written 9 February 2021

By Lucy Abraham and Glass Door's advocacy working group

Within the first weeks of 2021, one front-line staff member and one guest of Glass Door Homeless Charity’s hostel service tested positive for Covid-19. It could have been worse. Thanks to frequent testing, thorough COVID-safety procedures and quick responses, we were able to identify and contain the infection. Yet new data from University College London revealed the pandemic is rapidly spreading now within the homeless population of London, with the number of cases in January more than double that seen in the whole of last year.

An outbreak within a homeless setting would be disastrous. The people we support often have health problems you would expect to find in people decades older. The average age of death of a homeless man in London is 47, around 30 years below the figure for the population as a whole. For women, it is 43. Health outcomes for this group are equivalent to some of the most clinically vulnerable, yet their illnesses often remain under-diagnosed.

Homelessness is not only a housing issue; it’s also a public health issue. It’s clear to Glass Door and many in the sector that this group needs a special, targeted vaccination plan.

Barriers

Officially, the homeless population is not recognised as a special group to receive prioritisation for Covid-19 vaccinations. They are expected to receive the call from their GP based on age and clinical vulnerability along with the rest of the population. However, we can’t ignore the barriers that many in this group face.

If someone is not registered with a GP and/or does not have a formal diagnosis of their pre-existing conditions, they won’t receive that crucial GP call.

We believe everyone should have a safe home, and as the largest open-access provider of homeless services, Glass Door supports many who have been turned away elsewhere. We know how important it is to make accessing services as easy and barrier free as possible.

We are working with local GPs to encourage everyone we support is registered. Some people have trouble filling out forms. Some wrongly assume they need an address to register with a GP or have been turned away by a receptionist. Undocumented migrants, refugees or EU nationals might be unwilling to seek official help for fear of reprisal from a system that has a history of being hostile. Our caseworkers are there to fight their corner.

Yet misinformation is rife, and conspiracy theories need countering. Many have faced repeated barriers to accessing housing, which has led to a generalised distrust in institutions.

We and our colleagues in the homeless sector have our work cut-out for us, and we can’t be everywhere.

A different approach

Earlier this year, some local authorities, including Oldham, Redbridge and Liverpool, took it upon themselves to prioritise individuals who are homeless, irrespective of clinical stratification.

In Liverpool, 363 individuals within the homeless population were vaccinated over a weekend in January. A follow-up report revealed that many were wary of taking up the opportunity, with only 58% selecting to have the first dose. One factor that seemed to make a positive difference: involvement of a trusted and engaged team. "We found that hostels where support workers were encouraging of the vaccination programme had a much higher uptake.  Detailed communication with hostel workers before the programme would likely increase uptake," the report explained

Relationships matter

We are pleased to see more local authorities coming on board. The next step will be to think creatively in the ways we facilitate opportunities for vaccinations.

We believe the best chance we have is bringing the vaccination to people and having care workers involved who are already embedded within the community.

“A window of opportunity”

The Mayor of London’s health advisor Dr Tom Coffey and the Deputy Mayor for housing Tom Copley have written to the Joint Committee on Vaccination and Immunisation urging them to use flexibility in their guidance to ensure rough sleepers are prioritised for vaccination.

They note that 800 individuals are currently in hotels thanks to funding from the Greater London Authority, currently due to end at the end of March. They write: 

We have a window of opportunity to vaccinate this group while this emergency accommodation is in place.

The same holds true for all those now staying in emergency winter accommodation. About 100 guests stay in rooms provided by Glass Door in central London. Across London, faith-based groups support another 300 during winter. When these programmes wind down in late Winter or early Spring, hundreds of people will be dispersed across London.

Let’s not squander this opportunity to reach people while we can. This pandemic has shown us that we are all connected. No one is safe unless we are all safe.

People experiencing homelessness are already some of the most marginalised, hard to reach and vulnerable members of our communities. Our best chance of reaching this population is to listen to their concerns, develop and distribute resources with trusted community centres, and bring vaccination programmes into the shelters, hostels, hotels and day centres visited by people who are affected by homelessness.


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