Omicron preparedness in homelessness settings

17 Dec 2021 12:31 PM

The worrying rise to date of the new Omicron variant is creating another perfect storm for providers of homelessness services this winter.

Vaccination rates are lower amongst people experiencing homelessness and they are more likely to have underlying health conditions making them vulnerable to COVID-19. Rough sleeping in many areas of the country is on the increase and there are far fewer winter beds available.

For those working in, or managing services, keeping up to date with changes in COVID-19 guidance from government and understanding what these might mean is going to be increasingly important.  As will sharing with, and learning from, others in the sector and working closely and collaboratively at a local level with local authorities (LAs) and public health (or health protection) teams.

The implications of Plan B

England has now moved to Plan B with new rules on mask wearing alongside strengthened advice on vaccinations, testing, working from home where possible and increasing ventilation when mixing indoors.

Plan B has some direct implications for homelessness services and this has led the Department for Levelling Up Housing & Communities (DLUHC) to update two key documents for LAs and providers of accommodation projects. These key documents are the Operating Principles for Commissioners and Providers of Night Shelters for People Experiencing Rough Sleeping and COVID-19: Guidance for Commissioners and Providers of Hostel Services for People Experiencing Homelessness and Rough Sleeping.

Some of the key changes include:

• Mask wearing is now mandatory in communal areas of hostels.
• As previously, residents or staff with symptoms of COVID-19 or testing positive should self-isolate for 10 days but additionally staff or residents who are identified as contacts of someone testing positive for the Omicron variant should also be self-isolating regardless of their vaccination status (pending a PCR test result).
• Vaccination of the population remains at the heart of the government’s strategy for minimising transmission. Providers of hostels and night shelters are asked to make every effort to encourage vaccination of residents. 
• Winter shelters that include shared sleeping areas should only open if there is explicit written consent of the LA and the local Director of Public Health.

The second of these points suggests, given the sharp rise in Omicron cases, that services should be planning for a major increase in demand for fully self-contained units of accommodation that can be used for self-isolation.  The guidance suggests that LAs should be assisting with this.  

With regard to vaccination - services should continue to think about how they can help with vaccination take-up.  Homeless Link ran a webinar on responding to vaccine hesitancy amongst people experiencing homelessness and this recording and additional resources to help build confidence is available.

The government has been encouraging LAs and providers of night shelters to put in place alternative models of winter provision (similar to the approach last winter) based on self-contained or single room models. Funding was again made available to deliver this through the Homelessness Winter Transformation Fund. The overwhelming majority of projects have moved away from communal sleeping models but the updated guidance further strengthens this:

“These settings should not be opened without written agreement from your local authority and the local Director of Public Health, based on a comprehensive risk assessment.”

All LAs should be planning to provide severe weather emergency accommodation (SWEP) in periods of severe weather for people who would otherwise be sleeping rough. Again this is likely to be mainly self-contained or single room provision.

For most winter projects which include single rooms with some sharing of facilities or communal spaces then it is the hostels guidance which will be most appropriate. It will be helpful for providers to read the guidance in full but a few points are worth highlighting:

• Hostels should implement daily monitoring of COVID-19 symptoms among residents and staff.
• Limit close contact between people in enclosed spaces and use face coverings where people are unable to maintain social distancing.
• Accommodation providers should work with local public health teams to support the development of solutions to deliver COVID-19 vaccinations

One particular issue that might be best considered urgently is a refresh of risk assessments and plans for management of ‘outbreaks’.   This is defined as ‘two or more confirmed cases in any facility within 10 days of one another’.  Notification to the local public health team is necessary. This is covered in more detail in the guidance.

If you are looking for more detailed advice, two respected Professors from the University College London (UCL) Collaborative Centre for Inclusion Health, Professors Al Story and Andrew Hayward have released a statement of advice to homelessness services jointly with the Faculty for Inclusion Health with additional recommendations for hostels and emergency accommodation.

Staying up to date

In terms of staying up to date with guidance and good practice related to Omicron Homeless Link suggests:

• Sign up to regular email updates from government on housing and homelessness related topics. This will include updates on any changes to the gov.uk pages and serve as an alert every time the guidance is updated.   
• Join the NHS England ‘Future NHS’ online platform where staff can join multiple workspaces on topics including health inclusion and vaccine equality to share, connect and learn from others. People can register for free on www.future.nhs.uk (it’s worth noting that once registered, access to the inclusion health workspace needs a further email to HomelessHealthCOVID19-manager@future.nhs.uk to enable you to be added.
• Wherever your service it’s worth keeping up to date with some of the work happening elsewhere. For example,
  Healthy London Partnership is an umbrella partnership of health service providers with lots of resources and guidance on COVID-19 and people experiencing homelessness that could be useful to others outside London too. They run regular short webinars and their next one (on 21st December) is on ‘Omicron preparedness in homelessness settings’

Staff and volunteers

Finally, a brief mention about staff and volunteers. DLUHC continues to encourage service providers to support staff and volunteers to get vaccinated and have access to regular testing.

The issue of mandatory vaccinations of staff is only relevant to a very small number of homelessness settings where Care Quality Commission registration applies. New regulations  Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021 (‘the regulations’) came into force on 11 November.