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Background and scope of guidance

Please note that due to rapidly changing circumstances, this guidance is subject to change. For the most up to date situation on COVID-19, go to: Coronavirus (COVID-19) on GOV.WALES and Public Health Wales.

This guidance is intended to assist Substance Misuse and homelessness services, and those working with vulnerable populations, especially those with drug and/or alcohol use disorders, co-occurring mental health, and complex needs. This document has been developed in line with current Public Health England guidance, and essential information for communicating with services users, members of staff, including volunteers, and family or carers. The guidance seeks to address some of the very specific issues that apply to the sector in responding to COVID-19 whilst continuing to support some of the most vulnerable people in Wales.

We are aware that many services and commissioners are already planning and adapting services to meet the current emergency. There will inevitably be a short notice to respond to emerging issues, and services are best placed to work with commissioners and make these decisions. Further advice for commissioners will follow to support this process and local flexibility.

This guidance should also be used by commissioners and providers of services to ensure the needs of their services are considered as part of the wider response and planning for COVID-19 and adapt to the evolving situation.

Whilst people who are homeless, those with substance misuse or with co-occurring conditions are not known to be at a greater risk of COVID-19 infection it is, however, acknowledged that these groups are significantly more likely to have pre-existing medical health conditions, lack financial resilience and may have specific barriers to following general public health advice. Additionally, it is vitally important that at this time we ensure that stigma is not further raised towards groups who are already subject to high levels of discrimination.

The Welsh Government along with other devolved nations is part of the UK Action Plan for tackling COVID-19.

Advice on COVID-19 is updated regularly and available on:

These sites are both updated on a regular basis with a range of guidance.

Please also note the advice from the information commissioner on data sharing 

•    Information Commissioner: Data protection and coronavirus 

Generic guidance for social or community care and residential settings is also available. There is also guidance from PHE specifically on rough sleepers and homeless services.

This guidance is taken to cover:

  • Day services for both substance misuse services and people who are homeless
  • Community treatment services for substance misuse
  • People with co-occurring conditions
  • Community services for people who are homeless
  • Hostels and temporary accommodation, including night shelters and houses of multiple occupation for these client groups
  • Housing First projects
  • Substance misuse outreach services, including mobile services
  • Homelessness outreach services, including mobile units and soup runs
  • Residential rehabilitation services
  • Community drug and alcohol services

This guidance will assist substance misuse and homelessness services, commissioners and employers in providing advice to their staff on:

  • the novel coronavirus, COVID-19
  • how to help prevent spread of all respiratory infections including COVID-19
  • what to do if someone with suspected or confirmed to have COVID-19 attends or has been in a substance misuse or homelessness service setting
  • what advice to give to individuals both service users and staff

Signs and symptoms of COVID-19

A coronavirus is a type of virus. As a group, coronaviruses are common across the world. COVID-19 is a new strain of coronavirus first identified in Wuhan City, China in January 2020.

The incubation period of COVID-19 is between 2 to 14 days. This means that if a person remains well 14 days after contact with someone with confirmed coronavirus, they have not become a case.

The following symptoms may develop in the 14 days after exposure to someone who has COVID-19 infection:

  • cough
  • fever
  • difficulty in breathing/shortness of breath

Generally, these infections can cause more severe symptoms in people with weakened immune systems, older people, and those with long-term conditions like diabetes, cancer and chronic lung disease. This may include those with drug and/or alcohol use or dependency, those experiencing homelessness and where physical health has been compromised. 

How COVID-19 is spread

From what we know about other coronaviruses, spread of COVID-19 is most likely to happen when there is close contact (within 2 metres) with an infected person. It is likely that the risk increases the longer someone has close contact with an infected person.

Respiratory secretions containing the virus are most likely to be the most important means of transmission; these are produced when an infected person coughs or sneezes, in the same way colds spread.

There are 2 main routes by which people can spread COVID-19:

  • infection can be spread to people who are nearby (within 2 metres) or possibly could be inhaled into the lungs
  • it is also possible that someone may become infected by touching a surface, object or the hand of an infected person that has been contaminated with respiratory secretions and then touching their own mouth, nose, or eyes (such as touching doorknob or shaking hands then touching own face). Our current understanding is that the virus doesn’t survive on surfaces for longer than 72 hours.

