Systems of Care: Homelessness Prevention and Community-Based Support in the United Kingdom and Northern Ireland

By Ahmed Odefunso

ABSTRACT

This article offers a systems-oriented analysis of homelessness services and community-based care in the United Kingdom, drawing jurisdictional distinctions between England and Northern Ireland. It synthesises evaluation evidence on the Housing First model, national and devolved strategy, and clinical guidance on integrated health and social care. The analysis treats prevention, housing, health, social care, voluntary and community organisations, and lived-experience participation as interacting components of a single system rather than as discrete programmes. It finds consistent evidence that Housing First improves housing stability and several measures of wellbeing, alongside persistent structural constraints—housing supply, fragmented funding, and difficulties integrating clinical services. Claims are bounded by the cited evaluations and guidance.

INTRODUCTION Homelessness is increasingly framed as a public-health issue requiring coordination across housing, health, social care, and criminal justice. The NICE guideline on integrated health and social care for people experiencing homelessness notes that the average age of death for this population is approximately thirty years lower than that of the general population, and argues that integrated care is both a moral and an economic imperative given the high public-sector costs of fragmented service use [1]. This article adopts a systems lens, examining how prevention, settled housing, and wraparound support interact, and attending carefully to the different statutory arrangements in England and Northern Ireland.

BACKGROUND AND LITERATURE REVIEW

The Housing First model Housing First is a housing-led intervention providing immediate access to independent, settled housing without preconditions regarding “housing readiness” or treatment participation [2, 5]. It separates housing from support and offers personalised, flexible, non-time-limited assistance for people with multiple and complex needs, including co-occurring mental-health and substance-use issues [2, 5]. Support is typically delivered through Intensive Case Management or Assertive Community Treatment [5]. Longitudinal analysis within such programmes describes a “cascade of events,” in which stable housing enables improved illness management, social connectedness, and quality of life [5].

English evaluation evidence The English Housing First pilots in Greater Manchester, Liverpool City Region, and the West Midlands were funded to test the model at scale between 2018 and 2023 [2]. By December 2022, over 1,300 individuals had received support and 1,061 had been provided with housing [2]. Twelve months after entry, 92 per cent of clients were residing in long-term accommodation, up from 84 per cent at six months [2]. GP registration rose from 60 per cent to 92 per cent [2]. Reported anxiety fell from 81 per cent to 71 per cent and depression from 80 per cent to 68 per cent [2]. The proportion reporting they “often or always” felt lonely halved from 35 per cent to 16 per cent, and involvement in antisocial behaviour fell from 34 per cent to 15 per cent [2]. Crack cocaine use fell from 37 per cent to 20 per cent, though there was no statistically significant reduction in overall substance dependency [2].

A cost-benefit analysis published in October 2024 found the programme offered good value for money [2]. Average support cost was £7,737 per person per year; expected annual benefits per person were estimated at £15,880, derived from improved personal wellbeing and reduced public-service costs [2]. The expected benefit-cost ratio was 2.1 based on long-term benefits and 1.1 based on twelve-month outcomes, indicating that even early benefits cover delivery costs [2]. Longer-term data indicate that 55 per cent of residents experienced improved mental health and 39 per cent improved physical health over three years [2]. Peer-reviewed meta-analytic evidence reports incidence rate ratios of 0.63 for emergency department visits and 0.76 for hospitalisations among Housing First cohorts, and finds no clear evidence that the model increases problematic substance use [5].

Clinical and prevention guidance The NICE guideline NG214, published on 16 March 2022, recommends person-centred, non-judgemental, trauma-informed services for people aged sixteen and over experiencing homelessness, including rough sleeping, temporary accommodation, and “sofa surfing” [1]. It recommends specialist homelessness multidisciplinary teams acting as expert hubs, “homelessness leads” within mainstream services where populations are smaller, and the involvement of “experts by experience” in design, delivery, and evaluation [1]. It addresses transitions such as hospital discharge and the registration of people without a permanent address with a GP [1]. Broader prevention literature emphasises intensive case management and Critical Time Intervention during high-risk transitions, and notes the “duty to refer” introduced by the Homelessness Reduction Act 2017 [4].

ANALYSIS AND DISCUSSION

A systems view Treating these elements as a system clarifies why individual interventions succeed or stall. Housing First demonstrably improves housing stability and several wellbeing measures, but its effectiveness is “intrinsically linked” to integration with broader public services [3]. Successful implementation often relies on co-commissioning between NHS Integrated Care Boards and local authorities [3]. Yet integration with mainstream mental-health and drug and alcohol services remains difficult, and the pilots highlighted a need for “systems change” to improve access for dually diagnosed clients [3]. The system's weakest links—supply and funding—constrain its strongest components.

