For people experiencing homelessness, accessing substance use treatment is rarely straightforward. Fragmented systems, strict criteria and the limitations of borough-based boundaries often leave people excluded before they have even had a chance to engage. At Phoenix Futures, our Regional Homeless Engagement with Substance Use Treatment (RhEST) service works to remove these barriers.
RhEST is the only pan-London substance use service, operating across 32 local authorities, each with its own structures and commissioning arrangements. Meanwhile, the people we support frequently move across boroughs, often out of necessity rather than choice. Traditional services, tied to specific geographical areas, can struggle to maintain contact when someone’s life does not remain within one set of boundaries. Our role is to bridge those gaps and ensure that access to treatment does not depend on having a stable postcode.
Our team focuses on building trusted relationships with people facing multiple disadvantage. Many have complex physical, mental and social needs. Consistency is vital, yet difficult to achieve within a system not designed for mobility. By working across boroughs, RhEST can stay alongside people no matter where they move, advocating for them when their circumstances do not neatly fit the criteria expected by commissioned services.
Recently we were involved in an initiative to develop a Rough Sleeper Pathway, designed to provide immediate hospital care for people sleeping rough with urgent health needs. This short-term project also included limited funding for residential treatment placements. The pathway enabled people to receive rapid access to physical and mental health assessments, stabilisation in a safe clinical environment and the breathing space to think about accommodation and treatment options.
Because RhEST already works pan-London and has strong relationships with a wide range of services, we were identified as the most suitable team to coordinate referrals. We worked closely with partners including the London Navigators, Homeless Health providers, Rough Sleeper teams, day centres, outreach workers and community treatment services. Together, we moved quickly, securing admissions within days of the funding becoming available.
During the short period the pathway operated, 15 people were admitted for hospital-based stabilisation and 11 of those went on to residential treatment afterwards. This is a substantial increase compared to previous years when no equivalent pathway or funding existed, and it clearly demonstrates what becomes possible when the system is allowed to flex around people’s needs.
Throughout the project, we saw how fragmented and complex the system can be for people to navigate. RhEST played a pivotal role in bringing together the right agencies to make the pathway work. Most importantly, we listened to the people using our service. Instead of asking them to fit the system, we made the system work around them. The flexibility built into the pathway meant we could respond to the realities of homelessness, advocating for people whose situations often fall outside standard criteria. We saw people previously considered “unsuitable” for residential treatment flourish when finally given the opportunity.
The project also highlighted how easily people can be excluded through assumptions about “lack of engagement”. For example, some participants faced barriers that made standard
preparation groups inaccessible. In one instance, a person with neurodivergent needs was unable to attend these sessions, yet this was misinterpreted as "low motivation". In other cases, people in coercive or unsafe relationships struggled to attend appointments and were similarly judged as disengaged. Looking more closely at individuals’ circumstances made it clear these expectations were unrealistic and unfair. The pathway created space to understand these barriers and respond appropriately.
RhEST’s involvement was about more than referrals; it was about building trust in a system where trust has often been lost. Many of the people we engaged would previously have remained on the periphery of services because the pace and structure of traditional pathways do not align with the realities of rough sleeping. A trauma-informed, motivational approach was vital to the pathway’s success.
This short-term funding showed what is possible when commissioning frameworks allow for flexibility. People experiencing homelessness often require more time, more consistency and a more personalised approach than standard services can currently offer. A pan-London model has proved highly effective in maintaining engagement for those who frequently move boroughs, and it highlights the need for greater discretion in decision-making around residential treatment.
We fully appreciate that funding for placements is a major consideration for commissioners. However, we would welcome a shift that allows teams greater latitude where conventional engagement expectations are unrealistic. People experiencing homelessness deserve the same access to treatment as those in stable housing, and achieving equity requires systems that reflect the complexity of their lives.
Once trust is established and people begin to engage, opportunities should be genuinely equal. As a sector we talk often about holistic and person-centred care; this work has shown clearly that flexibility must be part of that. Embracing the differences in people’s circumstances and widening the door for those facing the greatest challenges is essential if we are serious about improving access. The Rough Sleeper Pathway proved that, with understanding and adaptability, treatment can be accessible and transformative, for people experiencing homelessness.
Chris Annison
Head of Services - London
