotiations might strengthen cross borough
       working. These negotiations also strengthen the arguments for
       strategic day centres to be linked into the CHAIN IT system as matter
       of urgency.

20.7   The City Council has developed an action plan in conjunction with the
       PCT to support the Health Improvement Modernisation Plan (HIMP).
       This includes targets around rough sleepers and social inclusion. The
       Health Partnership Group which amongst other things focuses on
       homelessness was initiated by the Housing Department. This group
       brings together agencies from the voluntary and statutory sector who
       have a shared interest in homelessness issues and will be the main
       consultation group for the Homelessness Strategy.

20.8   The existence of the JHT demonstrates that Westminster has long
       accepted that mental health is a key indictor and trigger for
       homelessness. The work of the JHT and SMT is complicated by the
       high incidence of dual diagnosis, that is people with mental health and
       substance misuse problems, both teams experience some difficulties
       meeting multiple need. Often these clients lead chaotic life styles and
       are highly mobile so it difficult for workers to maintain meaningful
       contact. Consideration should be given to integrating the SMT and the
       JHT specialist workers since this might minimise the difficulties that
       both teams face.

20.9   The skill mix of these teams could also be extended so that more
       intensive efforts could be made to engage the hard to reach rough
       sleepers who currently occupy the grey area between failing mental
       health and personality disorder.

20.10 There is an increasing international link to homelessness that involves
      some people with mental health problems travelling from abroad to
      central London and quickly becoming street homeless. This places
      additional burdens on the JHT and adds to the complexity of their task.




                                                                               30
          The high incidence of mental health problems amongst rough
           sleepers is well documented. The JHT has been providing an
           essential link to treatment and support services. The work load of
           this team has surpassed predictions and the team needs to be
           strengthened to meet the level of latent need now made manifest
          It is intended to explore the potential to introduce an additional
           layer of workers who would be skilled enough to work with those
           who have personality and other difficulties but who are not
           currently falling within the legislative framework of provision.
          There is an emerging need to take primary health care onto the
           streets to reach those who are the most difficult to reach and to
           assist them off the streets this proposal will be discussed with
           Westminster PCT




21     THE PARTNERSHIP BETWEEN THE METROPOLITAN POLICE
       SAFER STREETS UNIT AND THE CITY COUNCIL.

21.1   There is a very delicate line between enforcement and social care that
       must be preserved if the City Council is to meet the objective of
       protecting the vulnerable. It is the role of the police to employ
       enforcement and the City Council to provide social care.


21.2   The Safer Streets Unit (SSU) funded by the Homelessness Directorate
       have formed an effective partnership with the City Council and by
       working together much has been achieved. It has been necessary and
       helpful to have police targeted responses but we need to make a step
       change that involves consistent enforcement across the City to prevent
       the hopping from one ‘hot spot’ to another and the criticism that we are
       creating displacement.

21.3   Work is being undertaken to ensure the implementation of a
       Information Sharing Protocol to which all relevant agencies can
       become signatories to ensure health and safety and to facilitate joint
       work.

21.4   Policing in the heart of London poses many conflicting demands
       particularly on resources. It may be worth considering a combined
       civilian team involving Community Support Officers, 500 have recently
       been commissioned for central London, and the City Councils Street
       Wardens service.


21. 5 Westminster and the Safer Streets Team will where possible work
      together to design out the potential for rough sleeping.


                                                                                31
21.6   The over riding police priority is to reduce crime, not to rid Westminster
       of rough sleepers. The police are however also concerned to reduce
       the fear of crime and to engage in policing that improves quality of life.
       Consequently with a dedicated team of officers the SSU, Westminster
       and the voluntary sector are together working to ensure our streets are
       cleaner and safer.


          The Metropolitan SSU has received additional funding from the
           Homelessness Directorate to expand the team and Westminster
           welcomes this.
          We regard the police as an essential partner and this strategy is
           in the main dependent upon their role commitment to
           enforcement. We will consider the introduction of byelaws and
           the extension of the Controlled Drinking Area to ensure they
           have the powers to employ enforcement.
          We will also work together to ensure that there is a balance
           between enforcement and social care and to ensure the
           vulnerable are protected.



