Guidance on COVID-19: provision of night shelters
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Operating principles for commissioners and providers of night
shelters for people experiencing rough sleeping. From: Department
for Levelling Up, Housing and Communities and Ministry of
Housing, Communities & Local Government Applies to England
Contents 1. Introduction 2. Priority actions to take 3. General
advice 4. Keeping people safe 5. Vaccination 6. If guests
were...Request free trial
Operating principles for commissioners and providers of night shelters for people experiencing rough sleeping. From: Department for Levelling Up, Housing and Communities and Ministry of Housing, Communities & Local Government Applies to England Contents
The government has announced that England will move to Plan B in response to the risks of the Omicron variant. Find out what you must do to help prevent the spread. 1. Introduction Local authorities and voluntary, faith, and community groups have gone to extraordinary lengths since March 2020 to protect vulnerable people who sleep rough from the risks of COVID-19. This has seen communal shelters either being closed or transformed into self-contained accommodation to reduce the spread COVID-19. These adapted models often provide safer environments, offer greater protection to individuals with underlying health conditions, and can produce better move-on outcomes for individuals. However, we know that local circumstances may mean that there are limited occasions where a service provider decides to put in place communal models to prevent people sleeping rough, particularly in extreme weather. 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 This guidance has been drafted with advice and input from the UK Health Security Agency (UKHSA). This guidance sets out advice on how night shelters can operate more safely, based on public health principles. It has been updated to reflect changes to measures which the government has announced to respond to the risks of the Omicron variant. This includes a move to Plan B in England.
Following this guidance will help people attending or working in shelters to take steps to reduce the spread of coronavirus (COVID-19) infection in the community, stay safe and save lives while the risk of infection remains. This guidance applies in England alongside the relevant associated changes to the law. It applies to night shelters only. It does not apply to private dwellings. 2. Priority actions to takeLet fresh air in Make sure you let plenty of fresh air into any shelters. You or the venue manager can do this by uncovering vents, and opening doors and windows. Letting fresh air into indoor spaces is important because when a person infected with COVID-19 coughs, talks or breathes, they release droplets and aerosols which can be breathed in by another person. The more fresh air there is to breathe, the less likely a person is to inhale infectious particles. Limit close contact Although social distancing is no longer required, staff, volunteers, and guests may choose to limit the close contact they have with people they do not usually live with, particularly if they are not fully vaccinated. This is a personal choice which can help reduce the risk of catching or spreading COVID-19. Shelter providers should be prepared to support those who wish to maintain social distancing, especially around those who may be more vulnerable. Providers of shelter accommodation may also want to consider the proximity and density of guests, as well as the duration and regularity of any interactions. Face coverings Face coverings are required by law in most indoor public places and on public transport, including taxis. In other indoor settings where a face covering is not legally required, individuals should continue to wear a face covering in crowded and enclosed spaces where they may come into contact with other people they do not normally meet. This includes communal areas in night shelters. Staff within night shelters are required to wear face coverings when they are in a part that is open to the public and when they are likely to come into close contact with members of the public. Staff may also wear face coverings when working in settings where face coverings are not required, and businesses are encouraged to support them in doing so. Some people, including children under 11, are exempt from having to wear face coverings in any setting. Furthermore, anyone with a health condition or disability, which means they cannot wear a face covering, has a reasonable excuse for not wearing one. Further guidance on face coverings is available. Wash your hands Guests, staff, and volunteers should wash their hands with soap and water or use hand sanitiser regularly throughout the day. Regular hand washing is an effective way to reduce the risk of catching illnesses, including COVID-19. Guests, staff, and volunteers should wash their hands:
