Securing £754,000 for a new homeless health service and national policy recognition for co-occurring conditions across London
| Outcomes at a glance |
|---|
| • Co-occurring conditions explicitly referenced in the 2025 national Delivery Framework, following the programme’s role in co-producing it through the national expert reference group |
| • £754,000 recurrent funding secured to establish a new Homeless Health Outreach Service, which opened in September 2025 and has supported over 100 people |
| • Programme secured a further three years of funding for 2026–29, with a refreshed operating model aligned to a more place-based, public health-led approach |
| • A new expedited autism assessment process for people rough sleeping is now being piloted and evaluated in Newham, alongside mutual learning sessions between autism and homelessness services |
The challenge
People experiencing homelessness frequently face co-occurring mental health conditions, substance use issues, and complex health needs. Between 2022 and 2023, 71% of people starting drug and alcohol treatment also had a mental health treatment need. Approximately 30 to 50% of people with serious mental illness have co-existing drug or alcohol conditions, associated with poor health and social care outcomes. 45% of people in contact with mental health services in England who died by suicide between 2010 and 2020 had a problem with alcohol use, and 35% had a problem with drug use. Dame Carol Black’s Independent Review of Drugs concluded that trauma and mental ill-health are drivers of and are associated with drug and alcohol dependence, meaning these are co-morbidities, not separate problems to be addressed independently.
The challenge is compounded in custodial settings. Research consistently shows that 70% of prisoners meet the criteria for two or more diagnoses. Poor mental health and other vulnerabilities are exceptionally common within the prison population, and continuity of care from prison to the community remains difficult.
Guidance exists. The 2025 Co-Occurring Mental Health and Substance Use Delivery Framework, NICE guidance, and Public Health England recommendations all set out what good looks like. To date, effective implementation across the system has not followed. Many people continue to experience services as inconsistent, inaccessible, and fragmented, with different services treating mental health, substance use, and homelessness as separate problems rather than interconnected ones.
For those in this position, the gap between where they are and where the system expects them to be is not a personal failing. It is a system design problem. The London Co-occurring Conditions Programme exists to address it by ensuring there is no ‘wrong door’ to support and treatment for people experiencing homelessness alongside co-occurring substance use and mental health issues.
Our approach
TPHC manages the London Co-occurring Conditions Programme, operating as the coordinating and facilitative resource at the centre of a complex, multi-stakeholder pan-London system. The programme works at both strategic and operational levels, bringing together OHID London, DHSC, the GLA, London Councils, ICBs, NHS providers, and voluntary sector organisations to drive improvements that no single organisation could deliver alone.
At the national level, the programme participated in the national co-produced expert reference group that developed the 2025 Co-occurring Mental Health and Substance Use Delivery Framework, advocating for the specific needs of people experiencing homelessness to be reflected in national policy. The programme was also a key partner in the NHS England-coordinated London Co-occurring Conditions Task and Finish Group, which co-produced a set of London principles, a consensus statement, and a quality checklist for system leaders.
At the local level, the programme facilitated the cross-system development work needed to establish new services and pathways where gaps were identified. In North Central London, we worked with partners to drive forward the planning, commissioning, and establishment of a new mental health outreach service for people experiencing homelessness. In North East London, we brought together statutory autism services, people with lived experience, and homelessness partners to design and evaluate a new approach to autism assessment for people rough sleeping. Mutual learning sessions between the Newham autism service and local homelessness services have already improved workforce capability in both directions, with the autism team building the homelessness workforce’s understanding of autism needs, and vice versa.
The impact
The programme’s influence is visible at both national and local levels, though all outcomes reflect collaborative work across multiple partners rather than any single organisation’s efforts.
Nationally, co-occurring conditions is now firmly on the agenda. The 2025 Co-occurring Mental Health and Substance Use Delivery Framework explicitly references that people experiencing homelessness are disproportionately affected by co-occurring conditions. The programme advocated for this inclusion as part of the national expert reference group. The Mayor’s Rough Sleeping Plan of Action has recognised Co-Occurring Conditions as a key strategic priority, and the programme will be working in partnership with the GLA on this going forward.
In North Central London, the programme was instrumental in driving the development of the new Homeless Health Outreach Service (HHOS). £754,000 in recurrent funding was secured via North London NHS Foundation Trust to establish the service, which opened in September 2025. It has already supported over 100 people who would otherwise have struggled to access mental health assessment and support.
The difference this makes in practice is visible in individual cases. During a Severe Weather Emergency Protocol period, two people rough sleeping in an NCL borough faced a return to the street after being assessed as not in ‘priority need’ for housing. Nurse-led assessments from the HHOS formally documented ongoing psychosis in both cases, providing the clinical evidence the housing system needed to recognise priority need and continue their accommodation. Without the service, that evidence would not have existed, and those two people would have been back on the street.
In Newham, an expedited assessment process for autistic people rough sleeping is now being piloted and evaluated. The programme identified a gap in provision, brought the right partners together, and supported the design of a test-and-learn approach. In North West London, a review of drug and alcohol related deaths identified a disproportionate incidence of traumatic brain injury, and the programme is now supporting a scoping assessment and gap analysis of existing pathways and services on behalf of the ICB.
Funded since June 2022, the programme has secured a further three years of funding for 2026-29. The changes to ICB structures have prompted a review of the programme’s London operating model, moving towards a more place-based approach in partnership with Public Health, to ensure it remains relevant and responsive to the system it serves.
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