Dear Miss Hamilton-Deeley Re: The late Mr Joseph Mochan Tha,nk you for your report, received on 30 March 2020, regarding the Record of Inquest for Mr Mochan. Firstly, we would like to express our sincere condolences to the family of Mr Mochan. Your report requested us to consider the following provisions to prevent further deaths;
1. A safe night shelter, open to all every night of the year, which would be able to accommodate 50 to 200 people each night. This should not be available on a first come first served basis, and should provide proper associated hygiene facilities, food, warmth and communal areas. 2 . A Homeless Healthcare Hub, which contains all the necessary services under one roof. This would be not unlike the (though it would be more sophisticated than) the University of Sussex Healthcare Hub. The report acknowledged it would not be possible for these to be provided overnight and requested that a discussion with all stakeholders begins. Your report has prompted the CCG and the Local Authority to come together to consider the findings. Brighton & Hove City Council (BHCC) is responsible for providing the night shelter and homelessness services, and has therefore considered a response to point 1 above. Brighton & Hove Clinical Commissioning Group (B&H CCG) is responsible for providing healthcare provision to the street homeless population and commission the Arch Healthcare Hub, and has therefore considered a response to point 2 above.

Brighton & Hove NHS Commissioners City Council
1. Night Shelter BHCC aims to ensure that no one has to sleep rough in the city and that its rough sleepers are kept safe during in the winter months. BHCC currently commissions a range of accommodation provision for rough sleepers and single homeless people offering both short term (hub) and longer-term accommodation options. The vast majority of this provision operates year round, and includes;
• Supported accommodation for adults and young people.
• Somewhere Safe to Stay - offering short term accommodation to those at high risk of rough sleeping while a solution to their homelessness is found. (Funded by MHCLG)
• No Second Night Out Hub - offering short term accommodation to those new to the street or new to rough sleeping while a solution to their homelessness is found. (Part funded by MHCLG).
• 365 Nightshelter - offering 15 beds in shelter type accommodation to rough sleepers. (Funded for 2 years from November 2019) In addition to the above where a rough sleeper or single homeless person meets the thresholds for a statutory duty, they may be offered accommodation in emergency provision (bed and breakfast) whilst the duty to them is explored. BHCC funds or facilitates the funding of 732 bed spaces in the city for single homeless people and rough sleepers as follows:
• 504 units of supported accommodation for adults
• 143 units of young peoples supported accommodation
• 60 units of mental health supported accommodation
• 54 short term shelter type accommodation spaces
• 22 Housing First units with an additional 20 units due to be brought online in 2020 - 2021 A further 29 supported accommodation units opened between January & March 2020 In addition, during the winter period there is a direct access Severe Weather Emergency protocol shelter, which is open when the temperature is predicted to be 'feels like' zero or below or there is an amber weather warning. The current provision ensures that, during the poorest weather, there are sufficient bed spaces to mean no one should have to sleep rough in the city. In January 2020 a report was prepared which considered the provision of a year round night shelter for all rough sleepers. This identified a number of risks and barriers, including resources (financial and workforce needed), the lack of an available suitable building, and the impact on the wider community. An important

Brighton & Hove NHS Commissioners City Council consideration was the evidence base that this model will have a positive impact on the outcomes of rough sleepers. Evidence of the impact of Night shelters on rough sleepers is currently very limited. The data provided by Homeless Impact concludes that Nightshelter provision does not have a positive outcome on health or substance misuse outcomes for rough sleepers. Anecdotal feedback about Nightshelter provision in Brighton shows that many of the most vulnerable rough sleepers choose not to access the provision available. Many rough sleepers do not feel comfortable in large shared sleeping environments and many of those who are most vulnerable such as women and those with mental health needs will not access even the safest and highly staffed service. Brighton & Hove City Council is, however, exploring models of shelter provision being provided in other areas of the UK and is looking at evidence based practice to design services which gives rough sleepers the best opportunity to recover from homelessness. This includes the expansion of Housing First a model of support with a strong evidence base of positive outcomes for rough sleepers. At present, there is no identified budget or building for the provision of a Nightshelter for all rough sleepers.
2. Homeless Healthcare Hub B&H CCG is committed to ensure that the patient population (in particular those that are the most vulnerable) receive the right care, at the right time, in the right place. The city continues to see high numbers of rough sleepers despite existing provision and strong links between health and social care to provide an integrated support offer. BHCCG and BHCC jointly commission a range of services aimed at reducing health inequalities and achieving positive outcomes that empower individuals to recover from homelessness and end the need to sleep rough. The CCG commissions a successful and integrated service model through Arch Health, who provide integrated healthcare to homeless people in Brighton & Hove. In February 2017, Arch took over the Integrated Homeless Healthcare Hub contract, which includes a GP surgery, hospital in-reach services, community health engagement, outreach to day centres and citywide leadership. The GP surgery has around 1,400 registered patients, with the organisation employing 2.3 FTE GPs. The organisation adopts a very broad view of health and wellbeing in order to promote 'inclusion health' amongst the city's most deprived and vulnerable population. Therefore, works very closely with BHCC and the Voluntary and Community Sector to ensure that a streamlined service is available to meet the holistic needs of all homeless people. In 2019, Arch Care received an 'outstanding' rating from the Quality Commission (CQC) and continues to aim high with an ambition to become renowned for its

j :'..':. r"'-' Sussex Brighton &Hove T '' NHS Commissioners City Council expertise on the design and delivery of integrated care, research, training and innovation in homeless healthcare. Homeless Healthcare services in the city are recognised as an exemplar model by NHS England/Improvement with the potential to be replicated across the country. The CCG acknowledges the need to develop a homeless healthcare hub with all necessary services under one roof. We believe the current commissioned service could be enhanced to develop a more integrated service with the Local Authority. A Feasibility Report has been commissioned to develop a strategic definition and preparation of this brief on behalf of Arch Health CIC for the development of a new healthcare facility for homeless and disadvantaged people in Brighton. The Feasibility Report will consider options to further the integration of services, and acquire the necessary estate/space to expend the clinical offer and house various services under one roof. The proposals include access for homeless people of the following services:
• Homeless mental health services (SPFT)
• Integrated primary care team (SCFT)
• Substance Misuse Services
• Health engagement team (Justlife)
• In addition, hosting visiting services such as Dentists, Dermatology, Hepatitis C specialist support, Benefits Support and Midwives, amongst others. The Feasibility Report was concluded in February 2020. Subsequently, the CCG has had to focus on the response to the Covid-19 crisis. As we enter the recovery period following the initial phase of Covid response, we will be reviewing the feasibility · report to include learning from the Covid response in relation to supporting the needs of the homeless population in Brighton and Hove. I hope this information provides the assurance that the CCG and Local Authority have acted on the directions within the report and we would be happy to provide further information on request.