Support those with COVID-19 symptoms or who have tested positive to self-isolate In order to keep people in shelters safe, providers should support guests who test positive for COVID-19, or have COVID-19 symptoms to self-isolate and get a PCR test, even if their symptoms are mild. Any individuals who test positive must self-isolate, even if they are fully vaccinated. This also applies to staff and volunteers working in shelters. Please see further guidance below on what to do if a guest develops COVID-19 symptoms. Encourage vaccination Vaccinations significantly reduce the risk of catching COVID-19. Anybody entering a shelter, whether as a member of staff, a volunteer, or a service user, should consider getting vaccinated, if they haven’t already. Providers should also consider how to increase uptake among their guests, including encouraging guests who have only had their first dose, to have their second. Get tested If you develop COVID-19 symptoms, self-isolate immediately and get a PCR test, even if your symptoms are mild and you are fully vaccinated. Staff and volunteers should self-isolate at home while they book the test and wait for the results. You must self-isolate if you test positive. Your isolation period includes the day your symptoms started (or the day your test was taken if you do not have symptoms), and the next 10 full days. This is the law. Providers should support staff, volunteers and guests to access regular asymptomatic lateral flow (LFD) testing, and confirmatory PCR testing where appropriate. Rapid lateral flow testing is available for free to anybody, and is particularly recommended if you will be in a high-risk situation that day. Find out more about how to get LFD tests. Providers should also develop plans to support people with COVID-19 symptoms, or a positive test, to isolate and to trace their recent contacts. The NHS COVID-19 app is a vital part of NHS Test and Trace in England and Wales. Using the app helps stop the spread of the virus by informing you that you have been in close contact with someone who has since tested positive for coronavirus, even if you don’t know each other. Those who are able to use the app should be encouraged to do so. Self-isolation If staff, volunteers and guests are a household or non-household contact of someone with COVID-19 they must self-isolate unless any of the following conditions apply:
However, if staff or guests are a household or non-household contact of someone identified as a suspected or confirmed case of the Omicron variant of COVID-19, these conditions do not apply and you must self-isolate, regardless age or vaccination status. NHS Test and Trace will make contact with the individual if this is the case. Fully vaccinated means that you have been vaccinated with an MHRA approved COVID-19 vaccine in the UK, and at least 14 days have passed since you received the recommended doses of that vaccine. See further information on vaccination and proof of vaccination. 3. General advice The purpose of this advice is to reduce the risk of COVID-19 transmission if self-contained sleeping spaces are not an option. Providers and commissioners of night shelters should consider whether they can provide self-contained accommodation options. For clear safety reasons individual rooms and individual washing facilities should be the aim to appropriately protect individuals from communicable diseases such as COVID-19. All forms of night shelter present a level of risk to people with clinical vulnerabilities. However, it is even more challenging to implement robust infection control and outbreak management in rotating night shelter models. These models present greater risks to all those involved. 4. Keeping people safeAccess, referrals and triage It remains important that anyone to whom the following applies should not enter night shelters. This also applies to staff and volunteers.
If a guest or potential guest has COVID-19 symptoms, even if they are mild, or falls into any of the above categories, providers should work with their local authority to support individuals to access self-contained accommodation to self-isolate as appropriate. This includes any guests who develop COVID-19 symptoms on site. Testing for COVID-19 Around 1 in 3 people with COVID-19 do not have any symptoms. This means they could be spreading the virus without knowing it. Asymptomatic LFD testing increases the chances of detecting COVID-19 when a person is infectious but is not displaying symptoms, helping to make sure people do not spread the infection. Rapid LFD testing is available for free to guests, staff and volunteers working on site. Providers may wish to consider supporting staff, volunteers and guests to access LFD tests. Find out more about how to get LFD tests. Those working with people who experience homelessness and rough sleeping are included in the list of essential workers prioritised for COVID-19 testing. In line with current public health advice, staff should also consider taking an LFD test before going into physical environments where there is a high risk of transmission, such as crowded and enclosed spaces, or before visiting people who are at higher risk of severe illness if they get COVID-19. If anyone on site receives a positive LFD test for COVID-19, they should be supported to immediately self-isolate, and to access a confirmatory PCR test. If the PCR test is positive, they must self-isolate and follow the stay at home guidance. Staff should support guests with symptoms to arrange a test to see if they have COVID-19 if the guest can self-isolate safely on site. Identifying contacts of guests that develop signs and symptoms of COVID-19 Providers should consider how they can support in identifying contacts of guests if a guest develops COVID-19 symptoms and/or tests positive for COVID-19 on site, or within 48 hours of leaving the venue. This could include keeping records of each guest’s stay, in order to identify possible interactions. Contacts are not required to self-isolate if any of the following apply:
