'It’s an opportunity to improve homeless people’s health'

With many homeless people temporarily housed in hotels during the pandemic, nurses have moved to tackle health inequalities while advocating for those left outside, says Rosa Ungpakorn, Advanced Nurse Practitioner at Central London Community Healthcare NHS Trust’s Homeless Health Service

Homeless health nurse practitioner Rosa Ungpakorn

We’re a responsive service anyway, but when the COVID-19 pandemic began, we had to think on our feet even more than usual. We’re lucky that our team is cohesive and willing to change, but it has still been challenging to adapt so quickly.

Our usual week would involve providing nurse practitioner clinics for people who are homeless, every Monday to Friday in day centres in Westminster and on rotation around several homeless hostels in Hammersmith and Fulham.

Before COVID-19 we had increased our street outreach with a pilot, Westminster Street Nurse. We had one nurse on shift all week, working in partnership with housing outreach teams to proactively bring health care to people.

Just before official lockdown happened, day centres were forced to close, as they were concerned about the health of the people using their services. Then the government gave funding to councils to house people in emergency accommodation – a lot of our patients are now in hotels, which is really good.

We quickly started supporting hotels. We’ve developed a standard operating procedure in line with primary care guidance for COVID-19, trying to do a lot of work on phones. We do have some face-to-face work, for example applying dressings, but we’re helping people to self-manage as much as possible.

We’re supporting patients with any health concern at all and helping people register with GPs, but as nurse practitioners we can deal with lots of the problems ourselves and are able to prescribe.

In mid-May, there were still 140 people on the street in Westminster which was alarming to see. St Mungo’s has assessed a lot of those people and many have conditions that make them more vulnerable to COVID-19, so there is more to be done to protect our homeless communities during this pandemic.

There’s a real worry that people in hotels will end up on the streets again too, which is why we feel street outreach is so important. We increased our capacity and now have two nurses every day, using bikes to cover larger distances and avoid public transport.

A homeless health nurse from the Westminster Street Nurse programme speaks to a patient on a London street

Above: Westminster Street Nurse in action 

We used to give outreach packs to people we saw before COVID-19, but we’ve adapted these to include hand wipes, soap, a government leaflet on the virus, foil blankets, and a snack bar because people have been struggling to get food. We’ve given our contact details and explained the symptoms of COVID-19 and said if they develop any of those to give us a call.

There isn’t any government guidance about how to do health-related street outreach, so from our pilot and from published research I did last year, I’m putting together guidelines. There’ll be a lot of things we can add that we’ve adapted and improved during COVID-19, so that should mean they’re even better when they’re published.

We’ve also got a new closer partnership with Turning Point Drug and Alcohol Wellbeing Service. If people are going into hotels and they’re using drugs, in order for them to stick to the ‘stay at home’ advice, it was thought necessary to get them onto methadone scripts. Lots of people who’d never considered getting on a methadone script before have decided they would like to do that. That’s been really positive.

The emergency accommodation has taken the strain off – people can now think about their health and at the same time access health care more easily

Bizarrely, there are pros and cons of COVID-19. Suddenly all this emergency accommodation has been given, but it’s so important that it can be given to everybody. When people are on the street, they’re just surviving. It’s hard to prioritise health when you’re trying to find somewhere safe to sleep, something to eat and a shower. The emergency accommodation has taken the strain off – people can now think about their health and at the same time access health care more easily.

We’re seeing people who’ve been on the street for years, who now look so well from being able to sleep in a bed, having food delivered regularly and all the people on methadone scripts are reducing their drug use.

There are huge health inequalities. The average life expectancy for people who are homeless is 44 for men and 42 for women. We’re planning what else we could do if the government does continue the funding – interventions to target these inequalities, like bloodborne virus screening, complete vaccination courses, smear tests and contraception. It’s likely that these interventions would be so much more successful, because people are inside. It’s an amazing opportunity to improve people’s health.

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