This morning’s tweet by Maggie a student Nurse who gave twenty pounds to a person experiencing homelessness gave me stark contrast to what happened yesterday and poise to reflect.
Yesterday we were in London. We were caught up in a crowd and swept past someone sitting in the rain calling for help.
As we reached the bottom of the steps in the crowded underground station I turned to the person with me and said. We should have stopped, why didn’t we stop, we should go back.
The moment quickly passed and we were caught up in the next thing, finding our way and offering directions (all be it confused and probably adding to the confusion across the language barriers).
That moment of guilt at not stopping can easily be assayed by other acts of kindness but that didn’t help that person in that moment of crisis.
So I can go into one about my own personal failings but that doesn’t alter the fact that not one person stopped.
A human being in distress and a whole cohort walked by. I think of the people in that crowd, different nationalities, people from all over the world. None of us stopped. People of different professions, people who would have, could have made a difference all walked on by.
How many of us can honestly say we didn’t see, made a conscious decision not to help? I suspect more of us than our discomfort might allow. An uncomfortable truth.
Our shadow selves perhaps that seek excuses.
Yesterday we were talking about the normalised Islamophobia in the UK. Normalised anti Blackness, Normalised brutality of women. Now perhaps on this day of “random acts of kindness” perhaps we need to sit with the normalised nature of homelessness and grapple with our positionality in ending this. Random acts of kindness won’t end homelessness.
“The legal definition of homelessness is that a household has no home in the UK or anywhere else in the world available and reasonable to occupy. Homelessness does not just refer to people who are sleeping rough, and is not just a problem found in high-value housing markets such as London and the South East.
The causes of homelessness are typically described as either structural or individual and can be interrelated and reinforced by one another. Causes and their relationship vary across the life course.
Structural factors include:
poverty
inequality
housing supply and affordability
unemployment or insecure employment
access to social security
Individual factors include:
poor physical health
mental health problems, including the consequences of adverse childhood experiences
experience of violence, abuse, neglect, harassment or hate crime
drug and alcohol problems (including when co-occurring with mental health problems)
bereavement
relationship breakdown
experience of care or prison
refugees
For most people who are at risk of, or experiencing, homelessness and rough sleeping there isn’t a single intervention that can tackle this on its own, at population, or at an individual level.
Action is required to support better-integrated health and social care, and to help people to access and navigate the range of physical and mental health and substance misuse services they require in order to sustain stable accommodation.
Health and care professionals play an important role, working alongside other professionals to:
identify the risk of homelessness among people who have poor health, and prevent this
minimise the impact on health from homelessness among people who are already experiencing it
enable improved health outcomes for people experiencing homelessness so that their poor health is not a barrier to moving on to a home of their own
There needs to be clear local action, partnership working (across the local authority, clinical commissioning group and other local organisations) and understanding and alignment of commissioning decisions to prevent and respond to homelessness across the life course. This can include:
reducing the risk of homelessness to children and young people to strengthen their life chances
enabling working-age adults to enjoy social, economic and cultural participation in society
breaking the cycle of homelessness or unstable housing by addressing mental health problems, or drug and alcohol use, or experience of the criminal justice system
This requires strong local leadership and prioritisation to identify unmet need, funding and actions to address gaps in provision.
St. Mungo’s Broadway and Homeless Link carried out an audit in 2014 of Joint Strategic Needs Assessments, Health and Wellbeing Strategies and Clinical Commissioning Groups’ commissioning plans in 50 upper tier local authorities. They found that whilst there are some good examples, more needed to be done to ensure that homelessness is consistently addressed through local authority and clinical commissioning group planning.” https://www.gov.uk/government/publications/homelessness-applying-all-our-health/homelessness-applying-all-our-health#:~:text=The%20legal%20definition%20of%20homelessness,London%20and%20the%20South%20East.
Having banged on about this and the consequent health inequalities long enough and just experienced silence from our CCG I’ve written to them again asking about progress. This person wasn’t here (Clacton) but homelessness and racial trauma go hand in hand I would have thought.
Homelessness is more than being without a home it’s about that lack of a safety net, for support I’d suggest.
My cousin, a person without close relatives (🙄) but with caring friends who couldn’t provide the help needed phoned in huge distress. She’s in debt. She’s never been in debt. Reminds me of another family I met. Destitute because of a “missing” housing benefit payment. A promised payment that never arrived. It went to court. Required to go to Colchester without transport or money to get there. When there is no buffer, there is devastating effects. Family arguments, recriminations, hungry children. Family problems one after another that can hit but don’t go well when there is no safety net. Was it the same as those whose livelihoods were crushed by the post office IT scandal?
