Background The COVID-19 pandemic presented an unprecedented risk to the homeless population and their health. To protect those currently or at risk of sleeping on the streets, the government implemented the ‘Everyone In’ initiative in England. This initiative included the provision of health and care support along with housing through collaborative working. This study aims to understand what worked well and less well in ‘Everyone In’ for improving physical and mental health outcomes for people experiencing homelessness through integrating support for housing, health and wider care needs.

Methods Between January and October 2023, in-depth interviews and focus groups were conducted in North East, North West, South West England and London with those involved in the delivery/implementation of ‘Everyone In’ and those who were accommodated. Thematic analysis was conducted using the constant comparative method. Case study analysis was further conducted to provide a contextual understanding of regional differences in implementation of ‘Everyone In’ through the lens of what worked well and less well to identify shared learning.

Results Twenty-five people accommodated through ‘Everyone In’ (age: 28-58 years; 88% males) and 43 people involved in planning, commissioning, and implementation of the initiative, from local authorities, third sector and policy (age: 25-62 years; 40% males) were recruited. The study found that ‘Everyone In’ was a responsive intervention and improved delivery of health interventions through the provision of ‘wrap-around’ support (i.e. multi-agency and coordinated) with housing, flexibility in funding and innovations such as use of group sessions within hotels for providing mental health support. In contrast, challenges in access were reported if people had to travel during the pandemic to collect their prescriptions. ‘Everyone In’ led to strengthened partnerships between health, housing and social sector. Unintended consequences for mental health in service users were experienced in response to self-isolating in en-suite accommodation. Legacy from the approach included provision of single occupancy accommodations, supported housing and more ‘joined-up’ services. Regional-level case studies highlight (i) support for people from ethnic minority groups; (ii) challenges with mental health and self-isolation; (iii) benefits of ‘wrap-around’ support and ‘joined-up’ working between local authorities, health and third sector organisations; and (iv) ongoing work and homelessness strategy after ‘Everyone In’.

Conclusion Flexibility in funding provision and availability, multi-sectoral partnerships and integrating housing with health and care support can improve engagement with services for people experiencing homelessness. The study illustrates the significance of being adaptable and responsive to addressing the multiple needs of people experiencing homelessness.

Funding The study is independent research carried out by the Public Health Policy Research Unit (PH-PRU) commissioned and funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme.