Pathway joins with others condemning UK plans to remove rough sleepers

 

Pathway, along with Crisis, and over sixty other organisations supporting people facing homelessness across the UK, have released a joint statement condemning UK Government plans to use rough sleeping as grounds for removing someone from the country.

Home Office guidance published last month outlines that the policy should only be used in cases where someone has refused or disengaged with support and is engaged in persistent anti-social behaviour or other criminal activity.

Everyone in our society should have a safe place to live and no one should be punished for experiencing homelessness. We know that housing is a social determinant of health and people experiencing homelessness face extreme health inequalities.

Without secure accommodation, people experiencing homelessness, particularly those sleeping rough, often end up using hospital emergency departments, rather than trying to access primary care, and they are in fact six times more likely to attend hospital than the general population, more likely to be admitted, and have longer average stays due to multiple and complex needs.

Clinical staff often witness the devastating consequences of homelessness, yet strive to provide the best patient care to the most extremely vulnerable and socially excluded. These new rules could deter people from seeking help when they most need it. We need to work together to solve the impact of homelessness, once and for all.

Read the joint statement here.

 

Homeless hostels get valuable support from palliative care specialists

 

 

 

MEDIA RELEASE

28.04.21  

Palliative Care specialists bring support to hostels in new pilot project, helping staff to better assist patient choice in end-of-life care. 

The majority of deaths among people experiencing homelessness occur with little or no palliative care support. It often falls to frontline homeless hostel staff, who are not health or social care professionals, to support people with very complex needs who are extremely sick. People living in hostels are often referred to hospital rather than asked about their preferred place of care. This project has enabled hostels to better facilitate greater patient choice.

In the first undertaking of its kind, researchers at the Marie Curie Palliative Care department at UCL (University College London) and the homelessness charity Pathway, partnered four homeless hostels in London with palliative care specialists from St Christopher’s and St Joseph’s Hospices.

The palliative care specialists were trained in some of the unique complex issues affecting people experiencing homelessness to become homelessness champions. These champions then attended the hostels for a couple of days a month to provide support for staff and residents in facilitating access to palliative care and other key services for people with deteriorating health.

The Marie Curie Palliative Care UCL researchers provided in-reach support by helping hostel staff to:

  • identify palliative care needs
  • refer patients to dedicated palliative care teams and one-to-one health care provision
  • refer patients to other care professionals
  • provide specialist care equipment
  • advocate for social care
  • refer to high support nursing homes when necessary

“I’ve seen so many people die, so much of it over the last 19 years. We have been working in isolation for such a long time and people don’t really know how hard it is to work here.”Hostel staff 

At the beginning of the project, the champions underestimated the needs of people living in the hostels and were shocked by residents’ lack of access to care.

One of the champions from St Christopher’s reflected: 

“I felt confusion when I first went in. I was shocked at the high level of need at the hostel and how much the staff in the hostel were expected to do. There were residents with physical care needs, emotional care needs, mental health needs, financial needs, needing a collective cross agency approach but hostel staff were left to do it. I couldn’t get my head around it as it’s not a residential home it’s not a care provider, it’s a homeless hostel.” 

Some hostel workers were initially sceptical about the potential benefits of the partnership with the hospice.

A Service Manager from one of the hostels said: 

“I had pre-judgements about us allowing people to die within the service, as I was concerned about the impact it would have on staff. Now, I can’t see our homelessness champions not being part of our support network. We’ve gained so much knowledge and confidence, particularly in practical tools that we now regularly implement, such as monitoring our residents’ health and recording information. What we have learnt during the partnership is vital to the work that we do and the training we received has been invaluable.” 

This project has demonstrated how supportive this partnership has been for hostel staff and how isolated they had previously been when supporting residents with complex needs and advanced ill health. The collaboration has helped develop a person-centred approach to care and a recognition of when more health or social care input is needed. Hostel staff have been empowered by support from the champions. This has increased their knowledge and understanding about health and social care issues and rights, and has enabled them to advocate more effectively for what residents need.

 

Briony Hudson, Senior Research Manager at Marie Curie, said:  

“This research demonstrates one model of how palliative care professionals can support people experiencing homelessness in their local area by providing in-reach support to both staff and residents. By becoming a familiar face within the hostel, opportunities for engagement and developing the trusting relationships that are so important when supporting people who have experienced exclusion emerge. What was clear from this research is that supporting people with complex needs is not just a role for palliative care, but requires input from a range of professionals and services to truly be able to offer person centred care and support for people towards the end of their lives”. 