22     FINANCIAL IMPLICATIONS and POTENTIAL FUNDING STREAMS

22.1   The Homelessness Directorate have confirmed that the £1m received
       by Westminster to fund additional workers in the JHT and SMT along
       with treatment and placements will be extended post June 2002. Then
       in line with local authorities outside of London Westminster will be
       funded to commission services direct. There will be a tendering
       process for borough wide work commencing in the winter after cross
       borough consultation and agreements on what type of response will be
       needed in April 2003.

22.2   The new Directorate are reviewing the funding for specialist substance
       abuse workers attached to the voluntary agencies - whilst this may be
       based on sound evaluation it does leave the Westminster Substance
       Misuse Team vulnerable. This team, which is very stretched, will have
       to pick up some of the work previously carried out by the specialist
       workers in the voluntary sector. Serious and early consideration should
       be given by the Directorate to increasing the size of this team.

22.3   Westminster would like to see small strategically located ‘wet’ day
       facilities made available for those abusing alcohol and have yet to
       identify appropriate funding streams for this initiative.

22.4   Additional workers for the JHT have also been funded by the RSU and
       will continue until June. The new Directorate has indicted that the work
       of the JHT is valued and the number of extremely vulnerable rough
       sleepers who have been hospitalised and subsequently accommodated
       has surpassed original predictions. The work of this team was


                                                                               32
       underestimated in the original funding bids and it will be necessary to
       maintain the current levels along with Directorates commitment to
       ongoing funding invested in HMII hostels.

22.5   There is a need for a general administrator to assist in the overall co-
       ordination of the City Councils response to rough sleeping and street
       culture and the Homelessness Directorate is to be asked to consider
       funding this along with a further post to co-ordinate street counts and
       analyse the data. The estimated cost would be £35k.

22.6   Outcomes of this strategy will continue to be measured by street counts
       co-ordinated by the City Council. The objective of this strategy is to
       realise a reduction of rough sleepers to double figures by March 2003.
       Reduction in associated street nuisance will be monitored by CST and
       the incidence of street drinking in the Victoria area evaluated by the
       Safer Streets Police Unit.




          There are financial implications arising from this strategy for both
           the City Council and the Homelessness Directorate. An urgent
           debate is required between the agencies to determine priorities
           and available funding.
          In the immediate the need for administrative support is urgent
           particularly with the immediate additional work relating to street
           counts.




23     MANAGEMENT STRUCTURE




23.1   The current management of the Westminster Rough Sleepers Project
       via the Steering Group to be revised to ensure a continued corporate
       and multi agency response. Tight strategic management provided by a
       Chief Officer who would ensure that that this objective is realised and a
       corporate response is provided.

23.2   There remains a need for the Director of Social and Community
       Service to lead corporately due to the vulnerability of the client group.
       However, the Housing Department are now much more involved to
       ensure full integration with the Supporting People initiatives and
       Homelessness strategy.


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23.3   There is a need to maintain effective communication with all the
       providers both statutory and non statutory. Information would then be
       fed both up and down the management structure. This would not veer
       too far from the current Gold (strategic), silver (tactical), and bronze
       (operational) structure but would strengthen the structure.


23.4   The Vision 21 findings make it clear that residents and the business
       community expect the City Council to co-ordinate and manage the
       response to rough sleeping and street activity and the diagram below
       illustrates how this might be achieved whilst ensuring that all strategic
       partnerships are in place and functioning.


23.5   The structure must ensure an effective and meaningful response is
       made toward eradicating the issues caused by street activity that
       causes such offence and distress to residents as well as addressing
       the misery to those trapped in the street culture scene.




