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Background

It is clear that we are facing an unprecedented global public health emergency caused by the continuing spread of COVID-19. All statutory services have a part to play in supporting the wider humanitarian response and homelessness teams have a key role to play.

Purpose

This guidance for local authorities sets out the need to put measures in place to:

  • ensure that people who are, or are at risk of, sleeping rough, and those who are in inadequate temporary accommodation have the support, resources and policies needed to protect themselves
  • have access to the facilities that enable them to adhere to public health guidance on hygiene or isolation
  • utilise alternative powers and funding to assist those with no recourse to public funds who require shelter and other forms of support due to the COVID-19 pandemic
  • mitigate their risk of infection and to ensure they are able to self-isolate as appropriate in line with public health guidance, in order to lower the risk of transmission to others

The priority must be the develop an effective local response to ensure people can access sanitation, be effectively isolated and have access to medical and other support as necessary in order to limit risk of wider infection within this group.

In addition, it is also of paramount importance that services designed to support people into permanent accommodation, such as Housing First and other ‘move on’ work, continue to be prioritised to assist with the aim of helping people into accommodation that allows for easier isolation.

This guidance must be read alongside the guidance for substance misuse and homelessness services which was published by the Welsh Government on 19 March and provides much of the information in relation to identifying symptoms, avoiding the spread, etc.

Other guidance

A written statement on provision for children of key workers was published on 20th March. If children can stay safely at home, they should. However, local authority housing and homelessness officers should work with their education colleagues to ensure that homelessness and housing support staff have access to school / childcare places during this time if required and as a last resort.

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.

For guidance on PPE in housing, health and social care supporting settings – see the latest advice from Public Health Wales.

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

Generic guidance for social or community care and residential settings is also available.

Centralised coordination, cohort and appropriate care

We want local authorities to operate a strategy of Centralised Coordination, Cohort and Appropriate Care for homeless populations in hostels, temporary emergency accommodation, and rough sleepers to prevent high mortality and minimise impact on the NHS. 

This approach is needed because:

  • Homeless people are at very high risk of extreme mortality due to high levels of, or pre-existing health conditions such as lung and liver disease. However, it should be noted that there is no evidence homeless people are intrinsically more at risk.
  • High-density congregate settings pose a higher risk of explosive, high mortality outbreaks.
  • Homeless people have a high frequency of symptoms that will clinically mask COVID-19 presentation, eg chronic coughs.
  • Homeless people are likely to delay seeking care if ill and most are dependent on emergency and hospital A&E services, which like everyone they should avoid attending.
  • Homeless people may unable to follow PHW guidance to self-isolate without additional support.
  • Homeless people do not have regular access to hygiene facilities and are therefore less able to take preventative measures

 
The key components of the strategy are:

  • centralised coordination cell led by local authority to ensure efficient deployment of resources of all partners
  • cohort homeless people based on those who have symptoms of COVID-19 as set out in PHW guidance and those who are asymptomatic
  • appropriate Care, accommodation and access to support for those who are symptomatic and those who are asymptomatic
  • rapid identification of clinical deterioration and escalation to NHS in line with PHW guidelines

Approach

a) Establish centralised co-ordination cell

Led by local authority and including relevant health and third sector providers to ensure:

  • co-ordination of management and logistics for all accommodation, health and support facilities
  • central registry of staff (including peers and volunteers) to maximise efficiencies in deployment, provide direct advice, support and training and recruitment as needed
  • co-ordination of management of logistics/distribution and stock management of all support and other equipment/supplies
  • oversight of response and ability to flex resources and adjust response as situation evolves
  • co-ordination of public health information and advice to people who are most marginalised and do not have access to new or the internet

b) Cohort

We understand that rough sleepers often have a range of complex needs and therefore it is likely to be difficult to ensure adherence with public health guidance on hygiene and isolation. In broad terms there are three key cohorts: those that will engage services, stay and adhere to advice; those that will engage but will present a number of challenges to maintain support; and those that require additional intensive support to engage. We understand that within all these groups some individuals will have varying complex and multiple needs.

Given the complexities within these groups of people such an approach is dependent on a range of accommodation options being available to respond appropriately, including:

  • hostels and Emergency Temporary Accommodation for rough sleepers (including those in B&B)
  • day centres and street services supporting rough sleepers
  • street/assertive outreach teams

c) Care and support

We recognise that increasing capacity is essential to enable a Cohort approach to be taken. The additional funding provided to support local authorities and their partners will enable the acquisition of additional accommodation and the re-modeling and re-purposing of buildings to meet the demand and to support the approaches needed to support people into suitable accommodation, to help mitigate the spread of COVID-19. 