 

Caroline Shulman, General Practitioner in Homeless and Inclusion Health, Pathway research fellow and Honorary Senior Lecturer at UCL, said: 

“People residing in UK homeless hostels experience extremely high rates of ill health, with multiple complex needs, frailty and age-related conditions at a young age. However, they seldom receive palliative care with the burden of support often falling to hostel staff. This was why it was crucial we carried out this project, to try and get support for hostel staff and for residents with complex or advanced ill health. We are delighted with how input from the palliative care specialists from St Christopher’s and St Joseph’s hospices have enabled residents to receive a more person-centred approach to their care. Building on experience from the Covid-19 pandemic, we are now exploring how we can extend and enhance this work to include a remote platform for sharing learning, within a multi-professional group, to improve support for this marginalised group.” 

– ENDS      –

NOTES TO EDITORS 

Homeless people die on average 30 years younger than people who are housed.  In 2019, the Office for National Statistics (ONS) reported that 778 people who were street homeless or in emergency shelters died in England and Wales with the mean age of death being 45.9 for men and 43.4 for women. This is more than 30 years younger than the general population.

While this project represents promising first steps in reducing inequity in palliative care access for people experiencing homelessness, there is a need for this marginalised group to have real and meaningful choice over the care they receive and where they receive it.

The research paper is now available to view on SAGE Journals here. The Oak Foundation funded this research.

For further information contact: 

Dr Caroline Shulman, General Practitioner in Homeless and Inclusion Health, caroline.shulman1@nhs.net

Dr Briony Hudson, Senior Research Manager, Briony.Hudson@mariecurie.org.uk

 

Pathway is the UK’s leading homeless healthcare charity. Pathway works to improve the quality of healthcare homeless and excluded groups receive by developing and sharing best models of care like the Pathway hospital teams; increasing specialist skills of workers in healthcare; influencing policy; and reducing stigma in healthcare against people experiencing multiple exclusion.

The Marie Curie Palliative Care department at UCL works to develop and evaluate new ways of improving the care of people with terminal illnesses.

The Oak Foundation commits its resources to address issues of global, social and environmental concern, particularly those that have a major impact on the lives of the disadvantaged. With offices in Europe, India and North America, they make grants to organisations in approximately 40 countries worldwide.

Pathway response to the report of the Commission on Race and Ethnic Disparities

 

The Government’s recent report of the Commission on Race and Ethnic Disparities (CRED) suggested that structural racism in the UK does not exist. We are extremely disappointed that this report has sown more division in society rather than increased our shared understanding of the impact of racism.

It is unfortunate that the report failed to fully take note of all the compelling evidence that racial disparities, particularly in health, are very significantly driven by structural social and economic factors, which include racism.

Pathway fully supports The Runnymede Trust response and open letter on this report.

Read our full statement here.

 

Charities Crisis and Pathway to merge to better tackle homelessness and health inequalities

Pathway with Crisis logo

Under Embargo 00:01 Tuesday 9 March

Contact: Crisis media team on 020 7426 3880, media@crisis.org.uk, or 07973 372587 (out of hours)

Charities Crisis and Pathway to merge to better tackle homelessness and health inequalities

 

News has been welcomed by organisations from across the health and homelessness sector

 

The national homelessness charity Crisis and Pathway, the leading homeless healthcare charity, announce that they are to merge in a bid to tackle the stark health inequalities experienced by people who are homeless and ensure that the healthcare system plays its part in ending homelessness across Great Britain.

 

The merger, which will see the charities maintain their own operations and existing identities, will build on the existing collaboration between the two organisations and make them a stronger, more united voice in their mission to address the health and support needs of people experiencing homelessness.

 

The two charities are coming together at a time when the coronavirus pandemic has highlighted how essential it is that homelessness is seen as a public health issue. Meanwhile opportunities to resolve and prevent homelessness through the healthcare system are routinely missed. The most up to date figures for 19/20 show that 2,950 people were discharged from either a general or psychiatric hospital with no home to go to.

 

Pathway and Crisis will work together to ensure that the health service, through all its contacts with people experiencing homelessness, fulfils its potential in actively resolving homelessness. The two charities will continue to advocate for policy responses to homelessness that save lives, reduce health inequalities, and promote positive health outcomes for people who are homeless.