Preventing the spread of infection

There is currently no vaccine to prevent COVID-19. The best way to prevent infection is to avoid being exposed to the virus.

There are general principles everyone can follow to help prevent the spread of respiratory viruses, including:

  • washing your hands often - with soap and water, or use alcohol sanitiser that contains at least 60% alcohol if handwashing facilities are not available - this is particularly important after taking public transport. Guidance is available on hand washing
  • covering your cough or sneeze with a tissue, then throwing the tissue in a bin. See Catch It, Bin It, Kill It 
  • people who feel unwell should stay at home and should not attend work
  • employees should wash their hands: 
  • before leaving home
  • on arrival at work
  • after using the toilet
  • between meeting clients (where possible)
  • after breaks and sporting activities
  • before food preparation
  • before eating any food, including snacks
  • before leaving work
  • on arrival at home
  • avoid touching your eyes, nose, and mouth with unwashed hands
  • clean and disinfect frequently touched objects and surfaces

Further information can be found on the Public Health England Blog and the NHS UK page.

It is recognised that sourcing hand sanitiser is currently not possible in many cases. Where you are not able to source this, it should be noted that effective and regular hand washing following the guidelines offers effective protection, hand sanitiser should be reserved for service users/settings (e.g. Outreach) if only available in short supply. 

Facemasks

During normal day-to-day activities facemasks DO NOT provide protection from respiratory viruses, such as COVID-19 and do not need to be worn. Facemasks are only recommended to be worn by infected individuals when advised by a healthcare worker, to reduce the risk of transmitting the infection to other people.

Governance and strategic planning response

This guidance provides direct advice to employers and staff in both homeless and substance misuse services. In each area however, commissioners and service leads should ensure that the needs of their services and service users are fully considered in strategic plans each the relevant area. Significant planning is already in place across Wales to respond to emergencies and these are now being mobilised to meet the challenge of COVID-19. It is therefore important that sector responses are linked fully into wider planning at a regional and local level, as they are nationally, not only to reduce duplication but to ensure the specific needs of services and service users in particular vulnerable groups. This will also ensure services are fully supported should the guidance and plans develop further. Substance misuse Area Planning Board (APB) leads should establish the relevant structures and contacts in each area. 

Operational guidance

At the time of writing this guidance services will be prioritising the adaption of working models but should follow general advice on hygiene and observations for symptoms and risks. It is now advised that where possible face to face services which can change to remote provision should do so, most services have already ceased group activities and should do so if they haven’t already. However, many services are vital to supporting these vulnerable client groups, such as hostels and prescribing services, so there is a need to prepare and consider the very specific barriers for the client population to adhering to and following some of this guidance.

Supporting people with complex needs

Homeless and substance misuse services support people with some of the most complex needs who may face very significant challenges during the current emergency. Frontline staff will know their service users well and should wherever possible tailor support to meet the needs of individuals. In many cases staff will have well developed relationships and be in a position of trust. Services should work to prioritise both their services and staff to supporting the most vulnerable including where possible providing outreach to those who are most disengaged.

Sharing information with service users

Given the developing situation is now having a significant impact on daily operations it is vital we share information about COVID-19 in a clear and consistent way. Services should provide reassurance and ask all service users to follow the general guidance on hygiene and assist service users to do this wherever possible, this should include the provision of hand sanitiser in both community and residential settings if available and if in short supply this should be reserved for outreach, in its absence wherever possible regular hand washing with soap, hot water and paper towels for drying hands and a bin for disposal is an effective precaution.

Services should display COVID-19 advice posters as well as providing general advice on hygiene. Support needs to acknowledge that for many people some elements of advice will require service users to be reassured and supported. In addition, service users should be encouraged to only follow official guidance and not anything from unreliable sources such as social media.

We know that many individuals supported through our services may struggle to access health services including primary care already. It is really important that as far as possible we ask individuals to NOT SELF PRESENT AT A&E or GP surgeries, consistent with advice to the general public. Wherever possible individuals should be asked, or supported to call NHS 111 or in an emergency 999.

Staff working in substance misuse and homelessness services

As previously stated there is no evidence that people who are homeless or people who have substance misuse issues are at heightened risk from COVID-19. However, they may be more vulnerable due to pre-existing or untreated physical health conditions or subject to additional barriers to prevention of infection. It should be remembered that service users are just as at risk of contracting COVID-19 from members of staff and therefore all staff should take precautions to avoid this through the hygiene and prevention practices and by following guidance if they feel unwell.

