On 12 August, in partnership with Lewisham council, Deptford Reach hosted a health and wellbeing day for members of the community and users of Thames Reach services. The invite was extended throughout the organisation as part of our ongoing commitment to bridging the inequality gap created by street homelessness.

While Deptford Reach is known to be a day centre hosting various activities for its visitors, since the pandemic the team have been extending their reach to ensure those in the wider community know about their resources and means of support. This has included outreach at Lewisham food banks.

The day involved drop-in services including COVID vaccinations, nurse appointments for general health checks, CGL (drug and alcohol support); Hep C, Hep B, HIV and syphilis testing with results given on the day; STI testing; advice and demonstrations for lateral flow testing, including handing out test kits on outreach; and information and advice on infection control.

It was a successful and positive event, ensuring people felt welcome and safe in Deptford Reach’s building, at the heart of the community. There will be more similar events in the future as part of the service’s focus on more outreach work. In the meantime the team facilitate regular GP and nurse appointments in the building, as well as supporting people to register with GPs in the community.

Sive O’Regan, inclusion health clinicial nurse specialist, said: “Really happy with today’s turn out for our point-of-care blood borne virus testing at Deptford Reach. A really well organised health promotion event that we thoroughly enjoyed being a part of and look forward to the next.”

Jordan McTigue, lead manager at Deptford Reach, said: “It can be difficult for people with experience of street homelessness, as well as those at risk of street homelessness, to access health services, so this is such an important day to get people engaged and get them vaccinated and protected against COVID-19, as well as providing resources and information to prevent ill health where possible.”

Prior to Christmas 2020. Just Eat, the well-known food outlet, in association with Social Bite, the organisation behind the Worlds Big Sleep Out in 2019, ran a fundraising campaign raising money to alleviate the growing problem of food poverty.

When ordering their takeaway, Just Eat customers were invited to donate a small sum on top of their order total to raise money to buy 200,000 Christmas meals for people in need across the UK. Thames Reach was one of fifteen charities selected to distribute the funds raised.

The campaign and the money raised exceeded expectations, and the charities quickly hit their target for the number of meals provided. With the help of some fantastic volunteers, Thames Reach staff across the organisation distributed 500 meals to people living alone and in food poverty over the Christmas period. This was particularly important this year, with the cancellation of  festive meals and services, which are so important for people who live alone and in poverty.

But this is not the end of the story. Because the fundraising campaign was so successful, we have continued to provide meals and groceries to vulnerable and isolated people through January, February and March. In fact, we have distributed an additional 1300 meals to people in need. This couldn’t have been more timely, with the pandemic seriously affecting those who needed to self-isolate, but who didn’t have the kind of family support so many of us can rely on.

We want to say a big thank you to Just Eat and its customers, Social Bite and our partners, particularly The Good Eating Company, which provided really high-quality ready meals, and a huge thank you to our fantastic volunteers. They distributed the meals and offered a little Christmas cheer and a warm smile to everyone they met.

“The national snapshot rough sleeping street count figures collected by the Ministry of Housing, Communities and Local Government (MHCLG) at the end of November 2020 show a significant reduction in rough sleeping compared to the same period in 2019.  These figures need to be treated with some caution: they are a snapshot of one night, and some areas undertake an estimate rather than counting.  That being said, the more accurate CHAIN database from the Greater London Authority (GLA) records people seen sleeping rough by outreach workers in London, also shows a reduction in Quarter 3 (October to December) against the same period in 2019.

“This follows an large increase in rough sleeping in April and May during the first lockdown, when many people who were precariously housed lost accommodation and came onto the streets for the first time.  Many of these people were helped by the ‘Everyone In’ response, which provided temporary accommodation, with many of these people now moved into long-term housing.

“People sleeping rough are not a static population.  Of the 3307 people seen sleeping rough in London between October and December 2020, 1582 were new to the street, and 1166 spent only one night on the street.  Rough sleeping is damaging and dangerous.  Investment by government in services to help people who are on the streets is welcome and is having an impact.  However if we are really serious about tackling rough sleeping we need to get to people before they end up on the streets, and prevent this happening.  The majority of people sleeping rough have significant support needs around their mental health or substance misuse (or a combination of these), and their homelessness represents a breakdown of the networks that should provide support, rather than a ‘simple’ housing crisis.   Work to build and reinforce these networks before people ended up on the streets was a major, albeit unsung, part of the effective response to rough sleeping in the early part of this century, but in the last ten years, local government funding cuts have meant that much of this work no longer happens.