 

The merger, which has been approved by both Boards of Trustees, aims to:

 

  • Increase the number of dedicated hospital teams that work with patients who are homeless across the country, to ensure they receive better quality care and are not discharged from hospital into homelessness.
  • Work with the NHS and wider health and social care services to help them prevent homelessness through evidence-based programmes such as Housing First and Critical Time Interventions that will ensure people get the support they need to leave homelessness behind for good.
  • Campaign for the changes needed to save lives and demonstrate the positive health outcomes of immediate access to good quality emergency accommodation
  •    Fill in knowledge gaps in inclusion health and homelessness research, including how to improve services, narrow health inequalities, assess the impact of government policies and the solutions needed to end homelessness for good.

The services both charities provide will continue unchanged for the time being. Longer-term, the two charities will look to enrich their services by combining expertise – for instance, Pathway teams being in place where Crisis Skylight centres are based.

 

Jon Sparkes, Crisis Chief Executive said: “Having worked together successfully for many years, this merger is an exciting opportunity for both charities to combine our expertise, resources and voices at a time when people experiencing homelessness need us more than ever.

 

“The pandemic has further exposed how dangerous it can be for our health when we don’t have somewhere safe to call home, yet far too often people are discharged from hospitals with nowhere to go. We are determined to see this change and will be working together to ensure that the NHS and wider health and social care system plays its part in helping to achieve our shared goal of ending homelessness for good.”

 

Alex Bax, Pathway Chief Executive, said: “Pathway was founded on the belief that the NHS has a huge part to play in preventing and ending homelessness. By joining together with Crisis we will be able to do even more to support front-line NHS colleagues, build the skills and knowledge of NHS staff, and show how health, housing and care services working together is the best response to homelessness. Leading organisations from across the homelessness and health sector back our merger, believing it will bring real change to people facing homelessness now and in the future.

 

Richard Murray, Chief Executive of The King’s Fund said: “I am pleased to welcome this new relationship between Pathway and Crisis. Pathway have played such an important role in helping the NHS improve services for homeless people and bringing their skills and experience together with Crisis offers real opportunities to cement and extend their impact. This should be a win-win for both organisations and the people they serve.”

 

Lord Victor Adebowale, Chair, NHS Confederation said: “This is excellent news. Over the last ten years Pathway has built its credibility within the NHS, bringing the care and treatment of homeless patients into the spotlight and focussing attention on the most extreme health inequalities that we face. At the same time Crisis has built the evidence base to show how ending homelessness in the UK is achievable. I can see huge value now in the two charities working together, helping the NHS with practical service improvements for homeless patients, while campaigning for wider structural societal and system change.”

 

Professor Andrew Goddard, President of the Royal College of Physicians said: “The RCP welcomes the new partnership as Pathway has played a key role in putting the health of homeless people firmly on the agenda of the NHS. Crisis is to be commended for providing the stability that will make sure this work continues.

The impact of the pandemic on charities has been significant, but it is partnerships such as this that demonstrate our resilience. There are many things on which we can and should work together, while recognising each other’s independence. We have no doubt this new relationship will bear significant fruit.”

 

-ENDS-

For further comment please email media@crisis.org.uk or call 0207 426 3880.

Notes to editor

 

Crisis and Pathway will remain two separate charities, operating in a group structure in which Pathway is a subsidiary of Crisis and Crisis is the sole Member of Pathway. In order to adopt this structure, Pathway has made amendments to its governing document which are being submitted to the Charity Commission review and approval. The new legal structure will formally come into place on the later of 1 July 2021, or the Charity Commission’s approval of the revised Pathway articles.

Homelessness data tables

Statutory homelessness: Detailed local authority-level tables 2019-20, Table A4P – Number of households owed a prevention duty by accommodation at time of application England, 2019-20 Financial Year.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/923144/DetailedLA_2019-2020.ods

About Crisis 

Crisis is the national charity for people who are homeless. We help people directly out of homelessness, and campaign for the social changes needed to solve it altogether. We know that together we can end homelessness.

About Pathway

Pathway is the UK’s leading homeless healthcare charity. We work with the NHS and other partners to create improved models of care for people experiencing homelessness. Our aim is to improve outcomes for homeless patients and help reduce health inequalities.

 

Hull Pathway Team Reduce Local Rough Sleeping by 77%

Hull city

 

 

 

 

 

 

The Bevan Healthcare Pathway team in Hull has dramatically improved both the health and housing outcomes for homeless patients. The team was commissioned by Hull Clinical Commissioning Group to deliver a local Pathway model of care and advocacy for homeless patients admitted to hospital.

