COVID-19 (Coronavirus) & Homelessness

covid19

 

 

 

 

 

 

UPDATED 31.03.20

The COVID-19 (Coronavirus) outbreak presents specific risks to people experiencing homelessness. People rough sleeping or living in temporary accommodation are in a high risk group, many with long term conditions, that mean becoming infected with the virus could have severe consequences.

The Government has issued advice regarding this virus. And on 16.03.20 the Government published guidance for hostels and day centres. Hostels and day centres are currently advised to stay open and take precautions broadly in line with those for the general public

Pathway is deeply worried that this guidance fails to address many of the practical concerns being raised by specialist homeless clinicians and the homeless charity sector across the country. This is our response.

We, and many in the homeless charity sector, advocate the advice given by Dr Al Story at our Homelessness and Inclusion Health conference on 12th March – with COVID-19 clearly explained by Prof Andrew Hayward – links to both presentations here. 

Pathway on 19.02.20 published an OPEN LETTER from London Clinicians COVID-19. London specialist homelessness clinicians and partners are calling on NHS England, Public Health England and the Mayor of London, to help support a rapid COVID-19 response for vulnerable homeless patients. The letter was published alongside a COVID-19 Homeless Sector Plan produced by Dr Al Story, Clinical Lead Find & Treat and Prof Andrew Hayward UCL Professor of Epidemiology and Inclusion Health.

This action plan is an evolving, practical plan and there are active discussions with colleagues across the NHS, local government and the charity sector about how to mobilise resources to deliver this plan.  It is based on the established principles in managing any epidemic. Separate infectious people from non infectious people, keep them apart. Care for and support both groups.

 

On 17.03.20 the Government announced emergency support funding for rough sleepers.

On 18.03.20 the Ministry of Housing, Communities and Local Government announced plans to protect private renters, including suspending new evictions.

On 19.03.20 the Government published COVID-19 Hospital Discharge Service Requirements guidance.

On 20.03.20 the Department for Health and Social Care launched a recruitment drive for ex-healthcare professionals to return to the NHS to help support the COVID-19 pandemic.

The Government’s dashboard showing reported cases of coronavirus in the UK, including new cases, cases by upper tier local authority in England and number of deaths can be viewed here.

Here is NHS England’s Emergency preparedness programme.

Health Education England e-Learning for Healthcare (HEE e-LfH) has launched a free, open access to COVID-19 e-learning programme. It includes key materials to help the health and care workforce respond to Coronavirus.

NHS London Clinical Networks have produced this Primary Care and Community Respiratory Resource Pack during COVID-19 guide.

 

Protocols and plans are being continuously made as this crisis evolves:

Great Chapel St Medical Centre COVID19 protocol.

The Journals Critical Care Medicine (CCM) and Intensive Care Medicine (ICM) have drafted an International review of critical care guidelines.

NHS guidance on NHS Hospital steps on COVID-19

South London and Maudsley NHS Foundation Trust (SLAM) has produced harm reduction strategies for alcohol dependence – many people moving into social isolation will be addicted, and may not be able to access detox.

BMJ paper summarises how to remotely consult for COVID-19, with useful tips such as how to assess breathlessness in the absence of a validated tool.

The RCGP with the BMA have produced this RCGP workload prioritisation during COVID-19 chart.

Barnet CCG, have shared this Barnet Primary Care Covid19 flowchart assessment for assessing COVID-19 patients remotely.

Other organisations also calling for action and offering practical support:

The World Health Organization

The World Health Organization has rolling updates on  COVID-19.

Crisis

Crisis is calling for emergency measures to accommodate and protect the homeless population, regardless of legal barriers.

Full text of Crisis’ open letter to The Prime Minister, seeking facilities and support for people facing homelessness to be able to self-isolate and protect themselves from COVID-19. 

Doctors of the World

Doctors of the World, in partnership with the British Red Cross, Migrant Help and Clear Voice, has developed COVID-19 advice in over 20 languages, free to download here.

Homeless Link

Homeless Link has also responded to the government guidance on COVID-19 for hostel and day centre services for people experiencing rough sleeping.

Homeless Link also has a useful COVID-19 resources page that is regularly updated.

The Museum of homelessness and Streets Kitchen have implemented emergency measures to respond to the rapidly escalating situation with COVID-19.

They have developed a 3-pronged strategy:

Mobilise: Outreach in a safe way to make up for a reduction in services

Communicate: Facilitate meetings with relevant parties to plan together

Advocate: Make asks of authorities and share knowledge on safe responses

This work has involved outreach work on the ground, screenings and the publication of a plan for the homelessness sector. Currently all the MoH efforts are focused on preventing unnecessary deaths during this pandemic. Look out for their continuous updates.

FEANTSA, the European Federation of National Organisations Working with the homeless, an umbrella group working with NGOs committed to combatting homelessness in Europe, has organised self isolation spaces for people experiencing homelessness diagnosed with COVID-19 in 15 locations.

Shelter has a resources page full of information and advice on housing and COVID-19.

Maternity Action have highlighted the particular impact of COVID-19 on pregnant women in a letter to the Chancellor. Their website hosts a range of useful information, including the telephone number of their advice line which offers help to women at risk of exclusion.

Groundswellhave developed resources to support people experiencing homelessness during the current coronavirus (COVID-19) pandemic.

The Camden Health Improvement Practice have shared their CHIP COVID19 response.

Friends Families and Travellers have produced guidance for Local Authorities specific to the needs of Travellers, Gypsies and Boaters.

Medact has drawn up a petition calling on all party leaders and all MPs to radically rethink public health and work together to ensure legislation is passed that protects everyone’s wellbeing now and through the duration of the COVID-19 crisis. Medact is calling for secure housing, secure incomes, access to care and international solidarity. You can sign the petition here.

