Across the eight boroughs of North West London (Brent, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow, Ealing, Kensington & Chelsea and Westminster) it is estimated nearly 5,000 people are experiencing homelessness, with a quarter of them sleeping on the streets.
We know that the effects of homelessness often increases the likelihood of someone having long-term underlying health conditions, and leads to people dying much younger than someone in stable accommodation; these risk factors, combined with the communal settings people often reside in, led to the decision to pool resources and make rapid plans to bring the COVID-19 vaccine to this group of people.
By 23rd March 2021 more than 70% of people experiencing homelessness in North West London (NWL) had been offered their first COVID-19 vaccine and almost 1,500 people had been vaccinated. As a partnership we want to share our reflections, lessons and guidance – which can be summarised by four overarching principles. True to our approach in rolling out the COVID-19 vaccination, this blog is written in partnership.
Principle 1: a coordinated response
Working in silos was not an option, NWL pooled individuals and organisations together to plan from the beginning – tapping into existing infrastructures. As Cameron Hill, Homeless Lead at NWL CCG explains “All homeless health partners worked closely to plan the approach – and the knowledge, skills and experience across primary and community care, voluntary organisations and our housing and homelessness sector meant effective joint delivery”. It was crucial to ensure this was not just a ‘health led’ approach; “Collaboration between health, Social care and the voluntary organisation was key. When this was evident, we got large numbers vaccinated.” explains Judy DeMello, Head of Quality, NWL CCGs.
Each day was different, but the pre-planning meant that each person had a clear role. This of course is critical in effective delivery of the roll-out, but also helps improve the relationship with services and the people we were vaccinating as Judy emphasises: “presenting a unified approach helps improving confidence in the system”. Rushed, chaotic approaches with mixed messages do not put people at ease.
Princple 2: use inclusion health principles
Everyone has the right to good health and to access healthcare, yet people experiencing homelessness face barriers and are often excluded from mainstream health services. As part of this partnership, we learnt from Westminster based specialist homeless health GP’s Great Chapel Street Medical Centre and the Hickey Surgery, we modelled these inclusion health principles in other boroughs. We used a mixed model approach to ensure our vaccinators were going where people were: in-reach at accommodation settings, community action days for people who were sleeping rough and pop-up hubs in community venues. Greenlight Medical Van were pivotal in helping us with some of the outer London boroughs. This removed structural barriers and meant people were comfortable where they were and around people they knew and trusted – it was also more accessible than expecting people to book a GP appointment and arrange travel.
Peer support was offered by charity Groundswell. The Groundswell peers used their shared experiences of homelessness to engage with people in advance, so the vaccine wasn’t ‘sprung upon them’. Peer Case Worker Dennis Rogers MBE explains how this trust in peers worked when he was working with the team “when I say I’ve had it [the vaccine], people will often then get it”. Judy adds “the volunteers were worth their weight in gold; supporting with going door to door at some of the venues also helped and the volunteers were great in keeping communication going whilst people were in the queue so that they did not get frustrated and walk away”.
Dr Dana Beale, Joint Clinical Lead GP at Great Chapel Street Medical Centre recalls: “in one accommodation setting, the support provider explained one of the residents (with significant health vulnerabilities) was not keen to come down to the vaccinating room – Dave [Groundswell Care Navigator] asked us for a couple of minutes. Right on cue, smiling patient entered the room ready for his vaccination. That prior relationship that Dave has with his clients/our patients meant on countless occasions during the campaign that someone who might have otherwise felt overwhelmed on the day was greeted and encouraged by a friendly face.”
Principle 3: a pragmatic and targeted model
Like the COVID-19 virus doesn’t discriminate, neither should the vaccine. When our roving teams were vaccinating people, it was available to all – staff, volunteers and people benefitting from the service or project. This camaraderie demonstrates a trust in the process and unites us all as people protecting ourselves and others. It was also logical, cohorting in accommodation systems was not a practical solution.
In terms of practicalities top tips from the partnership include giving people time to understand information and ask questions without pressure – this is where pre-engagement with peers and Groundswell’s Q&A vaccine guides in several languages was beneficial. Flexibility is also crucial in this approach, Dennis explained how one man felt uncomfortable going to a communal area in his hostel for his vaccination so with the clients consent and Dennis’ support, a nurse went to his room so he was still able to be vaccinated in a place he felt comfortable.
Principle 4: upscale using specialist knowledge and experience
Overall we learnt by doing, and working in these collaborative teams meant everyone had something valuable to contribute to the process; the NWL team calls this the “leverage and learn” approach. Mant of the roving vaccination teams in NWL had no specific experience in working with people experiencing homelessness. Kate Bowgett, Director of Services at Groundswell, and Homeless Health Nurse Consultant Anne McBreaty held a webinar for the clinicians to explain the barriers people who are homeless often face when accessing healthcare; how various accommodation settings work; what had happened in NWL during ‘Everyone In’. Kate explains “this was an open space with no judgement”.
Working with the teams in the homelessness services was crucial in our approach, people who hold trusting relationships with the individuals we were vaccinating. They can also advise on logistics such as suitable times and approaches so involve them in your planning. Judy explains; “I recall a successful day when the rough sleeper teams went to the local parks to see if they could locate some of the clients and promote the vaccination day. Also, St Mungos team calling around to try and get people in when it looked like there was likely to be doses left over.”
One accommodation setting fed back that “the team was very professional, supportive and friendly which helped the Service Users to feel confident and relax for taking the vaccinations. I really appreciate for your excellent communication which made the process easy and achievable without any issues.”
Like many things, rolling out the COVID-19 vaccination with short notice, huge numbers of people and lots of moving parts is never going to be simple. Nevertheless, we are proud to share our lessons and advice, Judy sums up the message of our NWL Homeless Health Partnership approach perfectly: “Collaborate, Collaborate and Collaborate more in the future!”
For more information on ‘what works’ when rolling out the COVID-19 vaccine to people experiencing homelessness, Groundswell has produced this short film and guide.
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