Key achievements include:

  • Reduction of rough sleeping by 77% from 71 of the 235 referred patients to 16.
  • An 88% decrease in very unstable accommodation from 139 patients to 16.
  • 100% increase in stable accommodation to 182 patients from 91.
  • Improved community follow ups – the team have grown to see this as a central part of the support they provide.
  • Improved access to ongoing healthcare aided by updating of patient records (nearly half were found to be out of date or incorrect on admission) and registration of non-registered patients with a GP.
  • The team were also reported to have a positive impact on hospital culture and how staff interact with patients from vulnerable groups.

The Bevan Healthcare ‘Pathway’ team began work at Hull Royal Infirmary and Castle Hill hospitals on 1st October 2019. The team comprises a band 7 nurse, two GPs, two health support workers, a healthcare assistant and an advanced nurse practitioner. Over the course of the first year, 235 patients were referred by hospital staff and community services. Patients were assessed by the team for their physical, mental health, housing, safeguarding and social support needs in order to form a care plan and discharge pathways that prioritise the needs of the patient. The ethos of the team is to deliver this support using a sensitive, compassionate and motivational approach with equal priority given to housing as healthcare outcomes.

A report on the first year of operation demonstrates that in-hospital intervention and advocacy by a dedicated team of healthcare professionals has a positive impact on the lives of people living on the streets or in unstable accommodation. The report describes how such initiatives are a cost-effective way to reduce the cycle of readmission that sees people experiencing homelessness repeatedly in hospital, and so can in turn help to improve hospital capacity.

Pathway has developed an integrated in-hospital care model to address problems of poor morbidity and mortality outcomes and inadequate hospital discharge in people experiencing homelessness, people in prison, Gypsies, travellers and sex workers. The mean average age of death for men in these vulnerable groups is 45, for women it is 43.

The first year of the Hull team has been deemed a significant success and it has been recognised by homeless charity, Emmaus to who gave them an Award for Outstanding Contribution and The Queens Nursing Institute who published a Best practice / Innovation Case Study of the team’s work. As a result, the team have been asked to speak at the upcoming European Federation of National Organisations Working With the Homeless Conference. To read the full report click here.

New street outreach guidelines launched

Pathway and the Faculty for Homeless and Inclusion Health are pleased to endorse new street outreach guidelines launched today.

Street outreach brings health care directly to people who are sleeping rough. Standards published by the Faculty for Homeless and Inclusion Health states that specialist primary care services should provide street outreach. Although many homeless health services around the UK are providing street outreach, until this report, there had been no guidance detailing how to deliver this kind of care.

The aim of the guidelines is to assist services to plan new health related street outreach projects, or to review services’ existing outreach. Homeless health services cover a range of locations, and the demographics of people sleeping rough in these areas may differ widely. This outreach document is designed as a flexible tool for sharing best practice and innovative ideas, allowing services to use them as appropriate to their areas.

The street outreach guidance was led by Rosa Ungpakorn, Advanced Nurse Practitioner and the winner of the Advanced Nursing Practice category in the 2020 RCNi awards.

The guidelines bring together people with lived experience and clinicians, and can be found here: Street Outreach.

Homelessness Training for GP Receptionists

A young woman behind a GP receptionist desk, smiling and looking helpful.

A new homelessness training package for GP receptionists will be launched this week at Homelessness and Health, the annual international symposium of Pathway and the Faculty for Homeless and Inclusion Health.

Over 70% of people who are homeless have physical health problems. Many are wrongly turned away from surgeries at the front desk because they do not have proof of address. People who are homeless attend A&E five times more often than the general population.

Everyone in the UK has a right to register with a GP, and proof of address is not required. The new video and training package is based upon current NHS England Guidance.  It offers simple tips to support patients and shows how important a doctor can be for a person who has lost their home.

Pathway produced the package with Experts by Experience and actors from Cardboard Citizens, on behalf of the NHS Healthy London Partnership.

Click here to view the video and find out more

 

Now is the time to tackle health inequalities, says major new alliance

PRESS RELEASE

 

A new coalition of nearly 80 organisations, brought together by the Royal College of Physicians, has been launched to press for urgent action to address health inequalities.

The Inequalities in Health Alliance (IHA) is demanding a cross-government strategy to reduce health inequalities: unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities, which may involve differences in access to health care or the standards of care available, can damage quality of life and even shorten life expectancy.

