DD2193 Homeless Health Peer Advocacy Project

Type of decision: 
Director's decision
Date signed: 
19 January 2018
Decision by: 
David Lunts, Executive Director Housing and Land and Interim CEO of OPDC

Executive summary

Approval is sought to award grant-funding of £135,000 over three years (to 31 March 2020) to Groundswell, to part fund its Homeless Health Peer Advocacy (HHPA) project. The funding will support health promotion activities to rough sleepers, provide peer mentors to ensure that rough sleepers attend medical appointments and help peer mentors enter into paid work. It will also enable Groundswell to extend the project into new areas of the capital. 



That the Executive Director of Housing and Land approves the award of £135,000 of grant funding for 2017-20 to Groundswell for its Homeless Health Peer Advocacy project.


Part 1: Non-confidential facts and advice

Introduction and background

1.1    The Mayor has committed to tackling homelessness and, in particular, noted that the rise in rough sleeping over recent years is a growing source of shame that we have a “moral imperative” to stop. In his draft London Housing Strategy, he pledges to support rough sleepers off the streets as quickly and sustainably as possible, with the key aim of ensuring a route off the streets for every single rough sleeper in London. 
1.2    The Mayor funds and commissions a range of pan-London rough sleeping services and other initiatives. These are services for rough sleepers, or initiatives to tackle rough sleeping, that cannot or would not be provided at a London borough level, as they are pan-London or multi-borough in their remit. A budget of £33.8 million for these services was approved (through MD1532) for the period 1 April 2016 to 31 March 2020. 
1.3    The shape and nature of these services and initiatives are underpinned by the pan-London Rough Sleeping Commissioning Framework. This includes a priority ‘to work with boroughs and partners to meet the physical and mental health needs of rough sleepers’. The Homeless Health Peer Advocacy (HHPA) project assists in meeting this priority by using peer mentors to ensure that rough sleepers attend medical appointments and sustain health treatment and by providing health promotion activities to rough sleepers. In addition, the Healthy London Partnership Homelessness Programme’s commissioning guidance for Clinical Commissioning Groups (CCGs) , published at the end of last year, recommends that London CCGs should commission peer support to help homeless people access healthcare and identifies HHPA as a model of good practice. 

1.4    The GLA has grant-funded Groundswell to provide this unique project since 2012, in which time it has won the Andy Ludlow Homelessness Award in 2014  and the GSK Impact Award in 2016 . The HHPA has enabled rough sleepers to attend 1,662 health appointments and 4,500 people have attended the health promotion in-reach sessions in this time. This funding has enabled the service to be rolled out across London. During this time Groundswell has levered in a total of £1.7 million of match funding as result of GLA investment. By the end of 2016/17, the project was funded by and operational in three London boroughs (Hackney, Wandsworth and Hounslow) and five CCGs (covering Westminster, Hammersmith and Fulham, Kensington and Chelsea, Tower Hamlets and Camden). During 2016/17, the GLA contributed £50,000 of grant funding and the boroughs/CCGs £461,000. The GLA’s share of funding towards the project fell from ten per cent to 8.5 per cent during the year, as Groundswell levered in funding from additional organisations.

1.5    With the support needs of those on the streets remaining at a high level (with 77 per cent of those on streets having an alcohol, drug and/or mental health need), there is a strong case for ongoing GLA investment to enable roll out of the project across the capital to continue. A further three years’ of GLA grant-funding would enable Groundswell to expand into another six London boroughs, resulting in the project working in a total of 14 boroughs across London. In 2017/18, it is envisaged that the London Boroughs of Greenwich and Southwark would join the project, as would Lambeth CCG and Guys and St Thomas’s Charity. 
1.6    It had, until recently, been expected that seed funding from 2017/18 onwards for this expansion would be available from the London Homeless Health Partnership (LHHP), but contrary to expectations the LHHP does not have any budget for this purpose. 

Objectives and expected outcomes

2.1    Last year, Groundswell exceeded the targets set out in their grant funding agreement with the GLA. It is therefore proposed that even more stretching targets are set for the next three years. These higher targets mean that the cost to the GLA per engagement would reduce from £70 to £14, resulting in improved value for money.