Any member of staff who either has symptoms should follow current advice to the public and should self-isolate and not attend work until they completed the period of isolation. Staff should, wherever possible, work remotely, though in many circumstances clearly this will not be possible.

If staff are advised to self-isolate they should follow the latest advice.

What to do if a service user, member of staff, or resident becomes unwell

It is essential to maintain current knowledge and information on the PHE COVID-19 case definition and respiratory signs and symptoms, and to note that the symptoms of COVID-19 infection may resemble those of drug and alcohol withdrawal amongst service users. Up to date case definition information can be found by visiting PHE webpages.

If the person is showing signs of respiratory illness the person should be removed to an area away from other people. If possible find a room or area where they can be isolated behind a closed door. If it is possible to open a window, do so for ventilation. Unless they are experiencing significant symptoms or have complications they should not call NHS 111. If the person affected is experiencing significant issues or has other complications then they should call NHS 111 themselves or, if unable to do so, a staff member should call on their behalf. If the individuals is seriously ill or injured or their life is at risk call 999 as an emergency.

In the event of an overdose event, administer Naloxone and follow lifesaving procedures as per protocol.

Whilst waiting for advice from NHS 111 or an ambulance to arrive, all others should avoid direct or close contact. The individual should avoid touching people, surfaces and objects and be advised to cover their mouth and nose with a disposable tissue when they cough or sneeze and put the tissue in a bag and then in the bin. If they don’t have any tissues available, they should cough and sneeze into the crook of their elbow.

Individuals reluctant or refusing to self-isolate

There may be instances where a symptomatic individuals will not follow guidance and advice and not self-isolate, presenting an ongoing risk of transmission to others. In this situation is it vital to try and ascertain their concerns and, where possible, to reassure and make appropriate arrangements to overcome these barriers. These concerns may include lack of access to food, washing and toileting facilities or medications, lack of understanding or support, or a lack of comprehension as to the implications. Every effort should be made to alleviate these concerns and provide support (Health Protection Legislation (Wales) Guidance 2010).

In the event that a symptomatic individual refuses to self-isolate, despite all efforts as outlined above, then as per Health Protection Legislation (Wales) Guidance 2010, health protection powers enable restrictions or requirements to be imposed on people and in respect of things and/or premises to protect human health, provided strict criteria are met. In the event of such a situation, the service should inform relevant internal management and contact Public Health Wales Health Protection Team on 0300 003 0032 to discuss and escalate as appropriate. You should include your local authority Environmental Health Officer in this process. These officers are duly authorised to implement the requirements of this legislation and work closely with the Health Protection Team.

In light of the Minister for Health and Social Services declaration that the incidence or transmission of Coronavirus constitutes a serious and imminent threat to public health, the Welsh Government has laid regulations (Health Protection (Coronavirus) (Wales) Regs 2020)  that are considered an effective means of delaying or preventing further transmission of the virus, so ensuring that the public are protected as far as possible from the transmission of the virus

For people who are sleeping rough and unwell with relevant symptoms, advice should be provided, and the offer of suitable accommodation sought.

If the individual refuses accommodation and is unable or unwilling to self-isolate, contact Public Health Wales Health Protection Team on 0300 003 0032 to escalate.

Rubbish disposal and storage of personal property

All waste that has been in contact with a possible COVID-19 case, including used tissues, should be put in a plastic rubbish bag and tied. The plastic bag should then be placed in a second bin bag, tied, and disposed of in the general waste after 72 hours.

In residential settings including hostels, if a symptomatic individual leaves the premises, for example, due to the requirement for hospitalisation then the guidance on handling linens and cleaning should be followed.

What to do if a symptomatic individual has recently been in the office, workplace or residential setting

In the event that a symptomatic individual has recently been on the premises, follow the cleaning and disinfection guidance: COVID-19: cleaning in non-healthcare settings on GOV.UK and Guidance for infection prevention and control in healthcare settings.

Cleaning the service or residential setting, including hostels, where there are possible cases

Follow the cleaning and disinfection guidance including laundry:

COVID-19: cleaning in non-healthcare settings on GOV.UK and Guidance for infection prevention and control in healthcare settings.

It’s good practice to establish a routine and robust cleaning programme, if this is not already in place.