Research commissioned by the Royal College of Physicians for the launch of the IHA shows widespread concern over health inequalities and overwhelming support for action.

Almost two thirds (65%) of those surveyed by Yonder felt that governments across the UK should be doing to more to address the issue and 81% agreed (52% strongly) that there should be a UK government strategy to reduce inequalities in health.

There are many causes of health inequalities but deprivation is a key factor. Of those surveyed, 78% agreed (50% strongly) that all parts of Government in each part of the UK should have to consider the impact of their policies on people who are less well off. Three quarters (75%) were concerned – 35% very concerned – that the health gap between wealthy and deprived areas is growing (Health Equity in England: the Marmot review 10 years on, January 2020).

Nearly a quarter (24%) selected access to healthcare as the health inequality they were most concerned about, with 17% opting for poor mental health and 16% long term health conditions.

The Royal College of Physicians has written to the Prime Minister on behalf of the IHA, acknowledging that the government has been focused on responding to the pandemic but pointing out that, with its impact felt differently by different communities, COVID-19 has exposed how health inequalities can have an impact not just over a lifetime, but a matter of weeks. Now, the second wave of COVID-19 is hitting those already most disadvantaged in our society.

As well as calling on Boris Johnson to develop a cross-government strategy to reduce health inequalities, the IHA wants the government to use the socio-economic duty, section 1 of the Equality Act 2010, to address health inequalities and to adopt a ‘child health in all policies’ approach.

RCP president Professor Andrew Goddard said: “Health inequalities are not an issue to be addressed once the pandemic is behind us; a focus on them is one way in which we can tackle COVID-19 in the short term, and help to reduce its impact upon the health and prosperity of the UK in the longer term.

“That such a large number and wide range of organisations should come together to form the Health Inequalities Alliance is a powerful statement that now is the perfect time to reduce the gap in healthy life expectancy by taking the right steps to reset the NHS, make social care sustainable, and reinvigorate our approach to public health.”

Professor Michael Marmot, Director of the UCL Institute of Health Equity and author of several key reviews looking at health inequalities, said: “The pandemic has exposed and amplified underlying inequalities in society. Health inequalities are the result. Tackling the social causes of health inequalities is even more urgent now. It is so important that these health care organisations have taken a leadership role in improving the health of the whole of society.”

Note to editors

A copy of the RCP’s letter to the Prime Minister and a full list of IHA members can be found below.

Yonder conducted an online sample of 2,129 UK adults 16+ between 5 and 6 October 2020. Data is weighted to be representative of the population of United Kingdom. Targets for quotas and weights are taken from the National Readership Survey, a random probability F2F survey conducted annually with 34,000 adults. Yonder is a founder member of the British Polling Council and abides by it rules. For further information see http://www.britishpollingcouncil.org/

 

To: Prime Minister
Cc: Cabinet ministers

 

21 October 2020

 

Dear Prime Minister

I am writing to you on behalf of the Inequalities in Health Alliance (IHA), a new coalition of almost 80 organisations with an interest in improving the health of the UK. We will launch the IHA publicly on 26 October. In February, following the publication of Health equity in England: the Marmot review 10 years on, I wrote to you along with other medical royal colleges and the Royal Colleges of Midwifery and Nursing urging you to adopt its recommendations and go further.

While we have since been concentrating on responding to the pandemic, health inequality has remained a strong focus. Indeed, with its impact felt differently by different communities, COVID-19 has exposed how health inequalities can have an impact not just over a lifetime, but a matter of weeks.

We have come together around three things we think the government needs to do as quickly as possible:

develop a cross-government strategy to reduce health inequalities

  • commence the socio-economic duty, section 1 of the Equality Act 2010
  • adopt a ‘child health in all policies’ approach.

As you can see from the membership list of the IHA, these calls have broad support across the health and care sector.

A cross-government strategy is required because health inequality is the result of many and varied factors. As the secretary of state for social services said in his foreword to the 1980 Black Report, written by one of my predecessors, “the influences at work in explaining the relative health experience of different parts of our society are many and interrelated.”

Mr Jenkin went on to say it was “disappointing that the Group were unable to make greater progress in disentangling the various causes of inequalities in health” but he recognised that “the difficulties they experienced are perhaps no surprise given current measurement techniques.” We now have a wealth of data and ways of analysing, and I have no doubt your chief adviser and his team will be able to do that disentangling.