                                                                                   34
                                   CHIEF OFFICER
                                    JULIE JONES,
                            Director Social and Community
                                       Services




                          Executive Steering Group
                             Strategic Planning




Hostel and      CAT                  DAAT, SMT,             JHT,        SEM,
Day Centre      Managers             Specialist             Police,     police
Managers                             Providers              Health      CST, LTP
                                                                        Planning
                                                                        Licensing




      Operational Group                 Stakeholders, Residents,
                                        business community, visitors,
                                        users




                                                                        35
                              SUMMARY AND
                            RECOMMENDATIONS

The City Council accepts responsibility for co-ordinating services and
outreach in both the voluntary and statutory sector within Westminster. The
needs and opinions of residents, visitors, the business community and users
themselves must also be responded to. The co-ordination will be provided by
a dedicated Manager, Steering Group, Operational Group and Stakeholders
Forum.


The main proposals contained in this document are that:

   Westminster has a large service provision within the City to meet the
    needs of rough sleepers and we are of the view that these services may
    still be attracting new users. Therefore any new local provision will have to
    be located within existing buildings already providing services to rough
    sleepers and street users.

   Westminster will aim to reduce the current number of rough sleepers to
    double figures by March 2003. Westminster is also committed to
    minimising anti social behaviour including street drinking and begging
    which causes offence and distress and leads to a feeling that streets are
    unsafe and dirty. It is acknowledged that this must be enforcement led by
    the Safer Streets Team.

   An audit of those currently sleeping rough will be undertaken and agreed
    care plans put in place for vulnerable people. Westminster does not accept
    that any one should feel it is their right to sleep out on the streets. This
    audit should be managed in partnership with the Homelessness
    Directorate, and ensure that those people where the Council has a duty of
    care are provided for. This activity will be linked to the introduction of the
    new Community Protection Directorate and demonstrates a shift toward
    enforcement.

   The flow onto Westminster streets should be reduced by seamless 24hr
    assertive outreach and enforcement. This should be provided by CATs
    and the Safer Streets Unit, preferably by one provider who could also
    integrate a 24hr telephone ‘Helpline’ which would provide one point of
    contact. It would include a street ‘rescue vehicle’ that facilitates the
    transfer of users from the streets and day centres into hostel
    accommodation and would be badged to publicise the number. We would
    like to see outreach workers who can be more easily identified by the
    public and street users to counteract the myth that nothing is being done.




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   Attention will be paid to cross border issues to minimise displacement and
    enhance co-ordination. Westminster is committed to working closely with
    colleagues in Camden, Lambeth and the City of London.

   Those assessed as vulnerable will be prioritised for assistance and
    services and will be protected by managing the interface between
    enforcement and social care.

   An integrated and co-ordinated City Council response will be provided with
    dedicated officers from several Departments with overall Chief Officer
    management. Westminster aims to provide a holistic response across the
    City led by the Community Protection Directorate in the longer term.

   A detailed review of the quality and range of hostel provision is required to
    avoid unnecessary exclusions. A review of day centre provision is also
    being undertaken with the aim of ensuring integrated assertive out reach
    whist ensuring that those in most need are targeted.

   Beggars and street drinking schools will not be tolerated. Effective action
    will be taken including a review of the Controlled Drinking Area and further
    Bylaws will be considered. Westminster will work in close partnership with
    the Safer Streets Police Unit to achieve this.

   The current partnerships need to be strengthened and new ones formed in
    response to legislative changes and a reconfiguration of new providers of
    services.

   Information Sharing Protocols need to be agreed by the police, the City
    Council and voluntary agencies. The Homelessness Directorate should
    include an Information Sharing Protocol as part of their Service Level
    Agreements.

   Westminster is looking to commission ‘wet’ day care within existing hostel
    provision in both the North and South of the City. A proposal to integrate
    the specialist workers from the JHT and SMT into one operational team to
    more effectively meet the issues of dual diagnosis and co-work should be
    developed for consultation.

   The Project Manager needs administrative assistance to deal with the
    increasing and extending workload. In particular data collection and future
    street counts which cannot be managed within existing resources.

   The City Council should consider applying for powers provided by Byelaw
    to prevent the laying down of bedding, sleeping and begging City wide.

   There should be an overall objective by all partners to shift from ‘hot
    spotting’ to a more sustained and integrative approach.




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