The approach
National guidance in response to the Covid-19 pandemic requires that all rough sleepers are provided with accommodation in order to safeguard as many homeless people as possible, to bring in those on the streets to protect their health and stop wider transmission, particularly in hot spot areas, and those in assessment centres and shelters that are unable to comply with social distancing advice1 .
The outlined approach is based on the following principles:
- Focus on people who are, or at risk of, sleeping rough, and those who are in accommodation where it is difficult to self-isolate, such as shelters and assessment centres
- Make sure that these people have access to facilities that enable them to adhere to public health guidance on hygiene or isolation, ideally single room facilities
- Utilise alternative powers and funding to assist those with no resource to public funds who require shelter and other forms of support due to the Covid-19 pandemic
- Mitigate their own risk of infection, and transmission to others, by ensuring they are able to self-isolate as appropriate in line with public health guidance.
Key actions taken to support Sheffield’s homeless population
- A local homeless cell has been set-up, led by Sheffield City Council, to plan and manage the Sheffield response to supporting the homeless. The cell includes representatives from the local authority (public health, housing, social care) and local NHS representatives (Sheffield Clinical Commissioning Group, mental health and primary care)
- Sheffield City Council teams are working in partnership with South Yorkshire Police to stop homeless people from congregating in facilities such as day centres, soup kitchens etc. where there is a higher risk of transmission.
- Changes in processes have been put in place to enable rough sleeper teams to gain consent to contact GPs to access medical records to identify people requiring to shield or who are at increased risk so that appropriate accommodation can be offered.
- Significant work has been undertaken to ensure existing services remain in contact with clients in order to continue to provide support. In addition, the rough sleeper team is proactively encouraging those who have not already registered with a GP to register with the Devonshire Green practice in order that their wider primary care needs can also be met.
Challenges
Covid-19 presents a significant risk to the city’s supported, sheltered and temporary accommodation. If these sites were to experience significant levels of infection they would be put under severe pressures. These sites support this vulnerable group well with established supporting infrastructure and have developed relationships with people they support. These relationships are key as they enable individuals to comply with infection reducing actions such as social distancing.
Whilst individual providers have been implementing additional processes and safeguards, St Luke’s Hospice has been working with Sheffield City Council and Sheffield Clinical Commissioning group to deliver online advice sessions on how to safely support rough sleepers and homeless people for supported and temporary accommodation during the pandemic. In addition, St Luke’s Hospice, using Project Echo, specialised video conferencing technology, are managing to advise and interpret the most up to date guidance on Personal Protective Equipment (PPE), infection control best practice for staff and clients, and a whole host of other issues relevant to the situations this vulnerable group may find themselves in.
There is also an additional primary care response provided until the end of March 2020 through the Devonshire Green practice with daily virtual care to patients within hostels and hotel accommodation who are currently unsupported by local primary care and also provide additional advice and guidance to staff as required. A current challenge is the need for additional IT support to be given to the Devonshire Green practice to allow access to patients’ records where they are registered with other practices across the city.
Other achievements
- Agencies and charities are working together even more closely through sharing resources, pooling volunteers and have been able to act quickly to provide a Covid-19 emergency response.
A spotlight on the benefits realisation tool
To ensure that services across the city are configured and co-ordinated to best support the homeless, a benefits realisation tool has been developed. This tool consists of a number of achievements for the individual to work towards with the ultimate aim of delivering the overarching outcome that they can move into structured housing.
One major advantage of the tool is the ability to incorporate the key agencies that support the individual (health, social care, voluntary sector) or that they come across (police etc.). If any particular area(s) is a particular issue for the individual then the mix and bias of the personally tailored achievements can reflect these with the added benefit of enabling all of the agencies to understand better how their roles fit together and support the individual to achieve their overall outcome.
From feedback gathered locally, there is lots of enthusiasm for this approach within a cohort of homeless people where this approach has been trialled, both in terms of the rewards offered (meal vouchers etc.) and also certificates of achievements.
The strength of this approach more generally is that it is underpinned by structured questions. These questions can be used by any of the professionals to gauge success and so does not require complex IT solutions or the systems across the city to share data. This approach also enables a local delivery of services to be developed for all of the achievements so that agencies can have an identical prompt in terms of suggesting services that individuals could access and/or refer them to, helping to ensure consistency of messaging across all the sectors and link to other key areas such as social prescribing.
Implications: How we may work differently in the future
- Recognising the importance of continuing to provide health care to the homeless population during the pandemic, additional funding was agreed to extend extra primary care support offered by Devonshire Green practice until March 2021 and funding for a GP Health Inclusion Champion to support this work for two sessions a week. This provides significant additional support to the homeless population, enabled greater multidisciplinary working across health and social care teams than previously, and additional support to the city’s providers of temporary accommodation.
- Sheffield City Council’s housing team are currently piloting the benefits realisation tool and its outputs will be used to inform partnership working and the strategic development and commissioning of services going forward.
Testimonial from staff and referrals
Knowing how successful the technology is in reaching out to other organisations and communities facing difficult situations, we recognised that the homeless are a particularly vulnerable group who need extra support at this time, and we have been very happy to help.
We have been able advise on the most up-to-date information, such as interpreting PPE guidelines for their sites, infection control best practice for staff and clients, and a whole host of other issues relevant to the situations providers may find themselves in.
This has been an outstanding example of how organisations are coming together at this most difficult time to share their knowledge and experience. St Luke’s is very proud to help fellow care and support workers by sharing knowledge in the fight against coronavirus.
St Luke’s Hospice, Sheffield