“Around 50% of people sleeping rough on London’s streets are non-UK nationals, and the often punitive legal response to this group, means that it is often difficult for charities like Thames Reach to give them the help they need to get and stay off the streets.  There has been progress in this area with a greater flexibility around exclusion and help to find work, but the figures remain consistently high.  Putting needs rather than nationality first is crucial if we are to begin to make a difference for all people experiencing street homelessness.”

Following the amendment of guidance that ensured staff working with homeless people were treated as “frontline health and social care” staff, the public health body deciding on vaccination priorities, the Joint Committee on Vaccination and Immunology (JCVI), has recommended flexibility from authorities, meaning that the vaccine allocation should give attention to mitigating health inequalities.  The committee has identified people who are experiencing homelessness as a group who are affected by these inequalities, something that has been a priority message for Thames Reach for some time. This has already meant that some hostel residents have been offered vaccination.

Thames Reach welcome  JCVI’s recognition that the people who use our services can be particularly vulnerable, as this opens the route to earlier vaccination for people who are particularly at risk because they live in hostels or other shared accommodation, as well as those who already meet the criteria due to their age or clinical vulnerability. In the meantime Thames Reach are maintaining the protocol of ensuring that as many people as possible are registered with their GP, in order to make sure they are offered the vaccine at the appropriate time for optimum safety for all.

The London Assembly Housing Committee has released its report on ‘Five Steps to Build on Everyone In in London’. It takes a thorough look at the current landscape of rough sleeping in London, and the legacy left behind by the ‘Everyone In’ initiative. Highlighting that rough sleeping in London has increased by 170% in the last decade, the committee has produced at set of recommendations for the Mayor of London and government alike in order to reduce the devastating impact of street homelessness on people’s lives.

The cross-party Housing Committee examines matters relating to housing in London and takes a lead on scrutiny of the Mayor’s Housing Strategy.

The report takes a close look at numbers of people spotted rough sleeping in each quarter of the year, and breaks down these statistics to understand more about the people behind the numbers: their demographics, their support needs, and what brought them to the streets. This report has a particular focus on the first three months of the year, when the economic and social impact of the first lockdown manifested in an unprecedented increase in the numbers of people seen sleeping on the streets.

The report also deals with the response to this, particularly the provision of temporary accommodation (the ‘Everyone In’ initiative), and the Greater London Authority (GLA) and charity response to this.

Audrey, a Thames Reach support worker at Deptford Reach who was seconded to one of the hotels we ran during ‘Everyone In’, is interviewed on page 18 of the report:

“While supporting clients in the hotel, I was able to see that clients engage more with support staff than they do while working at the day centre. A client that I had difficulty engaging with before COVID was identified by the London Street Rescue team as a rough sleeper. The client had no identification, no bank account, and no job. The client was in the hotel from April to September. I met him in the hotel, and he engaged with me rather quickly. After completing an assessment with him, and understanding his predicament, I was able to support him to obtain an ID, a bank account, and Universal Credit. Currently, the client is living in private rented sector accommodation.

Working with the client helped him to realise that he neglected himself and had not taken care of himself properly. He told me that he would “take care of myself now,” and this goes to show how much he has learned from his experience rough sleeping.”

At Thames Reach, we find it encouraging that the Plan Points stated at the end of the report are already very much engrained in Thames Reach’s mission of ending street homelessness, in particular the cross-sector collaboration and the tailored solutions for people with high support needs, which we outlined in our recent statement outlining our vision for 2021.

Thames Reach have seen that people have continued to come onto the streets since the first lockdown, and while ‘Everyone In’ has ensured that the first group of people experiencing homelessness were temporarily housed and provided with support from our teams such as Private Sector Lettings (PSL), the people we work with are not a static population, and that the need for effective prevention work is greater than ever.

