On 8 October, Crisis, along with s​eventeen leading health and homelessness organisations, have written an open letter to the Prime Minister warning of the double threat of coronavirus and the cold weather ​that people forced to sleep rough are facing. 

Following recent research published in The Lancet which found that the Government's move to get ​nearly 15,000 people sleeping rough into safe accommodation at the start of the outbreak saved hundreds of lives, the letter urges the Government to protect people by providing self-contained accommodation as a priority due to the high risk of coronavirus transmission in communal night shelters. 

 

The Rt Hon. Boris Johnson 
MP Prime Minister 
10 Downing Street 
London 
SW1A 2AA 
 
Dear Prime Minister, 

Re: Charities and health bodies warn of ‘risk to life’ to people facing homelessness and Covid-19 this winter 

As leaders of homelessness charities and professional health bodies, we are speaking as one today to issue an urgent call for action from Government. With the double threat of the coronavirus pandemic and winter, people experiencing homelessness, including those new to sleeping rough on our streets, require decisive action from central Government to provide appropriate protection for everyone who needs it. This must come in the form of self-contained accommodation, as it will be difficult to make communal places such as winter night shelters secure from coronavirus. 

The dire economic consequences of the pandemic will see more and more people pushed into homelessness by the financial pressures of job loss and unaffordable rents. People experiencing homelessness, particularly those who are sleeping rough, do not have a safe home to self-isolate in or follow sanitation guidance. At the same time, funding packages for local councils to support people into safe, stable and self-contained accommodation are drying up; meaning that more and more will be forced to sleep rough or stay in shared – and therefore potentially unsafe – accommodation. 

In its initial response to the coronavirus crisis, your Government’s quick action through the Everyone In scheme saved lives. This extraordinary effort meant that nearly 15,000 people were offered emergency accommodation in hotels and hostels. As demonstrated by a study recently published in The Lancet, because of this timely 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 Simply put, without Everyone In the loss of life as a result of coronavirus would have been much higher. 

Now, with cases of coronavirus once again rapidly rising across England, combined with the threat that winter already poses to the health of people sleeping rough, we are urgently calling on you to ensure that local authorities can provide people sleeping rough with safe, self-contained accommodation during the pandemic. This must be followed up with increased funding, which is critically needed to enable local authorities to provide effective support. The support into accommodation from local authorities must apply to all those who need it across the country, as we saw with the early approach of the Everyone In scheme. 

As organisations working in health and homelessness, we see every day the extreme health inequalities already faced by people who experience homelessness. Housing is a social determinant of health; living on the streets or without a stable home makes you more vulnerable to physical illness, poor mental health and drug and alcohol problems. People who are homeless are three times more likely to experience a chronic health need, including respiratory conditions. A recent study found that among a sample of people facing homelessness 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.2 The interaction people who experience homelessness have with healthcare often begins and ends with a visit to Emergency Departments. Instead we must provide healthcare to people in advance of them reaching a health crisis, which requires community-based care and multi-agency support. 

These health inequalities, with the added health impacts of coronavirus and the cold, mean that failing to protect people in unsafe living conditions over the winter months poses a grave risk to life and will place an enormous and avoidable pressure on the NHS. We cannot rely on winter shelters this year to accommodate people sleeping rough. We are concerned that despite the best efforts of shelters to adhere to social distancing, they are designed as communal spaces which makes social distancing and self-isolation extremely difficult. International examples have shown us the impact of coronavirus on people facing homelessness if they have no option but to remain in shelters and hostels where self-isolation or social distancing is impossible. In a study by the Coalition for the Homeless in New York City, it was found that the mortality rate from coronavirus for people staying in shelters was 61% higher than the rate among the general population.3 

We have strongly welcomed your Government’s quick and decisive action in the face of the coronavirus pandemic. We implore you to take similar bold action ahead of the winter months to ensure that everyone who needs it has self-contained accommodation to stay in throughout this public health crisis. This will require a cross-departmental approach to meet people’s holistic needs. With this action and help for people to move on from homelessness for good, we can save lives and end rough sleeping in this country. 
 
Yours sincerely,  
 
Jon Sparkes, Chief Executive, Crisis 
Professor Andrew Goddard, President, Royal College of Physicians 
Professor Martin Marshall CBE, Chair, Royal College of General Practitioners  
Professor Andrew Hayward, Director, UCL Institute of Epidemiology and Health Care Dr Katherine Henderson, President, Royal College of Emergency Medicine  
Dr Adrian James, President, Royal College of Psychiatrists 
Dr Marcel Levi, Chief Executive, University College London Hospitals NHS Foundation Trust 
Christina Marriott, Chief Executive, Royal Society for Public Health 
Professor Maggie Rae, President, Faculty of Public Health 
Dr Chaand Nagpaul, Council Chair, British Medical Association 
Professor Parveen Kumar, Chair, British Medical Association Board of Science   
Dr Nigel Hewett OBE, Secretary, Faculty of Homeless and Inclusion Health 
Dr Crystal Oldman CBE, Chief Executive, The Queen’s Nursing Institute 
Alex Bax, Chief Executive, Pathway 
Steven Platts, Chief Executive, Groundswell 
Steve Douglas CBE, Chief Executive, St Mungo’s 
Polly Neate CBE, Chief Executive, Shelter 
Mick Clarke, Chief Executive, The Passage