Jurisdictional distinctions: England In England, national strategy as published in December 2025 prioritises ending homelessness by breaking cycles of crisis, moving from short-term, fragmented funding toward multi-year settlements, and introducing targets for preventing homelessness among people leaving public institutions such as prison, hospital, and care [2]. The Supported Housing (Regulatory Oversight) Act 2023 aims to improve standards in exempt supported accommodation [2]. Reported challenges include the high cost of temporary accommodation, the shortage of affordable one-bedroom and accessible homes, and the “cliff-edge” effect of short-term funding cycles [2, 3].

Jurisdictional distinctions: Northern Ireland In Northern Ireland, the Northern Ireland Housing Executive holds statutory responsibility, a mandate under the Housing (Amendment) Act (Northern Ireland) 2010, which requires a homelessness strategy at least every five years [3]. The current “Ending Homelessness Together” strategy, introduced on 23 March 2022 and running to 2027, aims to make homelessness “rare, brief and non-recurring” through three cross-cutting objectives: prioritising prevention, providing settled accommodation and support, and supporting transitions into settled housing [3]. It is delivered through annual action plans and progress reports, and sits alongside a Youth Homelessness Action Plan launched in November 2024 and a Domestic Abuse Action Plan published in December 2024 [3].

Housing First has operated in Northern Ireland since 2014, delivered primarily by Depaul and the Simon Community NI [3]. A feasibility study published in October 2024 recommended a four-year expansion of 220 additional units, estimating approximately 250 individuals experiencing chronic homelessness, with 150–200 in Belfast [3]. It identified two delivery paths: continued commissioning through the Supporting People budget, or integration into the broader “Complex Lives” model, and stressed fidelity to Housing First principles including tenant rights and choice [3].

However, official scrutiny has raised concerns. Audit reporting indicates expenditure on temporary accommodation reached £40 million by 2024–25, with a rising portion spent on hotels and bed-and-breakfast facilities, prompting calls to purchase 600 dedicated temporary-accommodation units [3]. The Executive typically spends less than 10 per cent of its homelessness budget on prevention, despite prevention being a primary objective, with calls for a statutory duty to prevent homelessness [3]. Governance has been described as “cluttered” and “confused,” and the social-housing waiting list with homeless status had grown to nearly 32,000 as of March 2025 [3].

Lived experience and the voluntary sector Across both jurisdictions, the evidence converges on co-production. NICE recommends involving experts by experience throughout the service cycle, and prevention literature identifies lived-experience involvement as vital for engaging harder-to-reach groups [1, 4]. The English pilots found “values-based” recruitment, often including people with lived experience, highly successful [2]. Voluntary and community organisations are integral: Northern Ireland's strategy relies on partnerships via Central Homelessness Forums and Local Area Groups, and English delivery depends on community partnerships involving social landlords, mental-health services, and peer-mentoring groups [3, 5].

Several cautions follow for anyone interpreting this evidence. The English evaluation figures describe pilot cohorts supported by dedicated funding and trained staff, and results may not transfer automatically to services operating under different funding or housing-market conditions. Likewise, the Northern Ireland material combines strategic documents, feasibility work and audit commentary of differing purposes; these are best read as complementary perspectives rather than as a single evaluation. The comparison between jurisdictions is therefore illustrative of structural differences, not a ranking of performance.

For practitioners in the voluntary and community sector, the systems perspective suggests a practical question: where does a given service sit within the wider pathway, and what depends on it? A hostel, a floating-support team or a peer-mentoring group is rarely effective in isolation. Its contribution is shaped by the availability of move-on accommodation upstream, by the responsiveness of health services alongside it, and by the stability of the funding that sustains it. Recognising these dependencies helps organisations to argue for investment where the system is weakest, rather than only where their own service is most visible.

CONCLUSION A systems view reconciles apparently conflicting findings. Housing First is strongly supported for housing stability and offers good value for money, yet its benefits are constrained by supply shortages, fragmented funding, and difficult integration with clinical services. The jurisdictional picture differs: England emphasises multi-year settlements and institutional-discharge targets, while Northern Ireland faces governance fragmentation and under-funded prevention despite a clear strategic vision. The consistent lesson is that prevention, settled housing, integrated health and social care, voluntary-sector partnership, and lived-experience participation must be strengthened together; weakening any one element limits the whole.

REFERENCES [1] National Institute for Health and Care Excellence. NG214: Integrated health and social care for people experiencing homelessness. https://www.nice.org.uk/guidance/ng214 [2] UK Government. Evaluation of the Housing First pilots. https://www.gov.uk/government/publications/housing-first-pilot-national-evaluation-reports [3] Northern Ireland Housing Executive. Ending Homelessness Together 2022–2027. https://www.nihe.gov.uk/housing-help/homelessness [4] UK Government. Homelessness Reduction Act 2017 guidance. https://www.legislation.gov.uk/ukpga/2017/13/contents [5] UK Government. Housing First pilots: implementation and process evaluation. https://www.gov.uk/government/publications/housing-first-pilot-national-evaluation-reports