Symptomatic individuals

Any individuals displaying symptoms should isolate for 7 days in line with PHW guidance. Additional advice should be sought via NHS Helpline 111 where symptoms are of significant concern to support workers. If the individual is seriously ill or injured or their life is at risk call 999 as an emergency.

For those requiring isolation accommodation options should be secured which enable individuals to isolate within a single occupancy room with en-suite facilities so as to ensure they are not placing other individuals at risk. They must not simply be placed in a B&B and left to manage the isolation themselves. As a minimum requirement individuals must be supported, have access to food and suitable hygiene facilities, have access to clinical support dependent on symptoms, and all accommodation must be appropriately cleaned as required to support infection control. To note, food, drink and medication should be left outside the door for individuals to pick up. Likewise, harm reduction materials need to be accessed (see separate guidance). Specific consideration should be given to those on supervised Opioid Substitution Therapy and you should contact their substance misuse provider immediately. 

We acknowledge these options are not necessarily those we would pursue in a normal situation but we recognise the unprecedented nature of this emergency. We also recognise the exact nature of the accommodation will be dependent on the needs of the individual. For those with less complex needs and who are willing to engage, lower risk and will self-isolate there are a number of options we would wish you to be pursing:

  • the block purchase of B&B or other hotel accommodation with single rooms and en-suite facilities which could be taken over by the authority to ensure suitable hygiene standards are adhered to and support staff are available
  • the acquisition of university accommodation blocks
  • the modification of existing accommodation to allocate some specifically for those who are symptomatic

For individuals with more complex needs and who may be less willing to engage then options include:

  • the use of modular accommodation with suitable hygiene facilities where individuals can be supported by outreach workers
  • the adaptation of existing hostels, to provide separate isolation pods away from other individuals and separate hygiene facilities
  • consideration should be given to moving people within specialist hostels and supported accommodation who are ready to move more independent accommodation if they are ready

People who are homeless are more likely to have experienced trauma in their lives and may be less willing or able to engage with services and instructions to self-isolate. Local authorities and support providers should recognise the importance of taking a person-centred, trauma informed approach to understand why people may be reluctant to engage and should work to find solutions that enable people to access accommodation and self isolate when required. This may include consideration of location, peer support, pets, mental health support and addiction issues.

For individuals who require additional intensive support in order to engage, options include the use of modular accommodation with suitable hygiene facilities where individuals can be supported by outreach workers.

Read guidance about dealing with people who are unwilling or unable to self-isolate or follow coronavirus lockdown instructions in supported and temporary accommodation, hostels and people who are sleeping rough.

Individuals who are not symptomatic 

The key for this group is to ensure access to suitable hygiene, accommodation and support. Again, individuals must not simply be placed in a B&B and left to manage themselves. As a minimum requirement individuals must be supported, have access to food and suitable hygiene facilities, and all accommodation must be appropriately cleaned as required to support infection control. It is still advised that food, drink and medication is provided safely and preferably by leaving outside doors where possible. Likewise, harm reduction materials need to be accessed (see separate guidance).

It is also important that agencies make every effort to provide accurate information about personal hygiene practices and ensure that people understand this information.

We recognise again that the exact nature of the accommodation will be dependent on the needs of the individual. For those with less complex needs and who are willing to engage and lower risk there are a number of options we would wish you to be pursing:

  • the modification of existing accommodation to allocate some accommodation sites specifically for those who are asymptomatic – and separate from those who are symptomatic
  • the repurposing of office or other buildings to provide accommodation and suitable hygiene facilities
  • the block purchase of B&B or other hotel accommodation with single rooms and en-suite facilities which could be taken over by the authority to ensure suitable hygiene standards are adhered to and support staff are available
  • moving on from supported accommodation to more independent living
  • the acquisition of university accommodation blocks

For individuals with more complex needs and who may be less willing to engage or adhere to advice then options include the adaptation of existing hostels with access to separate hygiene facilities.

For individuals who require additional intensive support to engage, options include the use of modular accommodation with suitable hygiene facilities where individuals can be supported by outreach workers.

Specific groups

We know that the rough sleeping population includes a significant proportion of people who will have recently left prison or custody. Welsh Government continues to explore how ongoing work in Wales to support homeless people during this crisis period can be aligned to work within the Ministry of Justice and Her Majesty’s Prison and Probation Service in Wales.

In relation to those who are currently accommodated by the Home Office and are navigating the immigration system, the responsibility to provide accommodation currently resides with the Home Office. If further advice is provided, we will ensure it is disseminated.

Further guidance

The Minister for Housing and Local Government has issued additional statutory guidance relating to priority need and vulnerability.

We will provide further guidance if the evolving situation necessitates additional measures. 

We will also work to ensure that where best practice is identified, this is disseminated across Wales.

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