The BMJ has a practical guide for GPs on when to suspect COVID-19 and how to respond.

The No Recourse to Public Funds Network (NRPF) has this guide to assisting people who are receiving social services’ support and COVID-19.

The Lancet has published a paper on parenting through COVID-19, with useful links to parenting resources.


The Doctor shines a light on the Pathway model

 

 

 

 

 

 

by Eva Morrison

 

Pathway teams have been profiled in the December 2019 and January 2020 editions of the BMA’s The Doctor magazine; illustrating the work of homeless health interventions in London and Brighton.

 

These articles are timely, as last year the BMA declared the homelessness crisis a ‘public health emergency’ at its annual representative meeting in June.

 

The Doctor talked to Pathway clinicians in London, Manchester and Sussex, and made visits to the Royal London Hospital and Brighton teams, witnessing homeless healthcare in action.

 

“A hospital admission is an amazing opportunity. Someone is in a place where you can help them and where they may want help also. It can be an opportunity to break the cycle,” said Dr Peter Buchman.

 

 

 

 

 

 

 

The Doctor documents the struggles of staff, patients, and the system – shadowing the work of our teams and other colleagues on the frontline. The demand, and complexity of patients, combined with the lack of ability to make a difference to their homelessness, is growing ever apparent to those working in primary care.

 

The January feature highlights the example that even though there are around ten emergency accommodation sites in Brighton, and The Doctor visited three, – it was clear that even with well-meaning staff, hostel and temporary accommodation is not necessarily suitable for vulnerable or ill patients.

 

Inclusion health teams across the country are working in less than ideal situations, often making the best of almost nothing, with whatever resources they have.

 

In most towns and cities across the UK housing is becoming near-impossible in most circumstances. Few houses are being built, and therefore supported accommodation is quickly filled with patients who are unable to move on.  Some of these sites, suitable in the past for emergency accommodation, are now being used for people staying for months or years at a time.

 

Homeless patients are complex, and vulnerable. It can take a long time to build up trust before a patient feels able to go to hospital, make GP appointments or engage with other services. Our colleagues try to do as much as they can, but this all puts a strain on health care professionals as well as patients.

 

Services themselves are chronically underfunded. Support services such as substance misuse, social care and mental health services have been cut back over the last decade. This has resulted in primary care having to fill in for gaps in services, and even picking up patients who really need specialist care – and specialist care is really what a lot of homeless patients need.

 

Pathway teams see the effects of childhood trauma, and austerity in many of their homeless patients daily. With the numbers of people experiencing homeless increasing, combined with a lack of accommodation, the UK is facing an ever growing problem.

 

The Royal London team, like the Pathway team in Bradford, is fortunate to have access to a six-bed respite facility. This makes a huge amount of difference to the patients they treat. It enables those who need more help to receive it in a supportive environment.

 

“It’s about celebrating your victories and not dwelling on the times when you aren’t able to do anything,” said Dr Chris Sargeant.


Homeless Hospital Discharge Nursing

The emerging discipline of homeless hospital discharge

Sam Dorney-Smith

by Samantha Dorney-Smith

 

Pathway were recently granted a 15-month leadership grant from the Burdett Trust for Nursing to identify, network and support all nurses working across the UK in the emerging discipline of homeless hospital discharge.

Homeless hospital discharge nurses work in partnership with patients experiencing homelessness to achieve timely, holistic and compassionate assessment, treatment and discharge plans that improve health and housing outcomes.

Most of these nurses work in hospitals, although in many cases this is an in-reach intervention from community-based services. Some nurses work in Pathway teams, but many others do not. A small number of nurses that work to achieve better discharges for people experiencing homelessness are entirely based in the community.

The first clear reference to homeless hospital discharge practice was in 2003. A Department of Health document ‘Discharge from hospital: pathway, process and practice’ stated that all acute hospitals should have formal admission and discharge policies to ensure that homeless people are identified on admission, and that the discharge of homeless people should be notified to relevant primary health care and homelessness services.

Fast forward to 2019, and there are now around 25-30 specialist nurses in the UK directly involved in homeless hospital discharge (nearly all of whom have been involved in this project), and the NHS Long Term plan cited homeless hospital discharge teams (in this case a Pathway model team) as an example of good practice to reduce health inequalities.

Additionally, since October 2018, the Homelessness Reduction Act (2017) has now conveyed a ‘duty to refer’ on Accident and Emergency departments and inpatient settings for patients identified as experiencing homelessness, or being at risk of homelessness within the next 56 days. This requires patients to be referred to a Local Authority for support (with their consent). The hope is to focus acute hospitals on their responsibilities for safe discharge in this group. It may also result in the recruitment of more nurses into specialist roles.

Our Burdett funded project has revealed that homeless hospital discharge nurses need to be experts in clinical advocacy, patient empowerment, motivational interviewing, and health and housing rights. In addition, they need a broad clinical background in physical health, mental health and addictions and a good understanding of public health, and the concept of ‘making every contact count’, as well as an ability to gradually chip away to deliver systemic culture change. Having said that, to a large extent best practice has been developed locally by expert practitioners ‘doing the job’, and the evidence base is still limited.

Through shadowing and observation, interviews, and group workshops, the project has attempted to define the homeless hospital discharge nurse role clearly, including providing a breakdown of the knowledge, skills and experience required for the role with specimen job descriptions. An early vision for best practice has been defined, and local innovations have been highlighted. Continuing professional development needs have been analysed, and voluntary standards for practice are being developed.

Finally, and perhaps most importantly the project has helped the nurses to develop a shared vision of quality, and has defined this in terms of the value of a safe, effective and compassionate discharge, rather than by cost reduction per se (although the need to deliver efficiency has been taken into account).

The full report and resources developed on the project can be found here.