Thames Reach have signed a letter to the Department of Housing, Communities and Local Government requesting the expansion of the Protect programme based on the principles of Everyone In, as well as ensuring that frontline workers and vulnerable people in emergency accommodation are prioritised for the vaccine(s). Other organisations working in homelessness have also signed the letter: Crisis, Homeless Link, St Mungo’s, Housing Justice, Groundswell, The Passage, Pathway and Faculty for Homeless and Inclusion Health.

New variant SARS-CoV-2: why we must act to protect the lives of people facing homelessness.

As organisations working with people facing homelessness, and delivery partners of the government’s Everyone In scheme, we are calling on the Westminster Government to work with us to urgently sanction the next phase of Everyone In to protect people most exposed to coronavirus.

People facing homelessness are extremely vulnerable to severe health outcomes and mortality from Covid-19. With the discovery of the new SARS-CoV-2 variant, which is believed to be more than 50% more transmissible, there is projected to be a large and rapid increase in incidence with levels of hospitalisations and deaths in 2021 expected to be higher than in 2020.

Current Tier 4 measures put in place to protect people from the new variant are due to be expanded in the new year. These measures, while necessary, are extremely challenging and in some instances impossible to follow whilst homeless including in congregate settings that have shared facilities. For a time-limited period until high levels of vaccine uptake has been achieved, we would like to work with the government to realise:

1. Expansion of the Protect Programme based on the life-saving principles of Everyone In, and including a commitment that no one returns to the streets
2. Ensuring that people who are homeless in emergency accommodation, and frontline staff, are prioriitised for the COID-19 vaccine(s). 

Expanding the Protect Programme based on Everyone In principles

Through the extraordinary efforts of national and local government, nearly 30,000 people have been supported to move into emergency and other forms of accommodation since the start of the pandemic. In London, where the most robust data is available, London Councils reported that on May 4^th there were 3,630 people in emergency accommodation.

 This bold and world-leading action saved lives and relieved pressure on the NHS at a critical time. A recent study published by the Lancet showed that because of this response 266 deaths were avoided during the first wave of the pandemic among England’s homeless population, as well as 21,092 infections, 1,164 hospital admissions and 338 admissions to Intensive Care Units.[1]

 However, as the pressures of the coronavirus pandemic on people’s jobs and lives remain, many continue to be pushed into homelessness as the pressure becomes too much. From July to September 2020 in London, data shows 1,901 people were seen sleeping rough for the first time, which is 55% of the total number of people seen sleeping rough in this period (3,444 people).[2]

While government funding and initiatives have continued to support people sleeping rough, or at risk, into safe accommodation, the funding has had conditions attached. This has meant some people are falling through the gaps in support and therefore remain sleeping on our streets at a time where the new strain of coronavirus makes homelessness a heightened risk to life.

This includes through the new Protect Programme. While incredibly welcome, the programme reaches 10 local authority areas and focuses on supporting people who are defined as clinically vulnerable. However, barriers to accessing healthcare mean that people experiencing homelessness may not be recorded as being clinically vulnerable, even though they would meet this definition if they were diagnosed. Anyone living on the streets and many people who experience other forms of homelessness are by definition vulnerable.

With people newly becoming homeless, and the new strain of coronavirus increasing the rates of the disease, we are ready and willing to work with the government to expand the support available for people sleeping rough or in unsafe accommodation. With the success of Everyone In, local councils and charity partners have the experience of arranging self-contained accommodation, cohorting, and socially distanced support, and can act quickly.

As a result, we would like to work with the Westminster Government to expand the Protect Programme based on Everyone In principles. This will mean all local authorities once again fully funded to support everyone who needs it, regardless of immigration status, local connection, and priority need, into safe and fully self-contained accommodation. Given the increased transmissibility of the new Covid variant, it will be critical that accommodation is provided with individual washing and other facilities to avoid any need for shared spaces.

Once supported into self-contained accommodation, local authorities and support services can also work with individuals as they have continued to do so throughout the pandemic to provide a plan for move-on accommodation. We welcome the move-on options that have been developed as part of the original Everyone In programme and ask for a renewed emphasis on helping people into stable, long-term accommodation to help ensure that no-one is forced to return to the streets when coronavirus restrictions ease.

