Everyone In – Supporting Homeless Clients on the Frontline During Covid-19

Sam Dorney-Smith talks about nursing homeless clients during Covid-19

I usually work as a Nursing Fellow for the Pathway charity, and as the Homeless Health Programme Lead for the Queen’s Nursing Institute (QNI). I have also been working one evening a week since January for Doctors of the World, undertaking medical outreach in the City of London.

On Saturday 20^th March 2020, I arrived to volunteer at the Ministry of Housing Communities and Local Government (MHCLG) funded Limehouse Holiday Inn alongside volunteer GP Sophie Mylan. I had been asked that week by the Find and Treat Clinical Lead, Dr Al Story, to find volunteers through the London Network of Nurses and Midwives to help the Covid-19 effort, and thought I should volunteer to be one of the first on scene.

The ‘Everyone In’ programme of hotels had only been finally agreed that week, and Limehouse was the first of these hotels to start taking clients from night shelters, the No Second Night Out projects and Heathrow Airport. The day before, I had been sitting with Find and Treat and we had been assured everyone had been triaged to assess medical vulnerability, and to find if they had symptoms – so I was just volunteering to check in and see if any support was needed.

When I arrived, of the 37 clients they had there already, the staff identified to us three clients immediately that they thought were medically vulnerable. They were medically vulnerable, and two of these had Covid symptoms! Thus started a pretty intensive period of triage and urgent support provided by multiple volunteers and self-redeployed staff to support getting ‘Everyone In’ safely, and cohort them effectively.

I stayed supporting this 150 bedded hotel and another 200 bedded hotel, City Travelodge, for 6 weeks. During that time we managed around 25 symptomatic clients, mostly on the floor we designated for symptomatic clients at Limehouse. I had to source everything – staff, clinical equipment, PPE, locked cabinets etc., over the initial few days, and develop messaging and procedures in the hotels to make them safe from a public health point of view.

All clients received a medical triage, and clients with addictions and mental health problems were plugged into emergency support to stabilise them and help them settle and self-isolate. The response was very effective, and (I believe) saved many lives (particularly in comparison to big cities in America for example).

Throughout this time I also provided telephone triage support to more remote outreach workers as part of a team, and also continued my own outreach in the City on Tuesday evenings, helping to bring people in.

Since then I have moved for a few weeks to continue to support with medical triage in the hotels in North West London, but I am now discussing being part of a virtual Pathway team to support people to move on.

Throughout the whole time I have been supporting the Healthy London Partnerships Homeless Health Covid control in producing guidance to support the care of all the 4000 in across London. I have also supported inclusion health nurses and Health Visitors around the country via the QNI Homeless Health network, providing information, resources and networking platforms. It’s been a busy to say the least…

But I’ve loved being back on the front line.

And I’ve loved being part of a system where it’s possible to say ‘yes’. Yes, we have accommodation. Yes, we can get you rapidly scripted. Yes, we can get you mental health support even though you have an addiction. Yes, to food, new clothes, a SMART phone, a TV in your room. Yes, to simple things like Language Line when you need it (although admittedly accessing services like GPs had been difficult so it hasn’t all been perfect). Yes to sharing information sensibly to benefit people’s health.

I really, really hope the system learns from this, and doesn’t go back. But either way it’s good to know we saved lives when it was needed.

Sam Dorney-Smith
Homeless Health Programme Lead, QNI
Nursing Fellow, Pathway