Project/service to be funded


Expected outcomes



Homeless Health Peer Advocacy Project

Annual grant agreements for 2012-16, approved through DD667, DD1047, DD1149 and ADD375 were issued to the provider. An additional 3 years of funding would enable the project to be expanded to additional areas of the capital. Proposed GLA funding: £135,000 for 2017-20 to Groundswell for the Homeless Health Peer Advocacy project (£50,000 in 2017/18, £45,000 in 2018/19 and £40,000 in 2019/20).               


To meet the physical and

mental health needs of rough

sleepers, in line with priority 8

of the pan-London Rough

Sleeping Commissioning



To carry out a minimum of 7500 1:1 engagements


To provide 2500 health promotional activities 


To expansion into 6 local authorities


To support 45 peers to enter paid work



Equality comments

3.1    Under section 149 of the Equality Act 2010, as public authorities, the Mayor and GLA are subject to a public sector equality duty and must have ‘due regard’ to the need to (i) eliminate unlawful discrimination, harassment and victimisation; (ii) advance equality of opportunity between people who share a relevant protected characteristic and those who do not; and (iii) foster good relations between people who share a relevant protected characteristic and those who do not. Protected characteristics under section 149 of the Equality Act are age, disability, gender re-assignment, pregnancy and maternity, race, religion or belief, sex, sexual orientation, and marriage or civil partnership status (all except the last being “relevant” protected characteristics).

3.2    Of those seen rough sleeping in 2016/17:
•    53 per cent were non-UK nationals 
•    47 per cent had a mental health need
•    15 per cent were women
•    most of those seen rough sleeping (56 per cent) were in the 26-45 age group
•    nine per cent were under 26 years old
•    11 per cent were over 55
•    four people were under 18.

3.3    As rough sleepers are over-represented among those with the protected characteristics of race and disability, the proposals in this paper are likely to have positive impacts on these groups.

Other considerations

a) Key risks and issues


Risk description



Mitigating action


Rough sleepers refuse to engage with Homeless Health Peer Advocacy project


The experience of the project to date is that rough sleepers are willing to engage, primarily because of the innovative use of former rough sleepers as peer advocates. However, if there is refusal of engagement, Groundswell have previously worked creatively in their other services to incentivise take up of their services and develop more engaging promotional material.

Not being able to expand in other boroughs. 


Groundswell have been in early discussions with Lambeth, Greenwich, Southwark, Guys and St Thomas’s Charity and will endeavour to roll out the HHPA project into new areas. They have had confirmation from Greenwich and are in talks with the other boroughs above.

b) Links to Mayoral strategies and priorities

The objectives of the proposals are in line with the pan-London Rough Sleeping Commissioning Framework priority 8, as well as the Mayor’s draft London Housing Strategy which includes a commitment to ‘fund and commission a range of pan-London services and other initiatives. These will focus on identifying rough sleepers and intervening rapidly to support them off the streets, providing specialist support for particular groups, and helping rough sleepers stay off the streets.’.

c) Impact assessments and consultations

The pan-Rough Sleeping Commissioning Framework was made available for consultation with key stakeholders and partners and was subject to a full equalities impact assessment. The draft London Housing Strategy has been subject to a full-integrated impact assessment and statutory consultation with the public was recently undertaken.


Financial comments

5.1    This decisions requests approval to expend £135,000 towards the provision of Homeless Health Peer Advocacy (HHPA) project. The project will be delivered by Groundswell and will run for a period of three financial years (2017/18 to 2019/20).

5.2    The expenditure will be funded from the Rough Sleeping budget (MD1532), which has been allocated a four-year indicative budget of up-to £33.8m (£8.450m per/year) and have been profiled to be spent as follows:








  1. The confirmation of the future years funding is subject to the finalization and sign-off by the Mayor.


  1. This project has been funded by the GLA since 2012 (see table below), in which time its share of funding towards the project fell from ten per cent to 8.5 per cent (in 2016), with Groundswell securing the additional funds from the boroughs/CCGs.




Amount (£)

















Planned delivery approach and next steps

7.1    The GLA will continue to monitor the service on a quarterly basis to assess performance against targets. The performance of the service will be reported to the quarterly internal Rough Sleeping Internal Governance Group convened by the Deputy Mayor for Housing and Residential Development. 


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