Ensuring people facing homelessness and frontline staff receive are vaccinated

These measures are urgently needed to not only protect people from the new strain of coronavirus, but to also support access for people facing homelessness to a coronavirus vaccine.

Priority for the vaccine to date has been predominantly based on age. However, parallels can be drawn between the vulnerability shared by the chronologically old and the biologically old, and while age is a key proxy for vulnerability to Covid-19, chronic homelessness could also be considered a valid and justifiable equivalent proxy.

For example, a recent study found that among a sample of homeless hostel residents in London, the levels of frailty were comparable to 89-year-olds in the general population. Participants had an average of seven long-term health conditions, far higher than people in their 90s.

Further, around a third of people who are experiencing the worst forms of homelessness would be deemed ‘clinically vulnerable’ and 1 in 10 would be deemed ‘extremely vulnerable’ to the virus. But unless people who are homeless and vulnerable to the virus are plugged into health services and reached with the vaccine, many people will remain at serious risk of the virus.

The increased threat for people facing homelessness is also recognised by the Joint Committee on Vaccination and Immunisation (JCVI). It acknowledges the health inequalities faced by people who are homeless and advises that a targeted approach will be needed including through the use of local Screening and Immunisation Teams. As such, we are asking the JCVI to prioritise people who are homeless in emergency accommodation, and frontline staff for vaccination due to increased risk of outbreaks.

This will need to go hand in hand with a comprehensive delivery plan to ensure people facing homelessness can access the vaccine. This should include access to people in provision provided by faith and community groups, or non-commissioned accommodation services such as those supported by the Homelessness Winter Transformation Fund.

Through an expanded Protect Programme which supports people into self-contained accommodation, people facing homelessness most at risk to the dangers of the new strain of coronavirus would be more easily identifiable, which would facilitate provision of the vaccine.

To ensure the success of such an approach, local health and social care teams can be involved in the support offered through the Protect Programme, by ensuring that enhanced infection, prevention and control measures are strictly implemented and adhered to across every facility accommodating people who are homeless.

Again, as delivery partners to local and national government, homelessness charities stand ready to assist the roll-out of vaccination to people facing homelessness and to front-line staff working in homelessness.

[1] Lewer, D. et al (2020) ‘COVID-19 among people experiencing homelessness in England: a modelling study’. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30396-9/fulltext

[2] Combined Homelessness and Information Network (CHAIN) reports: https://data.london.gov.uk/dataset/chain-reports

[3] Raphael Rogans-Watson et al. Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel. July 2020.

Thames Reach’s mission is to help homeless, vulnerable people to find decent homes, build supportive relationships and lead fulfilling lives.  The work of our Prevention teams are a key part of our strategy to encourage client independence through the support of rough sleepers, or individuals in temporary accommodation. Area Manager for Prevention, Zandi Zungu, talks us through Thames Reach’s prevention offer, consisting of a wide range of different services which centre around providing skills, employment or accommodation with the aim of preventing homelessness.

Our Peer Landlord scheme will undergo an expansion in Hackney as we will be providing supportive accommodation to individuals who are homeless or at risk of homelessness.  Peer Landlord will be offering accommodation to people who are working, and in a new aspect of the scheme, we will offer rooms to individuals whom have no recourse to public funds.

Within our Greenwich Private Rented Sector (“PRS”) scheme, we have successfully housed 64 individuals in private accommodation over the last year across several London boroughs.  The scheme has a tenancy sustainment rate of 82%.

The Sustaining Tenancies Accommodation & Resettlement Team (“STAR”), works in partnership with Shelter, St. Mungo’s and Stonewall Housing to prevent homelessness across London by supporting people with complex needs to get and keep a home, find employment, build their skills and improve their mental health.  Recently, the STAR team has responded to concentrations of rough sleepers previously inaccessible due to lockdown.  As a result of this work, there has been an increase in the number of service users assisted by the team.

Within the Central European Homeless Assistance Service, (“CEHAS”), we work with rough sleepers within the six North London boroughs to access employment and training including those who might have additional support needs.  A key part of this is helping people regularise their status, particularly where they have a history of working in the UK.  Presently, we have helped 17 clients achieve full settled status, and obtain Universal Credit, thus leading them closer to employment.