The socio-economic duty is key to ensure that the needs of vulnerable people, who can all too often be forgotten, are considered in every decision. It is vital that the impact of policies made at the highest level of government on the poorest in society are weighed up before final decisions are made. This gives us the best chance at avoiding unintended consequences falling disproportionately on the most disadvantaged.

 

Finally, the importance of early years for adult outcomes is also well known. The pandemic has again reminded us of the importance of high levels of general good health. We welcome your recent focus on obesity, because we have seen all too clearly that by allowing more and more children to become obese in the past, we increased their risk of dying from COVID-19 in the present. We need to be prepared for future pandemics, and make sure all public policy is focused on making sure every child has the best chance of good health throughout their life.

Doing these things should be a key part of getting the UK back on track. And the public agrees. In a recent poll by Populus commissioned by the RCP, we found that

81% agreed that there should be a UK government strategy to reduce health inequality

  • 78% agreed that all parts of government in each part of the UK should have to consider the impact of their policies on the less well off.

When asked which one aspect of health inequality concerned them the most, 24% said access to healthcare, followed by the prevalence of poor mental health at 17% and long-term health conditions at 16%. Problems with access to healthcare have of course been exacerbated by the pandemic, and we are pleased to be supporting the ‘Help Us, Help You – NHS Access’ campaign.

There are many things to do as a country in order to take control of the pandemic now and recover from it in the near future. A focus on health inequalities is one way in which we can tackle COVID-19 in the short term and help to reduce its impact upon the health and prosperity of the UK in the longer term. Chief among our tasks are resetting the NHS, making social care sustainable, and reinvigorating our approach to public health. We have the perfect opportunity to make sure that how we do these things reduces the gap in healthy life expectancy, that at its widest is 20 years between the richest and poorest areas of the UK.

As I said in February, the goal of 5 years of extra healthy, independent years of life by 2035 set out in the industrial strategy is a significant challenge, but one we must meet. Given life expectancy for the most deprived women fell by 6 months between 2012–14 and again in 2015–17, improvements will need to be seen by the next general election at the latest.

On behalf of the IHA, I urge you to give serious consideration to what we are calling for. We are not writing to criticise government efforts. Rather, we are stating the worrying facts of where we are as a nation and sharing our growing concerns about health in its broadest sense. We want to help people live longer and healthier lives so they can contribute socially, economically and creatively to the future  of the UK – an ambition I know we both share.

I look forward to meeting with you to discuss this in detail, and my office will be in touch with yours within the week to arrange that.

 

Kind regards

 

Professor Andrew Goddard MD, PRCP

President, Royal College of Physicians 

on behalf of the members of the Inequalities in Health Alliance

Members of the Inequalities in Health Alliance (updated 20/10/20)

  1. Academy of Medical Royal Colleges
  2. Alcohol Health Alliance
  3. Association for Palliative Medicine of Great Britain & Ireland
  1. Association of British Neurologists
  2. Association of Directors of Public Health
  3. Asthma UK
  4. British Association for Sexual Health & HIV
  5. British Association for the Study of the Liver
  6. British Association of Audiovestibular Physicians
  7. British Association of Dermatologists
  8. British Association of Physicians of Indian Origin
  9. British Cardiovascular Society
  10. British Dietetic Association
  11. British Geriatrics Society
  12. British Heart Foundation
  13. British HIV Association
  14. British Lung Foundation
  15. British Pharmacological Society
  16. British Psychological Society
  17. British Society for Allergy and Clinical Immunology
  18. British Society for Genetic Medicine
  19. British Society for Haematology
  20. British Society for Immunology
  21. British Society of Gastroenterology
  22. British Society of Rehabilitation Medicine
  23. British Society for Rheumatology
  24. British Thoracic Society
  25. Clinical Genetics Society
  26. Doctors of the World
  27. Equality Trust
  28. Faculty for Homeless and Inclusion Health
  29. Faculty of Forensic and Legal Medicine
  30. Faculty of Intensive Care Medicine
  31. Faculty of Occupational Medicine
  32. Faculty of Pharmaceutical Medicine
  33. Faculty of Public Health
  34. Faculty of Sexual and Reproductive Health
  35. Faculty of Sports and Exercise Medicine
  36. Guys’ and St Thomas’ Charity
  37. Health Foundation
  38. Institute of Health Equity
  39. Intensive Care Society 43. Joint Royal Colleges Ambulance Liaison Committee
  40. Local Government Association
  41. Medact
  42. National Voices
  43. NHS Clinical Commissioners
  44. NHS Confederation
  45. NHS Providers
  46. People’s Health Trust
  47. Pharmacist Cooperative
  48. Royal College of Anaesthetists
  49. Royal College of Emergency Medicine
  50. Royal College of General Practitioners
  51. Royal College of Midwives
  52. Royal College of Nurses
  53. Royal College of Ophthalmologists
  54. Royal College of Paediatrics and Child Health
  55. Royal College of Pathologists
  56. Royal College of Physicians
  57. Royal College of Physicians and Surgeons of Glasgow
  1. Royal College of Physicians Edinburgh
  2. Royal College of Psychiatrists
  3. Royal College of Radiologists
  4. Royal College of Surgeons Edinburgh
  5. Royal College of Surgeons Faculty of Dental Surgery
  1. Royal College of Surgeons
  2. Royal Colleges of Obstetricians and Gynaecologists
  3. Royal Pharmaceutical Society
  4. Royal Society for Public Health
  5. Scottish Deep End Project
  6. Social Work Scotland
  7. Society for Endocrinology
  8. Society of Acute Medicine
  9. Strategy Unit
  10. Town and Country Planning Association
  11. UK Health Alliance on Climate Change

