The COVID-19 pandemic has been challenging for everyone, but for some people their personal situation has created additional pressures on top of what is an already difficult situation. In most cases this has made them more vulnerable and exposed to the possibility of contracting COVID-19 and, subsequently, experiencing a poor outcome. The homeless and those living in temporary accommodation are one of these vulnerable groups.
People who are currently rough sleeping or have been homeless in the past, often have underlying health problems that put them at increased risk of developing the worst symptoms of any virus. They are already more likely to die at a much younger age, with the average age of death being 45 for men and 43 for women, compared to 76 and 81 years for the rest of the population (ONS, 2018). However, they can also struggle to access the very health services that could help protect them and give them a better chance at a long and happy life.
In Southend various charities have been instrumental in offering support and helping local people overcome homelessness for good through short-term essential services and long-term solutions. On average (before lockdown), one charity alone (HARP) had over 12,700 visits to their day centre in the year ended March 2020. They’ve helped over 1,000 people who are either homeless or at risk of homelessness every year, as well as providing housing at 27 locations for up to 226 people that might otherwise be sleeping on the streets.
Supporting the health of this vulnerable group is something I feel really passionate about. Although I was used to working in a general practice I was concerned, especially during the pandemic that the most vulnerable in society were not accessing adequate health services. I enjoyed attending home visits in the community and felt especially drawn to move away from my desk and be of service during these difficult times.
I was not sure about what helping the homeless would entail but was determined to give it a go as I felt I could make a difference as well as provide me with a rewarding career.
I am delighted to therefore help deliver the Southend Integrated Homeless Healthcare service, which is the result of a coordinated effort led by Southend West Central Primary Care Network in collaboration with HARP, NHS partners in Southend and Southend-on-Sea Borough Council and others in the voluntary sector. My role involved delivering regular community clinics on everything from vaccination support, all levels of illness from minor to major, chronic disease management, preventative health advice, COVID-19 concerns and promoting sexual health.
Relationships have continued to grow stronger in the last 12 months, as we’ve worked together to support homeless people in for a range of services.
Reaching this vulnerable group to deliver healthcare during the pandemic, has been challenging but essential. Many have a history of addiction, poor physical health and mental health and in many cases far lower life expectancy than the average person. The pandemic has meant that they’ve had to reduce the number of people attending their day centre services at any one time and in their accommodation services, with residents adhering to the same guidelines as everyone.
Protecting staff, volunteers and the clients themselves has been paramount and a vaccination programme has been key to this, therefore once we were given the green light to start vaccinating rough sleepers and vulnerable homeless clients, we went about setting up a vaccination clinic. We wanted to make every contact counted so worked with partners to set a Hepatitis C clinic at the same time run by a HepC Specialist Nurse, based at Addenbrookes Hospital in Cambridge, to screen the clients, smoking cessation, diabetes, hypertension, TB and sexual health services
Clients were invited to specific slots throughout the day, to reduce congestion and waiting times on the day, although they were also able to accommodate those who arrived without prior notice. Their attendance was logged alongside their vaccination details, date and HEPC testing date.
The day was a really positive experience for the staff and clients, with many appreciative and relieved that this service was being made available to the homeless. More importantly, some people who said no or were initially unsure attended later, after their fellow residents returned to their hostel. In all 99 people vaccinated and had a blood pressure test and 66 people had a HEPC test.
A further clinic was held in mid-March this year to invite those that didn’t attend the initial vaccination clinic.
The impact on local communities and services has been hugely beneficial with a reduction in A & E attendances and emergency psychiatric admissions, decrease in substance misuse referrals and an uptake in rehab and, therefore, improved the overall costs to the health services.
We work closely with mental health and addiction services holding regular MDTs to share data ensuring an holistic service.
Case Studies: Through screening we supported a person with liver cancer amongst the homeless residents and as a result arranged priority accommodation. We also identified three people with undiagnosed cases of Hep C and as such they received treatment. We currently are supporting a woman with a breast lump undergoing diagnostic testing who admitted she would not have attended the hospital if hadn’t been for our service.
In real terms we have successfully achieved
- Over 350 homeless patient interventions for a variety of medical problems,
- Hundreds of COVID 19 vaccinations administered to homeless people – first and second doses to date.
- Held two vaccination clinics run at the Bradbury Centre
- Two vaccination sessions at soup kitchens