All hostels and multiple accommodation units should put in place plans for a safe space and isolation of residents, as well as regular cleaning arrangements.

Specific actions for social and community staff visiting service users at home, or providing outreach services

Outreach services offer a vital link for some of the most disengaged and vulnerable individuals we support. At this time outreach, in particular to rough sleepers, will present an ongoing challenge. Wherever possible services should aim to maintain contact with all vulnerable individuals and try to know where there are and monitor if people are not attending usual meeting spaces. All outreach workers should follow social distancing guidance and review existing arrangements for safe working.

Prior to a home visit, staff operating social, community and outreach services should, if possible, ascertain if a service user, or member of the household is in self-isolation via telephone, text or e-mail. If they are self-isolating and a visit is deemed essential, then a full risk assessment should be undertaken with managers and to decide the best course of action.

If during telephone communication with a service user or their representative to assess their suitability for a home visit, it is thought that they meet the PHE criteria for a possible case, then a face-to-face assessment should be avoided.

If the individual requires urgent medical attention

If the individual is critically ill and requires an urgent medical attention or ambulance transfer to a hospital, phone 999 and inform the ambulance call handler of the potential links to COVID-19.

Following the individuals transfer to hospital, the room should be closed and should not be used until individual returns from hospital.

Homeless and substance misuse settings: preparing your premises

All services should plan ahead for action to reduce the risk of infection and how to manage should a service user or member of staff present with symptoms. Services such as hostels or prescribing services should prepare their setting reduce the risk of COVID-19:

  • Make sure settings are cleaned regularly and kept clean and hygienic during opening times. 
  • Provide hand sanitiser within settings and encourage all staff and service users to use on arrival and regularly, or wash hands with hot soapy water. 
  • Encourage regular hand washing with hot soap and water, ensuring facilities to do so are available. 
  • Display posters on COVID-19, handwashing and hygiene 
  • Ensure food is dispensed hygienically and avoid self-service.
  • Ensure free toiletries are available for service users who may not be able to afford them. 
  • Ensure desks, phones and other equipment is cleaned regularly and at least between use by different people. 
  • Provide tissues and ensure these are disposed of safely

Services should consider what rooms they have available for supporting someone to isolate whilst seeking guidance or medical assistance. If you are working in an open access setting or hostel you should have a safe room that you can ask someone to move to if they present with possible symptoms.

Hostels and night shelters

Where hostels provide individuals with individual rooms and shared facilities they should implement heightened hygiene and inform all residents of this, including where possible maintaining social distancing. They should follow the guidance for residential settings in relation to COVID-19. New admissions should be screened for possible symptoms before admission, where possible by a referring agency, using the NHS online symptom checker, if symptoms are present you should contact relevant agencies to seek accommodation where the person can self-isolate. If you do admit the person this should only be in an emergency and they should self-isolate immediately within the hostel. Wherever possible communal facilities should be cleaned between use by different people.  

Further guidance will be issued in relation to night shelters and accommodation where people share sleeping spaces. We recognise the vital service these facilities offer and wherever possible sleeping arrangements should be 2 meters apart in well ventilated room and all people should be screened before admission. 

Maintaining continuity of specialist substance misuse pharmacological interventions

The following section aims to provide information and guidance to substance misuse services (including criminal justice drug services), community pharmacies, GP shared care providers to ensure continuity of specialist substance misuse pharmacological interventions, including opioid substitution therapy (OST).

This information and guidance should only be applied in the event of a service user being required to self-isolate or in the event of service restrictions / closures resulting from COVID-19.

Such measures may require ongoing workforce planning and the direction of resources from non-essential services in order to facilitate ongoing continuity of essential services.

Continuity of OST supervised consumption services

Consideration should be given to sustainable and clinically appropriate alternatives to existing OST supervised consumption services including the move to provision of Buprenorphine prolonged-release injection (Buvidal). If such a model is to be introduced, all relevant substance misuse services and the Substance Misuse Area Planning Board need to ensure appropriate and timely arrangements including clinical governance arrangements are in place prior to implementation. It will be vital to ensure that regular contact is maintained will all service users to provide relevant support and to check on physical and mental health and wellbeing regardless of treatment regime.

Where service users are considered possible cases and required to self-isolate

All service users should be informed that in the event they are identified as a possible or confirmed case and required to self-isolate - they should inform their key worker/prescribing service as soon as possible.

