How lockdown changed the landscape for homelessness in Lewisham

Lewisham has been praised for helping homeless people through the pandemic in a report, published by the Kerslake Commission, which looks at how the country coped with protecting homeless people and rough sleepers during the Covid-19 lockdown.

Yvonne Davies from NHS South East London and Kerry Lonergan from Lewisham borough council reflected on this; the work the team did on the ground, the difference it made to the homeless community, and how they have built on it since.

What happened during the pandemic?

In March 2020, the coronavirus pandemic meant that those people who were homeless or rough sleeping, with little access to health support, were particularly vulnerable to the virus. In response the government announced the ‘Everyone In’ initiative to get the homeless community in, off the streets, and into safe accommodation.

NHS South East London and Lewisham Council realised this was the ideal opportunity to work with GPs and the Health Inclusion Team (HIT) to deliver services to the local homeless community in a way that was joined-up and focused on their health.

Looking back Kerry Lonergan from Lewisham borough recalled:

“We were visiting some of the night shelters, which were like a COVID hotbed waiting to happen. So we knew, quite quickly, that we needed to do something a bit different and change it. I think the other thing was everybody had the right mindset. You knew that all you had to do was call them and say, ‘we need to have a chat about COVID’ and everybody was happy to quickly make changes and cancel other stuff and pull together. It was very much a joint effort. So we just called lots of people together and started having conversations to make it happen.”

During this early part of lockdown, 136 people were taken off the streets in Lewisham borough and placed in safe, single room accommodation in hostels and other properties. Compared to other parts of the capital the local homeless community was small enough for outreach workers to know most rough sleepers by name. As time went on, other rough sleepers were identified and brought into safe accommodation.

Helping a vulnerable community to be safe and secure

Throughout lockdown, the teams supported accommodation providers to implement ‘bubbles’ in shared services; they attended residents’ house meetings via Zoom to give guidance and offered one-to-one support for services, so any suspected Covid cases were picked up quickly. Most of the people coming off the streets were helped into supported accommodation, resettled into private sector or social housing, or resettled via a rough sleeper housing pathway.

The Health Inclusion Team (HIT) realised that the vaccine rollout posed challenges for homeless people, not only because they were a transient community but because of their lack of access to IT for booking a vaccine.

With this in mind they decided to bring the vaccine direct to the community as Yvonne outlined:

“In Lewisham we had a dedicated bus that went around to all of the sites and we had 121 sites across Lewisham that we supported, which targeted 1300 people that are technically regarded as homeless or living in some type of kind of housing and supported housing emergency, temporary accommodation, hostels and the like.”

Each person was given a hard copy of their vaccine pass that they could keep with them which meant they could go anywhere for their follow up vaccination without having to access IT.

Stronger relationships after Covid

The circumstances of Covid proved a prompt for closer working, as Yvonne explained:

“Pre-pandemic, there was our GP enhanced homeless services across Lewisham that supported our homeless population. And we worked very much in isolation as well, but the pandemic really established relationships with council colleagues.

“Our relationships became broader and deeper with homeless providers and other community, and primary care services as well.  It was a matter of everybody coming together, viewing the homeless picture as a whole, and looking at how we can make sure the dotted lines that were already there are put formally place, utilised effectively, and communicated to the various groups and services and organizations so that people are aware.”

She added: “It’s been really eye opening, as well, to see the other side of it with housing and the challenges that they are facing. Everyone’s got a shared common understanding about those services and what we’re all trying to achieve. It’s been nice because now we’re involved in some borough-wide conversations about not only the services that we deliver or that we commission at NHS South East London, but we are also involved in the Council’s wider strategy on housing and rough sleeping, and our contribution to that and the recognition that health is really important.”

Now the Rough Sleeping Service provides weekly GP clinics for rough sleepers at Deptford Reach and Amersham Vale. This is invaluable for rough sleepers, many of whom aren’t registered with a local surgery or able to book an appointment, as it means that potential health issues can be picked up early. As an added benefit, at the same time as seeing a GP they can also get help and support with things like immigration issues and welfare benefits.

Providing space and opportunity for homeless people to live independently

Alongside the vaccine and health work ‘Everyone In’ has seen a move towards more stable accommodation for homeless people. The main difference is that before the overnight shelters, though they did have washing facilities, offered little more than a mat on the floor and anyone there had to leave at 7 o’clock in the morning.

Kerry explained how they have built on things since Covid:

“So everyone will go into what is, essentially, a hostel and they have their own room and their own space. There are shared facilities, a shared kitchen, shared toilets, but they actually have their own room and are not all bedded down in a dormitory. I think there was already a level of trust there and now I think they’re happier, not having to be kicked out of somewhere at 7 o’clock in the morning and having to find somewhere to go in that time before the day shelter starts.

She added: “The idea is that a team works with them to move away from that rough sleeping way of life – which is very particular – into a more financially active role so they begin to take part in work and employment. Key workers support them as many have mental health and/or substance misuse issues, they also help them try and find a job and increase their employability.”

Hearing the voice of the homeless community

Yvonne explained how local people’s real experiences are starting to shape services in south east London going forward:

“We were arranging the contract for our GP service that supports our homeless population. As a result of our relationships we were able to have some service users and homeless providers on our evaluation panel which is something that we probably wouldn’t have been able to do before.”

The work in Lewisham goes from strength to strength with the team being included in other health networks where the homeless community had not figured before, like the cancer network, and funds are in place for dedicated rough sleeper nurses.