“Everything’s gone crazy,” says Dr Wan-Ley Yeung, a specialist homeless GP, from his home in Greater Manchester where he is self-isolating. “It’s a really frightening time for [homeless people] and I worry about our client group, particularly the rough sleepers.”
Coronavirus could have a devastating impact on the homeless population, which is already hugely vulnerable, let alone during a pandemic. Forty-one per cent of homeless people have chronic illness, explains Yeung. The average life expectancy in England and Wales is 45 for men and 43 for women. Homeless people are among the most vulnerable to coronavirus, with individuals three times more likely to have a severe respiratory problem.
But staying safe is an almost impossible task for those without a home, and is what worries Yeung and other specialist homeless GPs. “They don’t have places to self-isolate. If you’ve got symptoms, you need to self-isolate. ‘What am I going to do?’ they’ll ask me.”
Official government figures suggested there were 4,677 people sleeping rough in 2018, but this is thought to be a huge underestimate. Last month it was revealed that council data showed almost 25,000 people slept rough in 2019, while charities calculate there are 40,000 people in hostels, night shelters and shared homeless accommodation.
Linda Swash*, 50, is one of those people. She became homeless more than two years ago when she was evicted from her property for falling behind on her rent. She was in a coma in hospital at the time and hadn’t been able to pay her landlord because of her illness. She used to sleep on night buses, but has been in a hostel for 14 months.
“It’s a scary thing for a lot of people,” she says. “You can see the fear in a lot of people’s eyes. I suffer with my lungs. People are saying it’s worse for us because we’re homeless.”
While the situation is worrying, specialist homeless clinicians, charities and local authorities are working together to come up with innovative solutions to the huge problems they face. The government has set aside £3.2m for rough sleepers and Prof Andrew Hayward and Dr Al Story at University College London have developed a plan that is being circulated to local authorities and clinical commissioning groups in the hope that they will adopt its recommendations to be able to test patients and staff, triage people and then house them in places – hotels are being set aside – where they can be cared for.
Meanwhile, specialist homeless GP practices have had to adapt. They are running most appointments over the phone. But getting information and messages out to their client group, a large number of whom don’t use or have phones, has been challenging. Dr Tim Worthley, lead GP at Arch Healthcare in Brighton, which has 1,400 registered homeless patients, says handing out phones has been invaluable.
“We’ve handed out four this morning already,” he says. “We had one person coughing and spluttering with a fever that he’d developed overnight who had no one to contact. He’d been out of prison for five days and in temporary accommodation. I very quickly assessed him in the waiting room, gave him a phone and rang him later to assess him properly.”
Worthley has developed a spreadsheet to keep tabs on anyone who is self-isolating. He takes their details and talks through what mental health, physical and substance misuse needs they have; whether they need food, have access to money and what level of risk they are. “At the moment, we have between 10 and 15 on the list. There have been a few more this morning.”
This system has been potentially life-saving already. He explains: “We sent someone to hospital a few days ago who had rung NHS 111 and been told they would not be got back to until the following evening. We rang her up and she was deteriorating quickly and she hadn’t thought to contact anyone to let them know. She’s now in hospital, but I don’t know yet whether it was coronavirus.”
One challenge proving impossible to overcome is the lack of testing available both for staff and homeless people. “GPs are struggling with this. All the while we can’t test, we are operating in the dark. We desperately need to test ourselves and patients,” says Worthley.
Specialist homeless GP practices tend to be staffed by small teams, so if one person goes off, it leaves a huge gap.
In Leicester, Dr Anna Hiley, who works at Inclusion Healthcare with 800 registered homeless patients and 1,000 registered asylum-seeker patients, has had to work hard to issue guidance in up to 45 different languages. She is using text messages to pass on information but admits: “There’s a degree of uncertainty about what’s going to happen. For non English-speaking people there’s confusion about what they should do. We feel a bit like we’re waiting for something and desperately trying to get ready for it.”
This is a sentiment shared by Dr Natalie Miller and Dr Dana Beale at Great Chapel Street medical centre in Westminster. They started early in coming up with a way to carry on functioning during the outbreak by contacting other organisations responsible for helping homeless people and thinking about what changes they needed to make. They’ve been encouraged by the way charities, the local clinical commissioning group and local authority have come together.
Now, they, along with many others, are keen to find places to host homeless people, both those who have symptoms of Covid-19 and those who need to stay safe. “The medical infrastructure is rapidly being put together. If we can quickly get the hotels and places where we can deliver care, we can mitigate a lot of deaths,” says Beale.
For now, people continue to sleep rough, making self-isolating virtually impossible. It is also not feasible for those living in hostels and temporary accommodation: many have shared facilities, while some have no kitchens and must go out every day for food.
Swash, as she sits in her hostel, knows that the future is uncertain. “I would like to think there’s support. I think they’re putting things in place … and staff are doing the best they can do. If there comes a time when they have to lock down the building, it’s a whole other story.”
She adds: “When staff start to [go off sick if they get the virus], that’s when I can answer how it will be because I have not got a clue. I’ve never been in a situation like this before.”
Although uncertainty and fear remain over what will happen to the most vulnerable in society, there is also hope. Ché Rosebert, a clinical psychologist who works with homeless people and health workers at East London NHS foundation trust, has seen a lot of goodwill over the past weeks. She is also positive about the future: “The good thing in the long run is if we can cut red tape now [with helping homeless people and getting them into accommodation], I don’t see why we can’t in the future.”
Back in Brighton, Worthley contemplates life post-coronavirus. “The hope is that we will realise that people don’t need to sleep rough and that there are alternatives when we get through this crisis.”
* Not her real name
