As the City of London launches public consultations on the Health and Homelessness Whole of Community System Response, we’re hearing a lot about “systems change.” This public engagement opportunity is the right time to ask, what even is this change, why is it good, and how can we support it?
We know that the emerging health and homelessness plan began with the convening of greater than 200 people from 70 organizations, including nonprofits, business, and government. Among those agencies, some had histories of harm and perceived harm, so this scale of cross-sectoral collaboration is an appreciable accomplishment in itself. But the change is something even bigger, announced in the first two words of the plan’s title page: People Centred. That is, it puts the experiences of those most impacted at the centre of the plan, seeking to understand what works for people, and then building out an entire system that supports those outcomes. Then, and only then, arriving at an appropriate budget and seeking the right amount of investment. So, how is that a good change?
With respect to health or social services, we likely all agree that client-centred care or patient-centred care is best. And sometimes we manage it. But it all unravels when a client or patient comes up against a part of the system that denies or delays care because someone isn’t presenting according to the rules or has come to the wrong door. In the context of health, homelessness, and exacerbating mental health and substance use issues, this may mean illness, infection, incarceration, eviction, relapse, or even preventable deaths. In all cases, it also causes an unraveling of trust in the system. It only works if the whole system supports the client to a good outcome. And that’s what this plan proposes.
"By focusing on contracts instead of people, we
co-create the conditions of failure for everyone."
In turn, the failure to invest in the full cost of services entrenches a culture of ‘leanness’ in nonprofits, where passion is meant to make up for resources, leading to poor compensation, burnout for nonprofit workers and, finally, suboptimal outcomes for the populations served and the larger community. In other words, by focusing on contracts instead of people, we co-create the conditions of failure for everyone.
To be clear, we are completely in favor of fiscal responsibility. But knowingly throwing an inadequate amount of money at a problem is truly wasteful and harmful. It damages our trust in both governments and nonprofits, and it also foments resentment of the vulnerable people we’re all seeking to help. Happily, this is the system change the whole of community system response proposes: it de-centres governments, organizations, and contracts and re-focuses on positive outcomes for unhoused Londoners and the whole community, building out an integrated system that supports those outcomes. This includes developing shared standards of care and supporting a highly-trained, fairly-compensated, and more resilient workforce. This promotes real accountability -- to clients, workers, and the community -- and this is systems change in action. But, here’s the thing: change is hard, and we all need to be brought along at speeds we can manage.
And those who work closely with unhoused Londoners know this, too. The advocacy of #TheForgotten519 in the summer of 2022 did much to change our point of view, highlighting what it feels like to work in a broken system with inadequate resources, unable to save people from wholly preventable deaths. Those frontline workers have created a genuine appetite for a system that begins with people’s needs and actually works for everyone.
In the past few decades, researchers have been able to aggregate data from housing and homelessness interventions to show what works best, so they also know why client-centred models work best. But the rest of us need to be brought along at paces that suit each of us best. This will require a robust public education effort and the opportunity for everyone to engage with the plan through informed public consultation.
“We all want change. We must
be brave enough to embrace it.”
How can we be part of the solution?
For this to be a whole of community system response, each of us will have to find our place in it. Most people are kind and generous, but have never had to consider what it means for housing to be a human right and a collective responsibility. Learning of a displaced neighbour, most of us would open our hearts, our pocketbooks, and even our doors, as Londoners did in the wake of the Woodman explosion. It seemed like the neighbourly thing to do. But somewhere between a few displaced neighbours and 2000 unhoused Londoners, we’ve forgotten that it’s more than a neighbourly thing. It’s the right thing: human rights require collective responsibility.
Others may feel they understand human rights, but still feel the dollar figure for ending homelessness is too high. For those folks, it may help to know the price we’re already paying to do the wrong things, even when we do the wrong things the best we can. It’s gross to assign a monetary value to human life, but the financial industry has done it for us and economists had to calculate it again to weigh the costs of COVID deaths vs economic slowdowns: estimates go as high as $10,000,000. US Dollars. Per human life.
With greater than 50 preventable deaths a year caused by homelessness, London is losing more than 500 million dollars annually in human potential just by not ending homelessness. And that’s without the additional expenses of near-constant emergency response and emergency healthcare – including 6,000 visits to emergency rooms by the highest acuity unhoused Londoners. Continuing to do the wrong things is far more expensive than trying to do the right thing. We have people willing to do that work on our behalf, eager to work in a better, client-centred system, and there needs to be a whole-of-government response to invest in real solutions. And each of us has much to learn.
We hope everyone will take the opportunity to attend a public engagement session ready to understand what’s different about this response, and why it could work with public support. Again, we are so fortunate to have true experts at the heart of this system change: the Londoners we’ve left ‘til now on the streets, along the river, and in the parks and the people who work with them and care for them daily. We all want change. We must be brave enough to embrace it. Unhoused Londoners muster courage all day, every day, just to survive another day. Frontline workers have been courageous in reporting the failures they see in our broken systems. And the City has shown courage in changing their point of view and convening so many individuals, businesses, and nonprofits to make real change. It’s now on the rest of us to be courageous enough to embrace real change, too.
Again, change is hard work. It means becoming something else, something unfamiliar. But if we want our community to become something else – something better and fairer – this is the work we must do, our part of the whole of community response. And perhaps, in this moment, we become better versions of ourselves, too.
Wednesday, August 30, 7-8:30pm at South London Community Centre
Thursday, August 31, 7-8:30pm at Medway Community Centre
Tuesday, September 5, 7-8:30pm. at Byron Optimist Community Centre
Wednesday, September 6, 7-8:30pm at East Lions Community Centre
Thursday, September 7, 7-8:30pm at Carling Heights Optimist Community Centre