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  • Improved access to ongoing healthcare aided by updating of patient records (nearly half were found to be out of date or incorrect on admission) and registration of non-registered patients with a GP.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



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


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


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.”



Notes to Editor


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




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.


Pathway and Crisis explore a closer, long-term relationship


Pathway and Crisis are in active discussion about opportunities to work more closely together to better address the health needs of people who are homeless, including the prevention of homelessness in health and NHS settings. The Coronavirus pandemic has highlighted once again that homelessness must also be seen as a public health issue, and yet opportunities to resolve homelessness through healthcare systems are routinely missed.

The two organisations are now exploring the options for a merger and a new group structure. This could take the shape of Pathway remaining a separate charity while becoming a subsidiary of Crisis. Details of such an arrangement will be explored over the next few months and include conversations with a variety of our respective stakeholders.

Should these discussions lead to a merger, the overall objective would be to increase our joint impact:  on the lives of people using our services; on the spread of inclusion health services and the quality of clinical practice across the NHS; and in wider policy and system change. Both organisations share a vision of the National Health Service delivering world-leading, evidence-based interventions to end homelessness and the suffering and ill health that flow from it.


Make COVID19 emergency housing provision permanent


Pathway, the Faculty for Homeless and Inclusion Health, and the London Network of Nurses and Midwives, call on government to continue the groundbreaking approach to housing and healthcare provision for people experiencing homelessness, that has been set up as part of the national response to Covid19.

We acknowledge and are grateful that UK Government and local authorities distributed previously unimaginable funds to quickly mobilise rough sleepers off the streets and into accommodation at the outset of the public health crisis.

We have a once in a generation opportunity to achieve something remarkable:


we can end homelessness.


And we can do this as a direct result of the public health approach driven by the COVID-19 emergency.

It was a huge change and achievement to move people out of homelessness. We are calling for this change to be made permanent.

Read our full statement and recommendations: UK Homelessness: Press the reset button


Open letter and Homeless Sector Plan






Pathway has today 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.

Covid 19 and homelessness – Government guidance for hostels and day centres not helping

Statement in response to new UK Government guidance, 17 March 2020

Pathway is deeply worried that the guidance issued by Public Health England yesterday (16 March 2020) fails to address many of the practical concerns being raised by specialist homeless clinicians and the homeless charity sector across the country.

We are already hearing reports that following the guidance is resulting in homeless patients being told by NHS 111 and local authorities to go to A&E.  At the same time A&E colleagues in at least one central London hospital report telling people with mild symptoms to go back to the street. Homeless patients very obviously have nowhere to go and self isolation on the street is not possible!

Professional colleagues in infectious disease epidemiology and in the clinical management of homeless patients have been working on a detailed plan to look after homeless patients with compassion and care, and to avoid a serious spike in Covid 19 infections in the homeless population in London. The plan proposes rapid, active testing for Covid 19 in all London’s homeless services, separating homeless patients who test positive from those who are virus free, and setting up new emergency temporary facilities (perhaps in hotels or other currently available vacant buildings) to care separately for each group.

“Test – Triage – Cohort – Care.”

To be effective we need the NHS, homeless charity sector, local authorities and public health services to mobilise resources rapidly. Delay will increase the level of background infection and reduce the effectiveness of measures to isolate vulnerable patients.

People experiencing homelessness are a very high-risk group. Compared to the general population people experiencing homelessness are 2.5 times more likely to have asthma, 6.5 times more likely to have heart disease, 10 times more likely to have COPD and 34 times more likely to have tuberculosis. Long-term homelessness is already associated with a mortality risk 10 times that of the housed population.

Pathway’s CEO Alex Bax said: “People on the street are by definition vulnerable to infection. The homeless population has very high rates of all the conditions known to increase the serious risks of Covid 19. We need rapid, co-ordinated action across all services, underpinned by clear clinical leadership and based on a coherent plan. The Government has said resources are available. We need to see them start to flow now, and crucially this means access to testing.”