Martin and Rachel on ‘good health’ during a pandemic

In July 2020 Groundswell launched their three year ‘Participation Works’ strategy. Each year of the strategy people from across the organisation will take turns to review progress against one of the three strategic goals: good health, progression and creating change. Four months into the new strategy, Rachel and Martin reflect on Groundswell’s ‘good health’ work; rather timely given we’re living through a major health pandemic.

First published October 2020, written by Martin Murphy, HHPA London Project Manager and Rachel Brennan, #HealthNow Network Coordinator, Groundswell.

We believe health is the foundation to move out of homelessness. When we planned the delivery of our strategy earlier this year we were able to clearly outline the activities that we would carry out that would directly contribute to the good health of the people we support, our volunteers and our staff – through homeless health services, health promotion and ensuring we were a healthy organisation.  All these activities were impacted by the pandemic. Nevertheless, as an organisation we acted quickly and innovatively to flex every aspect of our work to ensure we were still working towards good health, but within the constraints and challenges of covid-19.

In March some Groundswell staff and #HealthNow volunteers attended the Pathway conference.  Dr Al Story (Groundswell trustee) and Professor Andrew Hayward closed the conference outlining the bleak prospect of covid-19 for people experiencing homelessness if immediate action wasn’t taken to ensure people were provided with secure accommodation, appropriate to their individual health and support needs. At the end of March, as England went into lockdown, local councils were instructed to bring ‘Everyone In’ and hotels across the country became emergency accommodation for rough sleepers.

At the time of writing, it seems the ‘Everyone In’ approach prevented the worst fears expressed at the Pathways conference of the effect of the virus on people experiencing homelessness from being realised. This wasn’t down to luck – but the sheer hard work of health teams and homelessness professionals, individuals and services; many of whom we are proud to be in partnership with. Their first consideration was not for their own safety, but the safety and welfare of those people most at risk.

At the core of this tremendous effort and underlying the adaptability of these services and the courage of the individuals involved, is the acceptance, care and compassion they have shown to those in need.  This is demonstrated perfectly by long-term partner Great Chapel Street Medical Centre, a specialist GP surgery for people who are homeless in Westminster. One of our Care Navigator’s Dave who works with the team, reflected on their work a month into the pandemic. The qualities of acceptance, care and compassion are often unrecognised and undervalued; but in reality it seems they are quite possibly the biggest factor in keeping the number of cases and therefore deaths down so far. These qualities must continue to be prioritised as winter approaches and covid-19 continues to spread.

Throughout Groundswell’s work supporting people affected by homelessness we knew that maintaining ‘good health’ was much more than preventing people from contracting covid-19, it was ensuring all their health needs were still being met. One of our first health responses was to ensure that covid-19 guidance was applicable to people experiencing homelessness (because let’s be honest, ‘stay home’ isn’t really an option when you don’t have a safe, secure home).  We worked with our peers to develop action updates on topics including social distancing, what to do if you have coronavirus symptoms and advice if you are dependent on alcohol or drugs. Through the #HealthNow project we collaborated with partners to ensure the views of people with experience of homelessness were considered by Local Authorities when planning homelessness and covid responses.

Our Homeless Health Peer Advocacy Service (HHPA) adapted rapidly from an appointment-based service to delivering calls to those people deemed most at risk, checking in on their health and wellbeing. Many of these people were in temporary accommodation, their usual support teams were struggling with the huge spike in need and the effects of the virus on their own staffing levels. Our staff worked tirelessly to put systems in place so the team could safely contact people and respond to needs ranging from lack of food, access to medication and in some cases restoration of basic utilities. Alongside offering practical support, it was just as important to the people we were calling that they were listen to, many felt incredibly isolated and our peers were able to relate. One person who received regular calls said:

“It makes me emotional to think of how I could thank [Case Workers names] for their amazing support. It’s really hard to want to continue fighting when you face continuous obstacles with no way out.”

Based then on the success of these peer led calls in London, we developed a model of delivery and training package so partners could set up similar services in their local areas. To date we have trained volunteers in Dublin, Greater Manchester, Newcastle and Birmingham to deliver this service; although not always face to face, peer led health support is still being offered to people impacted by homelessness.

In order to continue to provide support to people experiencing homelessness throughout the pandemic we of course needed to support our staff and volunteers; we cannot achieve the good health goal without them – maintaining a ‘healthy Groundswell’ is always key. We understand that for our volunteers, the structure and value they gain from volunteering significantly contributes to their own good health. Through the health and wellbeing calls volunteers were still given the opportunity to provide direct support to people experiencing homelessness. The covid-19 monitoring project provided an opportunity for volunteers from our own team and wider network to contribute to the research and help influence local and national homelessness responses. All volunteers and staff continue to benefit from progression and wellbeing support – a core part of maintaining good health for our team.

One of our greatest challenges was how to recreate the essence of Groundswell that is so evident when people come to our office. Daily zoom coffee breaks and weekly team catch up’s for staff and volunteers have not only helped our London staff stay connected but have also provided an opportunity for members of our national team to feel better integrated.

Covid-19 has changed our perception of what contributes to good health outside of the typical measures we use to ensure physical and mental health needs are met. The pandemic is a stark reminder of the importance of the wider social determinants of health and going forward we need to continue to think about these in all our activities to support people experiencing homelessness, volunteers and staff.