Upon notification that an OST service user has been required to self-isolate, services should aim to undertake an immediate review and risk assessment of the individual’s clinical need in line with clinical guidelines and governance processes. 

  1. Formal planning arrangements need to be in place in advance of any cases for pharmacy delivery of prescription, if relevant
  2. Daily telephone contact needs to be established with individual
  3. Where possible, video-observed consumption via smartphone apps, e.g. Facetime, WhatsApp, etc. should be undertaken daily and consumption recorded by the service.  Where this option is not available, self-report consumption via daily telephone call must be documented
  4. The individual should be supplied/resupplied with take home naloxone kits. Individuals should be encouraged to store take home naloxone in a visible and accessible location for others to find in the event of an emergency

In the event of service restrictions or closures

In the event of restrictions or closures of any service providing pharmacological interventions via supervised consumption, the service is required to inform Welsh Government and the local substance misuse Area Planning Board representative with immediate effect. Upon which alternative arrangements should be made in line with local service continuity mechanisms to ensure service is resumed as soon as possible. Notice of nearby alternative services should be indicated clearly on the door of closed services. All services should now have contingency and emergency plans in place for service continuity of key services.

All services users affected by service restrictions or closures should be provided with sufficient notice of alternative dispensing arrangements. Such notices should take into consideration any potential issues in relation to literacy and communication needs.

Continuity of non-supervised consumption services

Where service users become symptomatic and are required to self-isolate:

Upon notification that a service user has been required to self-isolate, services should aim to undertake an immediate review and risk assessment of the individual’s clinical need in line with clinical guidelines and governance processes.

Where possible arrangements should be agreed between substance misuse services and the local health board for home delivery of prescribed medication in line with the individuals risk assessment and clinical need. In such event, mechanisms should be established for telephone contact between dispensing service and self-isolated individuals during the morning of the day of delivery.

Services should ensure all individuals provided with take-home / non-supervised medication are issued with information and guidance on safe storage, and supplied with take home naloxone kits. Individuals should be encouraged to store take home naloxone in a visible and accessible location for others to find in the event of an emergency.

In the event of service restrictions or closures:

In the event of restrictions or closures of any service providing non-supervised pharmacological interventions, the service is required to inform Welsh Government and the local substance misuse Area Planning Board representative with immediate effect. Upon which alternative arrangements should be made in line with local service continuity mechanisms to ensure service is resumed as soon as possible.

All services users affected by service restrictions or closures should be provided with sufficient notice of alternative dispensing arrangements. Such notices should take into consideration any potential issues in relation to literacy and communication needs.

Maintaining continuity of harm reduction interventions including needle and syringe programme services (NSP) and Take-home Naloxone provision

The following section aims to provide information and guidance to substance misuse services and community pharmacies to ensure continuity of harm reduction interventions including needle and syringe programmes (NSP) and Take-home Naloxone (THN). The guidance should only be applied in the event of a service user being required to self-isolate, or in the event of service restrictions / closures resulting from COVID-19.

Such measures may require ongoing workforce planning and the direction of resources from non-essential services in order to facilitate ongoing continuity of essential services.

Preparation for NSP stock shortages and delivery disruptions

Service delivery should continue to be in line with local and national clinical guidance. The quantity of injecting equipment should be sufficient to meet individual service user needs i.e. to achieve at least 100% coverage (clean equipment for each injecting event allowing for missed hits) and not subject to any restrictions or arbitrary limits.
  
Services providing an NSP service are encouraged to routinely monitor and maintain stock levels to account for unexpected surges in distribution and interruptions in delivery schedules.

Where possible, individuals attending NSP services should be encouraged to plan in the event of self-isolation and ensure they maintain sufficient paraphernalia to last 14 days in line with their injecting needs.

Where service users are considered possible cases and required to self-isolate

Where known injecting service users have been required to self-isolate, arrangements should be made alongside local outreach services for home delivery of injecting paraphernalia (including sharps disposal bins).

Services should ensure all individuals are issued with drug poisoning prevention advice, and where required supplied with additional take home naloxone kits. Individuals should be encouraged to store take home naloxone in a visible and accessible location for others to find in the event of an emergency.

It is essential that self-isolated individuals should be encouraged to place any needles and syringes in a sharps container and store in a safe location until it is possible to return to pharmacy for safe disposal.