I think of that now in the context of what I’ve learnt about systematic oppression and so called health inequalities. Inequalities by design.
I think about the many opportunities for intervention that added to the trauma instead of helping. What might have been different if people and systems had capacity to help.
Money would have helped to a degree. But what was needed was a timely response and care, “humanity”.
Like with covid and climate change, racism, all the isms, lessons we fail to face?
A normalised culture of tick box approach? While we silently standby and watch the next unfolding disaster? More people made homeless.
We went to the London museum. The weaponry and artifacts on display a story of violence, in common with many nations. Wonder how that might be different going forward.
I attended the Royal Society of Medicine webinar with Professor Martin McKee who talked about the divergence in the data, inconsistent testing capacity and a Nation who is already an outlier with excess winter deaths.
The encouraging data of covid infections going down as are hospitalisations and deaths but he reminds us how we’ve been here before. How not all viruses produce variants that get milder.
We’re reminded how a governments duty is to protect the lives of its citizens and I can’t help but inwardly scoff. Perhaps he hasn’t seen the data on inequalities.
Though he has seen how health deterioration data showed up in the Soviet Union, data that things were going seriously wrong.
We were reminded of how the infection rates are still very high. 4014 currently in Tendring (warnings of the unavailability of lateral flow). Up by 193 from last week (Zoe study 17 February 2022)
Crazy to get rid of testing at this point. We were told how we cannot go back to the status quo. Protections enable freedoms. Covid isn’t flu, it isn’t a cold. It’s a multi system disease.
English exceptionalism puts us again outside the norm. Only just now trying to protect our children with vaccination, abandoning them without addressing ventilation and HEPA filtration.
When we needed a steady ship we arguably had no pilot let alone a crew.
I learnt that in the US some states even banned lateral flow and it really makes me wonder about understanding.
We heard how in the history of cholera providing clean water was thought to be unaffordable. Exactly the same arguments used about clean air.
Fortunately because of public health these days here (UK) few children get seriously ill with anything. (Still ignoring the children with ME and the like?) Yet here we have a multi system disease that has been allowed to go unchecked without any one knowing the long term consequences.
There remains high transmission in schools. School absence. Covid deaths in children are too high
We were told as if we needed to be, population ahead of the game already, governments lagging behind; children need a structurally safe environment.
Masks in schools provide reassurance for many.
Downplaying risks to children has the effect of ‘protect our children’ trending on twitter with fears of vaccination instead of the disease.
I’m thankful for the vaccinations me and those I love have had. From babes in arms. https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/
The data we were told shows the benefits are clear to children and to caste doubt has been English exceptionalism we are told.
Fewer children have died during the pandemic including of covid than normally. Perhaps a hint to look again at road safety, other aspects of children’s lives.
Finally I hear someone questioning why we live with those high flu deaths. “Excess mortality should have been much less to begin with.”
Professor Martin McKee is asked if we are at the beginning of the end of covid. But the truthful answer is “no one knows what will happen, we don’t know where Omicron came from.” The two variants. “We need to be cautious” and makes the point about historical records, viruses don’t always get milder.
I listened as we were told Sweden is doing badly compared to Norway, Finland and Denmark.
Mobility fell, housing regulations got worse than their neighbours. They banned alcohol at one stage. They unlike the UK have a population that do as they are told, culturally it’s not possible to make a direct comparison with the UK. All that we’ve been told before.
So where is the health system legacy? Will it be found here? https://www.who.int/health-topics/sustainable-development-goals#tab=tab_1
GPs are seeing more people. More people are singing off the same hymn sheet we’re told, Mark Karney, Gordon Brown haven’t we already visited this before without meaningful action, investment not an optional add on. But the proof will be in the pudding. Be seen in marginalised groups. Be seen in the consequences of not investing in health.
When we walked on by the person crying for help in the street did we each ask ourselves “How can I make the world a better place?” As Professor Martin suggests. Those who in youth tore up a £50 note in someone’s face or so it was reported shouldn’t in my opinion be on this ship trying to make things better, but perhaps now they know better?
Did governments ask themselves that when they shared the news of dropping protections? Invest in social safety nets as per the findings? Consider the most marginalised and disadvantaged?