Find out whether you need to self-isolate and how you can protect others if:
If somebody gets any COVID-19 symptoms, they should self-isolate immediately and get a PCR test. Find out more about what to do if you have COVID-19. Cohorting of guests Providers should work with their local housing and rough sleeping teams to explore options for providing self-contained accommodation for those self-isolating. If isolation is not immediately possible, ‘cohorting’ based on COVID-19 status may be considered to mitigate some of the health risks. Cohorting is a strategy which can contribute to limiting the spread of disease by supporting people to access different areas/sites depending on their status. For example, contacts can be in a separate area of the shelter and non-contacts in another. The Clinical Homeless Sector Plan published by Pathway provides more details. Managing an outbreak An outbreak is defined as 2 or more confirmed cases in a single facility within 10 days of one another. In this event, commissioners and/or providers should seek advice from their local Health Protection Team. This remains the case whether the provider has a contract with the local authority or not. Local authorities should have a clear picture of all alternative local provision that could be used in the case of an outbreak. An outbreak control team may be brought together to consider appropriate mitigation which may include measures to introduce social distancing. While social distancing will no longer apply, it may be appropriate to retain it depending on the risks. Equally, it may be appropriate to reapply it after it has been lifted if assessments suggest doing so. Assessments will be carried out by service managers in consultation with or as a result of advice from Directors of Public Health or in the context of an outbreak control team led by the local Health Protection Team, who will be able to continue to advise on social distancing measures to control and prevent outbreaks. The use of social distancing should be targeted, time limited, and kept under review. 5. Vaccination COVID-19 vaccines are available to everyone free of charge. People who experience homelessness and rough sleeping are likely to have underlying health conditions, which can make them vulnerable to COVID-19. The Joint Committee on Vaccination and Immunisation has therefore prioritised them for being offered COVID-19 vaccines. They also may experience additional barriers to accessing vaccination. Providers have a role in informing people about the vaccine and should actively support guests to take up the vaccine where appropriate. This includes encouraging guests who have only received their first dose to access their second, and future access to any potential COVID-19 vaccine booster programme. There are leaflets and posters about the vaccination programme available. Providers should support local health teams in their vaccination plans, including helping them identify individuals in this group and appropriate sites to deliver vaccinations. There is no requirement for people to have an NHS number or to be registered with a GP to receive the COVID-19 vaccine from local teams. The COVID-19 vaccine is also available irrespective of immigration status and no data will be shared with immigration authorities when a vaccination offer is accepted. However, it may be operationally challenging to provide the second dose without GP registration or the ability to call back individuals. Providers should make every effort to support people to have their second dose and this will include local teams exploring options for offering second doses to those not registered with a GP. While this may be an opportunity to register some previously unregistered people with a GP practice, teams should be careful to communicate that GP registration is not necessary in order to get the vaccine. Local decision making should be undertaken on whether a shorter schedule may be offered in cases where the individual is unlikely to return for receipt of the second dose. 6. If guests were previously identified as clinically extremely vulnerable (CEV) The government will continue to assess the situation and the risks posed by Omicron and, based on clinical advice, will respond accordingly to keep the most vulnerable safe. Introducing face coverings, mandatory certification and working from home will help to reduce transmission, and add a further layer of protection for the most vulnerable. Those previously identified as CEV should continue to follow the same guidance as everyone else, but they may wish to consider taking additional precautions or seek advice from their health professional. Extra precautions could include:
