From crisis response to a new reality

Supporting the needs of people experiencing homelessness during and beyond COVID-19

COVID-19 has brought about a rapid change in the way health and care services are being delivered. 

Social distancing measures have led to reduced face-to-face contact, increased isolation and loneliness, and a growing preference for digital models of care and engagement. Local authorities have also been enabled to act quickly and decisively to find housing for people experiencing homelessness during the pandemic.

This is an ever changing picture. As lockdown is gradually lifted and we move to a new reality, it is important to reflect on these changes and ask: what does this all mean for people experiencing homelessness?

What did we already know?

The Hard Edges Scotland study revealed that around 6,000 people in Scotland experience homelessness, substance misuse and offending at the same time.

People experiencing homelessness who have multiple and complex needs may require a level of care coordination.

Health and social care services have traditionally been set up to deal with one condition at a time rather than multiple health problems meaning that it can be incredibly difficult for people to have all of their health needs coordinated and addressed at once.

The Scottish Government's research into health and homelessness revealed that people experiencing homelessness are more likely to attend accident and emergency (A&E) departments and acute services than people of similar age and sex in the most deprived and least deprived communities in Scotland. It also showed an increased interaction with health services preceding an application for homelessness and this suggested that there is an opportunity for health and care services to explore opportunities to work with housing and homelessness organisations to prevent homelessness and mitigate the wider impacts on people's health and wellbeing.

What's happening now?

Over the last few weeks, we have spoken with front line staff, who work with people experiencing homelessness and complex and multiple needs to understand how the people that they support are accessing services during COVID-19.

We hear often that health services can be inaccessible due to the restrictions currently in place, meaning that services which were difficult to access pre-COVID are even harder to access now. Support workers can no longer accompany their clients to appointments as a result of social distancing and this puts patients under additional pressure.

Multiple outreach teams are working to singular issues, all accessing the same people but only able to offer one part of a solution at a time. There is a real requirement for better coordination.

However, COVID-19 has created a willingness for change and there is a real appetite across services to maintain improvements in closer working, collaboration and information sharing going forward and not return to the old ways of working.

One thing that has really struck us in these conversations is the level of optimism and enthusiasm that exists amongst those critical front line services that we can capitalise on the lessons we are learning now to inform a better way of coordinating our approach in the future.

As we speak to people, we hear amazing stories of how historic barriers have been removed and how staff, and organisations, are working together to support people during the pandemic. From the great work done to house rough sleepers in hotels which has allowed health services to engage with people successfully, to the rolling out of video consultations for homeless patients by Edinburgh Access Practice, there are many great examples of collaboration and innovation.

One of the main challenges is how we coordinate and formalise the activities into structures that allow the good work to continue. As we heard from one homelessness organisation:

"One of the biggest risks is coordination. There's a lot of resources trying to reach the same people, we need better coordination. People do mean well, there's new initiatives starting all the time but if it's hard for staff to figure out what's happening across the city think how difficult it is for the people trying to access them."

What can we do in the future?

There has been a renewed commitment from The Scottish Government to put "tackling homelessness at the heart of our COVID-19 recovery." This a welcome commitment and it is encouraging to see the Homelessness and Rough Sleepers Action Group (HARSAG) reconvened to provide a structure to make this a reality.

New approaches are undoubtedly required to sustain the momentum of the good work already happening, however we should also look to capitalise on existing effective structures and areas of good practice. How can we take into account what we have learned during COVID-19 to affect change in the planning and commissioning of services?

A strong value base for collaboration and person-centred outcomes exists across the sector. The COVID-19 response has highlighted how strong leadership and trust has empowered staff to work differently and improve outcomes for people and it is important that we look to understand how we sustain this going forward.

People with lived experience, combined with the knowledge and expertise of front line staff, should be central to the co-design of services that truly meet the needs of the people they are trying to serve.

As one person we spoke to said:

"The willingness is there, the relationships are there, we need someone to sit with a plan to utilise services to their maximum. At the moment everyone is doing their own bit of their own plan but it's insular, we need to be more coordinated."   

This is a crucial time for homelessness in Scotland. There is a real opportunity to capitalise on the fantastic work that is already happening.

COVID-19 has brought into sharp focus the requirement to coordinate services around the needs of people and this should be forefront in our minds as we plan for a better future where people are able to access the help they need.