Pictured from left: Ellie Atkins - Leader in Adult Social Care and Homelessness, Sarah McClinton - Chief Social Worker and Jess Harris - Research Fellow, King's College London at a national peer network for social workers in homelessness last November. Introduction by Robert Lewis
A National Plan to End Homelessness (Ministry of Housing, Communities and Local Government, 2025) provided a welcome focus on the need to work across government departments to help improve outcomes for those people experiencing long-term homelessness and multiple disadvantage. Rough sleeping is one of the most visible signs of hardship and exclusion in our communities. It is an issue that goes beyond the theoretically simple notion that the provision of a roof, a front door, and a key, will resolve the challenges faced by those affected. Addressing the impacts of multiple disadvantage for those who are street homeless requires us to ensure that those affected have access to the same level of presentations, social care supports, and safeguarding consideration, that all our citizens should expect and deserve.
Drawing on her knowledge, experience, and passion for the subject, this blog from Ellie Atkins invites us to engage with these issues in a more meaningful and informed way. Ellie encourages us to broaden our thinking in relation to street homeless and advocates for social work to pick up the mantle and play a key role in addressing the challenge.
Hidden in Plain Sight - Reframing Adult Social Care Responsibilities in Long-term Rough Sleeping blog by Ellie AtkinsAcross England, responses to rough sleeping have largely been shaped through housing systems. Over the past decade, investment in outreach, emergency accommodation and housing-led initiatives has made a visible difference. Yet frontline practice continues to show that, for many people experiencing long-term rough sleeping, housing alone is not enough.
Beneath the surface is a group of people whose needs extend far beyond accommodation. Their experiences may include trauma, poor physical and mental health, substance dependency and, less visibly, cognitive impairments or difficulties with executive functioning. These factors can affect a person’s ability to engage with services or sustain a tenancy, yet they are not always central to homelessness responses.
This raises an important question: are current approaches capturing the full picture?
Beyond housing: a wider care contextIn practice, long-term rough sleeping often sits as much within adult social care and safeguarding as it does within housing. Many people who remain in street homelessness over extended periods have unmet care and support needs that fall within local authority responsibilities.
However, adult social care involvement has historically been variable. People whose needs span housing, health and care can move between services without coordinated support that reflects the complexity of their circumstances.
This is not simply a matter of service delivery; it reflects how systems are organised. Responses are often structured around single areas of need, while individuals’ experiences rarely fit neatly into one category.
Learning from practice in ManchesterFrontline work in Manchester provides a useful lens. A specialist social work team has worked with people who have remained outside traditional housing and support pathways for extended periods.
A consistent pattern of overlapping need emerges. Many people have experienced trauma, including childhood adversity, institutional care, domestic abuse or exploitation, alongside mental health challenges, substance use and serious physical health conditions.
Many also experience cognitive impairments, including acquired brain injury or differences in executive functioning. These may affect memory, decision-making, emotional regulation and the ability to organise or follow through on tasks.
From a social care perspective, some appear to meet thresholds for care and support, including difficulties with personal safety, managing health needs or navigating services. Others face heightened vulnerability to exploitation or self-neglect, raising safeguarding considerations.
Despite this, these needs are not always formally assessed or addressed within adult social care frameworks.
The hidden barrier: executive functioningOne less visible challenge is executive functioning: the cognitive processes that help people plan, organise, regulate emotions and take action.
Many homelessness systems assume people can attend appointments, complete administrative steps and maintain consistent engagement. For those with executive functioning difficulties, these expectations may be difficult to meet without additional support.
Responses can then focus on “non-engagement” rather than the barriers beneath it. This may contribute to repeated cycles through temporary accommodation, emergency provision and rough sleeping without needs being fully understood.
Reframing the role of social workThese challenges highlight an important role for adult social work within homelessness responses.
Social work brings statutory responsibilities together with relationship-based practice. Through Care Act duties, practitioners can assess care and support needs, while safeguarding frameworks provide a structure for responding to risk, including exploitation and self-neglect.
Relationship-based approaches are especially relevant for people who have experienced repeated exclusion from services. Building trust over time can support a fuller understanding of their circumstances, including how trauma, cognitive differences and environmental factors shape behaviour and decision-making.
From this perspective, patterns of disengagement may be understood not simply as choice, but as possible indicators of unmet need.
Closing the system gapIf long-term rough sleeping is understood primarily as a housing issue, responses may remain limited for those with more complex needs. A more integrated approach - bringing together housing, health and adult social care - could support more coordinated responses.
This does not reduce the importance of stable accommodation. Rather, where care and support needs are present, addressing these alongside housing may improve the likelihood of longer-term stability.
This shift could be supported through:
Greater clarity in policy and guidance around the role of adult social care within homelessness responses Development of specialist social work roles focused on multiple exclusion homelessness Increased recognition of executive functioning and hidden disabilities within assessment processes Stronger links with safeguarding frameworks to support responses to risk and vulnerability Opportunities for cross-sector learning, bringing together housing, health and social care professionals A broader understandingLong-term rough sleeping is rarely the result of a single factor. It often reflects housing exclusion, trauma, health challenges and unmet care needs.
Where responses focus on one aspect in isolation, people can continue to move between systems without sustained change.
Broadening the lens to include adult social care alongside housing may support a more complete understanding of need and create opportunities for more coordinated support.
For some people, this may make the difference between repeated cycles of homelessness and the possibility of greater stability.
seen at 14:37, 20 July in Social work with adults.