Latest COVID-19 peer research tells us what works and what needs changing

Since the beginning of the pandemic, Groundswell has been working with people experiencing homelessness, our #HealthNow partners and organisations to understand the pandemic’s impact and ensure experiences inform decision-making.

This briefing (number 11) reports on insights gathered through peer interviews during January to end of March 2021.

Recommendations for decision-makers

The insights highlight the need for local decision-makers and service providers to:

  1. Check you know your local vaccination plan for people experiencing homelessness. Is the plan flexible to mitigate health inequality in the way suggested in the DHSC Vaccine Roll Out Plan? If you would like guidance on vaccine rollout, check out our short film and advice.
  2. Ensure all people experiencing homelessness in your area are:
    • registered at a GP practice with up-to-date contact information (guide available here)
    • have been assessed for clinical vulnerability or pre-existing medical conditions
  3. Collect insight and learn from how homeless and inclusion health groups are being reached for vaccination locally.
  4. Have lateral flow tests on site and readily available. Guidance resources coming soon.
  5. Have accessible information available on testing and getting vaccinated. (Groundswell can send you resources for free in several languages, find out more here).
  6. Take steps to support people to access digital and remote support.
  7. Pathways to accommodation need to be clear for those:
    • who have been asked to leave temporary accommodation
    • who chose not to return to hostel accommodation
    • who are newly homeless
    • leaving institutions (such as prison).
  8. Ensure people moving to different areas have proper access to services and support in their new accommodation.
  9. Be clear and transparent about how long people can stay in new accommodation – uncertainty hugely impacts emotional wellbeing.

Key findings

Accommodation

The main concern raised was limited opportunities and support to transition into permanent accommodation, the pandemic being a key contributing factor. Those who did move experienced delays.

People placed in emergency accommodation felt there was a lack of clarity about the duration of their stay; this had a significant impact on their physical and mental health. While some positive experiences were reported, often support was scaled back as people returned to temporary accommodation.

The additional support to address health needs, access food and medication were often much more of a challenge for people who remained in existing accommodation yet needed to shield. For others they described not noticing a change in their accommodation situation at all.

COVID-19 prevention and response

Most people had not had virus symptoms. Those who had, often found access to testing, support and treatment challenging.

Efforts to ensure people experiencing homelessness are tested regularly are concentrated but inconsistent indicating a need for increased efforts to reach people, especially those who continue to experience health inequality and digital exclusion.

We heard varied thoughts about the vaccine, with many raising fears about its safety and effectiveness. Reluctance was often due to worry it had not been tested long-term. While several people had had the vaccine, some felt their health was good so it was unnecessary.

Accessing clear vaccine information and guidance was an issue, especially for those not accessing services or registered with a GP.

Prevention measures like hand washing continue to be challenging for many people, especially those rough sleeping. People also noted that ‘shielding’ information and ongoing prevention had reduced.

Some felt their lives had not been significantly impacted by the pandemic as they were already isolated or struggled to access support.

Health and wellbeing

The impact of the pandemic of people’s overall health and wellbeing continues to prevail. The common theme was the significant barriers faced when accessing healthcare. This had short-term health impacts but could cause long-term ones as earlier interventions are missed and existing conditions worsen.

People described having minimal or no contact with their GP during this time due to appointments “being too much hassle”, registration barriers and digital exclusion.

Long GP waiting times were common theme. Some telephone or online appointments were experienced as inappropriate and ineffective which further deterred people accessing services.

Some people could not engage in remote appointments due to lack of digital access, such as when asked to take photos of a medical issue.

An ongoing issue has been uncertainty about treatment for ongoing health conditions. However some did describe positive GP support, especially when through an ongoing relationship with a named GP, highlighting the importance of GP continuity.

 

What next?

To date, we have released 11 briefings and an overarching report. We are continuing to talk to people experiencing homelessness about their experiences of the pandemic. Over the next two months we will be focusing on hearing experiences of testing and vaccination models.

To read more insights from people experiencing homelessness during the pandemic visit our mobile reporter micro-site which is regularly updated with direct stories about the impact of the pandemic.

For regular updates about this project and related work, subscribe to our #HealthNow newsletter.