Located in Lewisham, Deptford Reach is our day centre within our Prevention offer.  At Deptford Reach, we provide case management, health services, mental health support, and social engagement activities to people who are vulnerably housed.

The Employment & Skills team at Thames Reach provides basic skills, digital skills, work readiness support, job opportunities, and in work-support to individuals who have a history of rough sleeping, or are currently living in hostels.  Throughout the lockdown, the Employment & Skills team has redefined their delivery model to engage with the most socially isolated and vulnerable service users.

George Slater, support worker at Croydon Reach, tells us all about his service, and his role in helping people rough sleeping across the borough to escape homelessness and then supporting them into new accommodation. George discusses his progression from Thames Reach’s Traineeship programme to a support worker, how the Croydon Reach team have come together to produce fantastic results, and how they feel prepared for future challenges.

I started at Croydon Reach in May last year as a Trainee and have since been given the opportunity to work my way up as an assistant support worker and then support worker.

Croydon Reach is responsible for handling the casework of verified rough sleepers in the local borough; we support our clients from the point of verification and then into temporary accommodation through their local council and back to more long-term independent living. Since becoming a support worker I have taken on the responsibility of overseeing the outreach side of our work and monitoring our rough sleeping population.

It’s been a very interesting year for Croydon Reach. We normally coordinate the Floating Churches Shelter during the winter months but this had to be cut short once lockdown measures were introduced, but all clients were found alternative accommodation that same afternoon! We also suddenly lost access to our daily drop-ins hosted by partner agencies such as Crisis, Salvation Army & Turning Point, as well as the ability to immediately place new rough sleepers into the No Second Night Out and Somewhere Safe To Stay Hubs.

The nature of our workload dramatically changed when the Government introduced the “Everyone In” policy at the end of March. Overnight, we suddenly had all of our rough-sleeping client base in local authority and Greater London Authority (GLA) hotel accommodation, giving us the opportunity to find sustainable, more permanent accommodation options for everyone. On the outreach side of things, we experienced a huge increase in the number of new rough sleeper referrals from Streetlink, and consequently we had a much higher volume of newly verified clients to work with. Thanks to the availability of GLA hotels we were able to accommodate everyone.

Despite the tragic consequences of COVID-19, Croydon Reach have had really positive outcomes in being able to get 90% of our clients immediately into temporary accommodation and placing 80 clients into permanent accommodation, including many of our most entrenched rough sleepers with a history of non-engagement. Although we’ve had to limit the usual face-to-face work that we do, the team has been able to work in the office safely and we’ve had the chance to streamline our workload and become much more efficient. The amount of increased casework we’ve experienced since March has been a positive learning curve for us all and we feel well prepared for the challenges we may face in the near future.

The Croydon Hospital Discharge project sees a Thames Reach staff member based at Croydon University Hospital, working with medical, social care and administrative staff both on wards and in the A&E department to avoid patients being discharged out onto the street. 

The service offers a person-centred approach to hospital patients focusing on enabling and supporting individuals specifically with support needs related to housing and welfare benefits. Thames Reach lead worker Teena Raval discusses how the project has adapted to the pandemic and plans for the future.

“One of the issues that has arisen during the pandemic is that people with pre-existing medical conditions have fallen through the net, as non-COVID medical procedures and appointments had to be cancelled. Anxieties around coming to appointments have also been a huge part of this, so mental health support is also really important in helping clients during and after the pandemic.

“The numbers of referrals from other services are about the same as usual, but we’re waiting to see what a second wave of the virus could mean for us. As the public integrate more, there is an increased risk, and people who were shielding will still need extra support and to take caution. The demand for our service didn’t ever decrease so we’ve been moving people on at the same rate as normal; 100% of people we were working with throughout the pandemic have been suitably housed.