Warning of ‘risk to life’ without action to protect people sleeping rough this winter

PRESS RELEASE

EMBARGOED until Thursday 8 October 00.01hrs

 

Medical bodies and homelessness organisations warn of ‘risk to life’ without action to protect people sleeping rough this winter

 

Seventeen of Britain’s leading health and homelessness organisations, including the Royal College of Physicians, Royal College of General Practitioners, Crisis and St Mungo’s have issued a warning that without urgent Government action to protect people forced to sleep rough this winter, lives will be at risk from the double threat of coronavirus and cold weather.

The group, which includes leading experts and a member of the Government’s SAGE advisory committee, is calling on the UK Government to ensure everyone who is sleeping rough is given safe, self-contained accommodation as a priority due to the high risk of coronavirus transmission in communal night shelters. They urge that councils are provided with the vital funding needed to protect people from the virus.

Their call comes as concerns rise that, as the weather turns colder, night shelters will be used to accommodate the increasing numbers of people sleeping rough as councils don’t have the funding for self-contained accommodation such as hotels, as was seen at the start of the pandemic.

The group warns that social distancing and proper safety measures for communal and dormitory-style shelters are likely to be all but impossible and should not be the answer ahead of the winter months. The group draws on international examples of communal shelters staying open during the pandemic which have shown the risk to life of this approach.

In March, the Government moved over 15,000 people who were sleeping rough into emergency, self-contained accommodation including hotels. According to a study in The Lancet this response meant an estimated 266 deaths were avoided during the first wave of the pandemic among England’s homeless population, as well as 21,092 infections, 1,164 hospital admissions and 338 admissions to Intensive Care Units1. The researchers predict that failure to maintain such measures could lead to further spread of the virus and more deaths among people who are homeless.

Previous studies have shown that people who are homeless are three times more likely to experience a chronic health need, including respiratory conditions. Warning that the economic consequences of the pandemic “will see more and more people pushed into homelessness,” the group warns that lives will be at risk if the Government does not act now to provide the funding and accommodation needed to protect people.

Jon Sparkes, chief executive of Crisis, said: “Without Government action, the reality of what could happen this winter is terrifying. Predictions of deaths among people who have nowhere else to go, other than our streets, or sleeping in communal night shelters that are not COVID-secure, must act as a wake-up call to Government.

“We cannot have hundreds, or even thousands of people forced to live in crowded places, where proper social distancing is impossible, and the risk of coronavirus transmission is incredibly high. The ‘Everyone In’ scheme saw unprecedented efforts to protect people, and undoubtedly saved lives – this must be repeated. As we face a second wave of coronavirus, Government must provide somewhere for each and every person sleeping on our streets to live and self-isolate safely.”

Professor Andrew Goddard, president of the Royal College of Physicians said: “This winter is set to be one of the hardest we’ve faced, particularly with the added pressure of COVID-19. For those who are homeless, or who have been pushed into homelessness by the pandemic, the threat is even more acute.

“We know that the efforts made to support homeless people during the first phase of the pandemic were truly life-saving. As we enter a second wave of COVID-19, these steps need to happen again.

“Without urgent action from the government to keep homeless people off the streets this winter, lives will most certainly be lost.”

