Models of housing and support to reduce risks of COVID-19 infection and homelessness: the moving on pilot randomised controlled trial

Mackie, Peter ORCID: https://orcid.org/0000-0003-1494-0864, Randell, Elizabeth ORCID: https://orcid.org/0000-0002-1606-3175, Dyer, Calie, Smallman, Kim ORCID: https://orcid.org/0000-0002-9283-8120, Hughes, Jacqueline, Trubey, Robert, Farthing, Penelope, Scoble, Charlotte, Rodriguez-Guzman, Guillermo, White, James ORCID: https://orcid.org/0000-0001-8371-8453, Aubry, Tim, Culhane, Dennis, Hume, Susannah, Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631, Greaves, Faye, Pell, Bethan ORCID: https://orcid.org/0000-0002-0786-6339, Moody, Gwenllian ORCID: https://orcid.org/0000-0002-2000-4944, Teixeira, Ligia, Mousteri, Victoria, Spyropoulos, Nick and Cannings-John, Rebecca ORCID: https://orcid.org/0000-0001-5235-6517 2025. Models of housing and support to reduce risks of COVID-19 infection and homelessness: the moving on pilot randomised controlled trial. Pilot and Feasibility Studies 11 , 132. 10.1186/s40814-025-01718-1

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Abstract

Background The UK government ‘Everyone In’ initiative in response to COVID-19 in England saw an unprecedented number of individuals experiencing homelessness moved into temporary accommodation (TA). A limited supply of settled housing meant swift access to settled accommodation (SA) would not be possible for all. This pilot RCT pursued a unique opportunity to examine the feasibility and acceptability of randomising people experiencing homelessness (PEH) to SA or TA and the impact on COVID-19 infection and housing instability. Methods A pilot RCT, with embedded process and health economic evaluations. 1:1 participant randomisation to SA (intervention group) or TA (control group). Recruitment in two local authorities (LA) in England. Participants were aged 18 and over, in single-person homeless households, temporarily accommodated by the LA with recourse to public funds. Primary outcomes: (i) LA recruitment; (ii) Participant recruitment; (iii) participant retention; (iv) LA adherence. Secondary outcomes: (i) completeness of data collection at 3 and 6 months; (ii) data linkage: percentage of participants consenting to data linkage and successful match rate. Results Of 144 LAs approached, 26 showed interest in participating, two entered the trial. LA hesitancy to participate reflects an unease with trials in services where RCTs are rare. These recruitment challenges resulted in an amendment from full-scale effectiveness RCT to pilot RCT design. Fifty PEH were recruited (29% from 175 approached). Fifty-six percent of participants were retained at 6 months. Fifty percent of randomisation allocations were adhered to by LAs, identifying difficulties in LA systems not amenable to randomisation and a lack of support for randomisation amongst front-line staff. Frontline workers felt strongly that allocations should be based on their judgement. There was a high level of outcome measure completion. All participants consented to sharing identifiers for linkage to health and other data. A match rate with NHS Digital was sought but could not be reported due to procedural challenges. Conclusions Whilst not recommended to proceed to a full-scale RCT in its current design, considerable uncertainties remain about the effectiveness and cost effectiveness of different housing interventions on health outcomes, COVID-19 infection and housing stability for PEH.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine Schools > Social Sciences (Includes Criminology and Education) Schools > Geography and Planning (GEOPL) Research Institutes & Centres > Centre For Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) Research Institutes & Centres > Centre for Trials Research (CNTRR)
Publisher:	BioMed Central
ISSN:	2055-5784
Date of First Compliant Deposit:	6 November 2025
Date of Acceptance:	6 October 2025
Last Modified:	06 Nov 2025 12:30
URI:	https://orca.cardiff.ac.uk/id/eprint/182186

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