“I’m the only Thames Reach member of staff on the project, so my role involves collaborating and liaising with a range of different services across Croydon and beyond, such as outreach services, other support organisations, as well as hospitals to ensure patients are receiving adequate support. These are long-running partnerships and we’re really proud of the work we do as a team. Each organisation has an important part to play, and we regularly work with the Salvation Army, Turning Point [drug and alcohol services], the council, Rainbow Health Centre [homeless health service] and Crisis to ensure a well-rounded support package is available to prevent individuals returning to hospital.

Moving forward, I’ll be looking at recruiting volunteers to support the project; there is only one of me from Thames Reach so we’re looking at doing training for new volunteers so we can run longer hours in the project. This wouldn’t be for a full service, but just for signposting and advice out-of-hours. Our service is vital to the hospital so we need to grow it accordingly.”

Learning and development is a crucial part of working at Thames Reach, and during the Covid crisis the ways in which staff have developed their roles and gained new skills have had to adapt. Thames Reach provide a year-round programme of training opportunities including Health and Safety, First Aid, Equality and Diversity and Social and Corporate Responsibility. We spoke with Sarah Jeeves, Learning and Development Officer, about how training has adapted to a new virtual way of working.

What were your main concerns about continuing your learning and development when lockdown started?

At first we were wondering what to do. Of course it wasn’t something we were prepared for, there was no Plan B but I wanted to keep the energy and strategy going despite lockdown. I’d never taught or facilitated teaching online before at Thames Reach, but I realised that we needed to adapt straight away. We still had the annual training programme to accommodate, as well as the Pathways Into Management initiative and the ILM [Institute of Leadership Management] qualification, both of which are training a group of internal candidates to progress in their career within Thames Reach into management roles.

How is virtual training going?

It’s been really well received. I’ve been pleasantly surprised at how well people have been engaging with everything. Staff seem to be taking it as an opportunity to improve confidence, as they can access training that would usually be done in groups from the comfort of their own home or office, so often will be more comfortable to ask questions and get involved. Across all training, places have stayed fully booked, so people are still engaged and ready to learn. We also have our cohort of trainees, who have come through the traineeship programme which is very popular. They were inducted at the start of May and are now on placement across Thames Reach, adhering to the same social distancing measures as all other staff. It’s going really well, I’ve been in regular contact with lead managers and the trainees’ supervisors and the feedback has been good so far.

How has training adapted?

While it’s definitely nice to have face-to-face interaction, under these circumstances we have to deal with the fact that this isn’t really possible. Now that we’ve gotten used to tech and the administrative side of things, we’re finding that training actually works better online, it’s more efficient. Our Cultural Diversity training, for example, works really well, as everyone can be in one virtual space at once while the trainer is talking, then we can split them into smaller groups once or twice over the course of the day. We do regular Emergency First Aid and Mental Health First Aid courses too, which can’t be done remotely due to the nature of the teaching, so that has been postponed for the time being.

As I said we haven’t been able to do Emergency First Aid as it’s not available from any trainer until lockdown is fully lifted, but it’s been great to see Senior Management get involved with training, and it’s clear that staff really appreciate it. I’ve been making and securing new relationships with trainers and organisers, which has been a big benefit. Homeless Link is one example who have been great to work with; they will be providing training on Managing Conflict, Violence and Aggression, to replace our Working with Challenging Behaviour training that had to be cancelled.

So it sounds like it’s generally been a positive experience. What are you bringing forward into learning and development in the future?

Building relationships with people internally and externally has been really good, I don’t usually get to sit in on training so I’ve learned a lot too. Even just getting to chat with other staff before the training starts has been really nice. I’ve been more hands-on with the tech and administrative sides of training, so it’s been a good learning curve for me. We’re definitely going to make the most of Zoom and Microsoft Teams in the future so training can fit around other work commitments and staff won’t have to travel. I was concerned that ILM and Progression Into Management candidates would lose motivation and momentum but we’ve seen people come together and make the most of virtual opportunities such as webinars, so we’re encouraged by this and looking forward to using these techniques going forward. I also organised Thames Reach’s first Staff Wellbeing Week last September, which was very successful. We’re currently working on doing an adapted version for this year, taking on board everything we’ve learned, so watch this space!

NB: Of course, the photo above was taken long before lockdown, from the fantastic Mental Health First Aid training run by MHFA England, which will resume for staff once lockdown is fully lifted