St Mungo’s Covid-19 and rough sleeping report: “Homelessness and health are inextricably linked and must be addressed together – starting with prioritising access to the Coronavirus vaccine”

Leading homelessness charity publishes new research examining health and homelessness during the pandemic, and calls on Government to adopt a new approach.

The Government has a ‘once in a generation chance’ to end rough sleeping but in order to do so must treat homelessness as a health, not just a housing, issue – and start by including those who are homeless in the group given priority access to Covid-19 vaccines.

Those are the recommendations of leading homelessness charity St Mungo’s which has today (26 January) published a new report – Housing and health: working together to respond to rough sleeping during Covid-19 – focusing on the health of people experiencing homelessness during the pandemic.

The research reveals almost one in four (24%) of the charity’s clients had a health condition which put them at serious risk from the virus, with illnesses such as diabetes, heart disease and severe respiratory conditions being common.

It also found:

  • 28% of St Mungo’s clients in emergency hotels were classed as vulnerable or extremely vulnerable to Covid-19; this rose to 54% of clients in Housing First and supported housing services
  • 18% of clients in emergency Covid-19 hotels were not registered with a GP when they moved in, despite there being no requirement to have a fixed address in order to register at a GP surgery, and
  • People accommodated in emergency hotels in London were twice as likely as the general population to be classed as ‘extremely clinically vulnerable’ (6% compared to 3% in assessments carried by the University College London Hospital Find & Treat team)

The report acknowledges the success of the Government’s ‘Everyone In’ initiative, which has now seen 33,000 people moved in to safe emergency accommodation, hailing it as ‘a monumental, collaborative effort involving both health and homelessness services as well as national and local government’.

It concludes there were two overarching factors which led to better health and housing for people helped by the approach to the first wave. Firstly, the provision of safe, clean, en-suite accommodation alongside the support that is needed and secondly, joined-up working between health and homelessness teams.

The report makes a total of 15 recommendations which include the expansion of the Rough Sleeping Accommodation Programme; the restoration of the £1bn lost to local authorities for funding homelessness and housing-related support services since 2008/9; and the importance of local authorities incorporating health needs into their homelessness and rough sleeping strategies, as good practice.

It calls for the following recommendations to be actioned immediately:

  1. Ensure people who are homeless are included in the priority group for the Covid-19 vaccine
  2. Stronger partnership working between housing and health services, with continued collaboration between the relevant Government departments along with Public Health England and the NHS
  3. Build on the success of ‘Everyone In’ and ensure the principle that there is sufficient, safe accommodation for everyone who needs it supported by the necessary Government funding
  4. Ensure continued access to emergency accommodation, immigration advice and employment support to people who are sleeping rough and have no recourse to public funds

Steve Douglas CBE, St Mungo’s Chief Executive, said: “Firstly we must thank all of our clients and all those who took part in this vitally important piece of research.

“We know from their stories told in this report, and from our experience as front-line practitioners, that health and homelessness are inextricably linked. ‘Everyone In’ was so effective because that is what happened.

“We worked together with health and local authority housing colleagues to identify the services and medical support that our clients needed. It was so much more than just providing a safe place to stay.

“Doctors and nurses were in the hotels, medication prescribed was delivered on site. We made it easier to get the help so many clients desperately needed, and the results are undeniable. People’s health improved – some for the first time in years. It undoubtedly saved lives.

“Now we need to make that ‘emergency’ response and the ‘Everyone In’ principles of joint working  become the norm. It is not difficult to do, but will need a different approach – starting by including those who are experiencing homelessness being included in the priority group for accessing Coronavirus vaccines.

“We urge all MPs, and everyone working across Government, to read this report and to take the learning from it. This is a once in a generation chance to make the changes needed to achieve our shared goal of ending rough sleeping. It must not be wasted.”

Ian, a St Mungo’s client who had been sleeping rough for five years before being accommodated during ‘Everyone In’, said: “Since coming off the streets, my health has improved. It is so important to be healthy and this is not possible when sleeping rough, especially during a pandemic.

“My weight was down to nine stone, but now it’s up to 11. If it wasn’t for St Mungo’s, I’m sure I’d be in a bad way health wise. In effect, they saved my life.”

Baroness Louise Casey, who led the Government’s initial response to homelessness during the pandemic, supports the report’s findings saying: “It has taken the Coronavirus crisis for people to see rough sleeping for the public health emergency it is.

“The Government has an option here to build on the successes of ‘Everyone In’. And it is clear that the dual issues of health and homelessness have to be addressed together, and must be actioned as a matter of urgency.”

Leading homeless health nurse at University College London Hospitals NHS Foundation Trust Samantha Dorney-Smith, who contributed to the research, echoed Baroness Casey saying: “This report underlines the vital role of good quality housing and key worker support, in protecting and improving the health of people experiencing homelessness – as well as the importance of providing accessible health services.

“Covid-19 represents a huge threat to people experiencing homelessness, and it is commendable that the Government funded ‘Everyone In’ programme – with associated voluntary sector support – has saved so many lives, and provide people with support that they wouldn’t otherwise have had.

“However we need to ensure that we learn from this programme, and sustain the gains, and I thoroughly endorse the recommendations made in this report.”

The research – which was carried out by St Mungo’s staff with clients from across a range of services – analysed data from needs assessments of 4,922 clients in total, 939 of whom were staying in the emergency ‘Everyone In’ hotels.

Since the start of the pandemic St Mungo’s has managed 32 hotels, supported 3,364 people in emergency Covid-19 accommodation and helped over 1,300 of those to move into longer-term accommodation.

The report released today builds on previous research by St Mungo’s showing that people who are homeless have worse health than most, and yet they find it harder to get the healthcare they need.