Alex Bax, chief executive of Pathway said: “We must go on keeping people safe from the virus and that must mean helping people off the streets.

“International evidence indicates that shelters with communal sleeping arrangements cannot be made Covid safe, regardless of the control measures in place.

“People experiencing homelessness must NOT be left on the streets but cannot be accommodated in venues with communal sleeping facilities. As levels of infection rise Government needs to provide the resources required to prevent hundreds of avoidable deaths among homeless people.”

 

-Ends-

Notes to Editor

Letter: https://we.tl/t-DjaH9tI4C7

Signatories include:

Jon Sparkes, Chief Executive, Crisis
Professor Andrew Goddard, President, Royal College of Physicians
Professor Martin Marshall CBE, Chair, Royal College of General Practitioners
Dr Katherine Henderson, President, Royal College of Emergency Medicine
Dr Adrian James, President, Royal College of Psychiatrists
Professor Andrew Hayward, Director, UCL Institute of Epidemiology and Health Care
Dr Marcel Levi, Chief Executive, University College London Hospitals NHS Foundation Trust
Christina Marriott, Chief Executive, Royal Society for Public Health
Professor Maggie Rae, President, Faculty of Public Health
Dr Chaand Nagpaul, Council Chair, British Medical Association
Professor Parveen Kumar, Chair, British Medical Association Board of Science
Dr Nigel Hewett OBE, Secretary, Faculty of Homeless and Inclusion Health
Dr Crystal Oldman CBE, Chief Executive, The Queen’s Nursing Institute
Alex Bax, Chief Executive, Pathway
Steven Platts, Chief Executive, Groundswell
Steve Douglas CBE, Chief Executive, St Mungo’s
Polly Neate CBE, Chief Executive, Shelter

 

  1. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30396-9/fulltext

 

See also:

Frailty among the homeless population comparable to that of 89-year-olds in the general population

Paper: Rogans-Watson, R., Shulman, C., Lewer, D., Armstrong, M., Hudson, B.F  

Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel. Housing care and support.

 

People experiencing homelessness are some of the most disadvantaged within our society. Homelessness is associated with extremely poor health outcomes with mortality rates 3–6 times those of the general population. Homelessness in the UK has been steadily rising throughout the past decade – having more than doubled since 2010.

When in their 30s, 40s, and 50s people who are homeless often experience health problems similar to much older people. Hostels and health services are not set up to deal with this.

This research, conducted in partnership with Pathway and researchers at the Marie Curie Palliative Care Research Department and Institute of Epidemiology & Health Care at UCL, involved the first exploration of premature aging among people experiencing homelessness in the UK. It involved a detailed geriatric health assessment of residents at a hostel in London.

Though the average age of participants was 56 (ranging from 38-74), the levels of frailty were comparable to 89-year-olds in the general population. Conditions usually associated with old age were common, with more than half experiencing falls, visual impairment, low grip strength, and mobility impairment. Cognitive impairment was also found to be prevalent but under recognised and rarely diagnosed. In addition, all participants had more than one long-term health condition, with an average of 7 long-term conditions identified per person. This is greater by far than even the oldest people in the general population.

These results might feel less unexpected among residents of a nursing home rather than a homeless hostel.

However, hostel staff are not healthcare workers. Their role is to support people to recover and move out of homelessness. This particular hostel had some support from specialist homeless nurses and a GP (most hostels in the UK do not have such services) but in spite of this, many health needs were unmet. Over a third reported difficulty managing medications, but functional assistance and care packages were rarely provided. Non-clinical hostel staff were the main source of support for residents.

The study demonstrates the need to assess frailty and consider geriatric conditions in people experiencing homelessness. A needs-based rather than age-based approach is essential, and would help reduce profound health inequities seen in this population. Good practice might include frailty screening by hostel staff, followed by comprehensive assessment in selected residents by a clinician. Selected patients should have care coordinators, as is recommended for frail older people, with cases reviewed in wider multi-agency meetings that include housing and social care services. There is a need for improved access to Care Act 2014 assessments in hostels and increased availability of appropriate stable sheltered housing and residential placements for older people who have experienced homelessness.

The degree of frailty and physical vulnerability also highlights the potentially devastating risk of COVID-19 to many homeless hostels, the need for vigilance to support social distancing, screening to detect outbreaks at an early stage, and self-isolation of people who are symptomatic. Without these interventions, outbreaks like those already seen in care homes could lead to a high number of preventable deaths among hostel residents.