Individuals collecting NSP paraphernalia items on behalf of those self-isolated

Individuals collecting NSP paraphernalia items on behalf of those who have been advised to self-isolate should not be discouraged or limited supply. Individuals should be reminded and discouraged from face to face contact with the isolated individual when delivering NSP items – instead posting the items through the letter box or leaving in a bag on the doorstep.

Individuals collecting paraphernalia for others should be discouraged from collecting and returning used NSP paraphernalia / sharps containers on behalf of those required to self-isolate. Instead self-isolated individuals should be encouraged to place any needles and syringes in a sharps container and store in a safe location until it is possible to return to pharmacy for safe disposal.

In the event of service restrictions or closures

In the event of restrictions or closures of any service provider of a needle and syringe or take-home Naloxone programme, the service is required to inform Welsh Government and local substance misuse Area Planning Board representative with immediate effect. Upon which alternative arrangements should be made in line with local service continuity mechanisms to ensure service is resumed as soon as possible.

All services users affected by service restrictions or closures should be provided with sufficient notice of alternative arrangements. Such notices should take into consideration any potential issues in relation to literacy and communication needs.

Specialist harm reduction advice to provide to service users

Services working with individuals actively using substances should ensure effective communication of advice in order to prevent COVID-19 infection, and continue to minimise substance related harms. Such advice should include and not be limited to:

  • hygiene practices e.g. hand and site washing, cleaning surfaces before and after preparing drugs, 
  • avoid sharing alcohol and drug consumption equipment, including drinking vessels, pipes, bongs, vapes, joints, snorting tubes, and injecting equipment etc. 
  • ensure take-home naloxone is available and stored in an accessible location
  • Do not inject alone due to risk of overdose - inject in the presence of others but not close contact – remain at least 2 metres away.
  • Identification of treatment, care and other ways to manage withdrawal symptoms if required to self-isolate

Individuals who are in contact with substance misuse services or homeless services and who are sex working should be advised that COVID-19 can be transmitted by close contact including kissing, coughing, etc. Close and direct contact should be avoided with anyone with respiratory symptoms.

Advice for those with additional/complex needs including homeless people (rough sleepers/‘sofa surfers’)

Individuals who are homeless may not have access to suitable hand washing facilities. In such instances services are advised to provide tissues, anti-bacterial hand wipes and hand gel and encourage use of hand washing facilities in local services.

In the event of restrictions or closures specialist services working with complex needs, outreach services should work to inform individuals of alternative arrangements/provision as soon as possible.

Homeless people in contact with support services

Individuals should be encouraged to report any new signs and symptoms of respiratory illness to NHS 111 via telephone (free from all phone boxes), and outline their current symptoms and details of their local support service and key worker. If the person affected is not able for any reason to call NHS 111 themselves then a representative from the support service / keyworker should call on their behalf. If the individuals is seriously ill or injured or their life is at risk, 999 should be called as an emergency.

Whilst waiting for advice from NHS 111 or an ambulance to arrive, individuals should wait in a safe and accessible location away from others. Information and advice will then be provided on next steps.

Services working with individuals with complex needs who have been required to self-isolate should undertake an immediate review and risk assessment of the individual’s health and welfare requirements. 

Homeless people not in contact with support services

Individuals should be encouraged to report any new signs and symptoms of respiratory illness to contact NHS 111, and outline their current symptoms, living situation, and best method of contact. If the person affected is not able for any reason to call NHS 111 themselves then an advocate should call on their behalf. If the individuals is seriously ill or injured or their life is at risk, 999 should be called as an emergency.

Whilst waiting for advice from NHS 111 or an ambulance to arrive, individuals should wait in a safe and accessible location away from others. Information and advice will then be provided on next steps.

Ensuring individuals who are homeless can self-isolate

In the event of an individual becoming unwell with suspected COVID-19 infection, Health Boards, local authority and housing services should be alerted and provide suitable accommodation to ensure that the individual can safely self-isolate for the required period. The accommodation should include separate bathroom and kitchen facilities. The individual may require additional support in ensuring access to medications, food and grocery deliveries etc. and this should be put in place. Daily contact via phone should be arranged if possible as per guidance in previous sections. Local authorities may need to commission additional capacity in supported lodging facilities and hostels.

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