7. Social distancing and capacity Social distancing rules no longer apply in law. This means that you do not need to implement social distancing (2m or 1m+) in night shelters, and guests do not need to keep apart from people they don’t live with. However, the further away guests can keep from other people, and the less time they spend in close contact with others, the less likely they are to catch COVID-19 and pass it on. Close contact increases the risk of spreading COVID-19. You should consider the guidance on risks associated with COVID-19 and actions you can take to help keep you and your guests safe. Please refer to the guidance on Keeping yourself and others safe, for further information and the actions to take to reduce the chance of spreading COVID-19. Directors of Public Health, in consultation with providers and relevant departments, are able to advise that social distancing is put in place in shelters, where the risks of rapid spread are particularly acute, if necessary to control outbreaks. This should be targeted and time limited. While social distancing will no longer apply, it may be appropriate to retain it depending on the risks. Equally, it may be appropriate to reapply it after it has been lifted if assessments suggest doing so. Assessments will be carried out by service managers in consultation with or as a result of advice from Directors of Public Health, who will be able to continue to advise on social distancing measures to control and prevent outbreaks. The use of social distancing will be targeted, time limited, and kept under review. 8. Hygiene On entering and leaving a shelter, everyone, including staff, should wash their hands thoroughly for at least 20 seconds using soap and water, or to use hand sanitiser if hand washing facilities are not available. Washing or sanitising your hands removes viruses and other germs, so people are less likely to become infected if they touch their face. Using soap and water is the most effective way to clean your hands, especially if they are visibly dirty. Hand sanitiser can be used when soap and water is not available. Those responsible for the building should use signs and posters to make people aware:
Providing regular reminders and signage to maintain hygiene standards. Hand sanitiser should be provided in multiple locations in addition to toilet facilities. Consider the needs of people with disabilities. There is further guidance on how to stop the spread of coronavirus. 9. Toilets Toilets inside or linked to shelters should be kept open and carefully managed to reduce the risk of transmission of COVID-19. Steps should be taken by those responsible to make the use of toilets as safe as possible:
10. Cleaning COVID-19 spreads through small droplets, aerosols and direct contact. Surfaces and belongings can be contaminated with COVID-19 when people with the infection touch them or cough, talk or breathe over them. Viruses on a surface could infect another person if they touch the surface and then touch their eyes, nose and mouth. Cleaning surfaces will reduce the amount of contamination and so reduce the risk of spread. The more a surface is cleaned, the more likely you are to remove viruses from an infected surface before you or another person touches it. People responsible for shelter provision should clean surfaces often and should pay particular attention to surfaces that are touched frequently, such as handles, light switches, and work surfaces. See guidance on cleaning in non-healthcare settings. Sufficient time needs to be allowed for this cleaning to take place, particularly before reopening for the first time or between different types of permitted activities. A decision should be made locally on how frequently cleaning should take place based on an assessment of risk and use of the building. If a venue is usually used for day activities with additional guests, providers can consider holding these activities in two different venues. If this is not possible, providers should take care with the cleaning guidance above between the two different uses. Staff and guests may consider avoiding handling personal belongings that are not their own where possible. Guests should be encouraged to handle their own belongings for the purposes of laundry or storage as far as possible. If this cannot be avoided, then staff and guests should wash their hands with soap and water for at least 20 seconds, or use a hand sanitiser after handling personal belongings that are not their own. See guidance on waste disposal in non-healthcare settings. 11. Other practical things for providers to consider Trustees and managers of night shelters venues should confirm that their insurance remains valid for operating their service. You may also need to consider the impact of any mitigations on capacity of your accommodation provision and your organisation’s finances. Providers also have a number of duties and liabilities relating to health and safety, and safeguarding. You may want to carry out a COVID-19 risk assessment in line with Health and Safety Executive guidance, and to refer to COVID-19 and safeguarding resources and positive practice in adult safeguarding and homelessness. |