The Covid-19 pandemic has not only re-highlighted the complex health needs of the homeless population in this country but it also highlighted a need to address the additional infection risks from smoking in a very vulnerable group.
As the country entered lockdown, Greater Manchester’s Covid-19 Emergency Committee secured emergency accommodation for hundreds of rough sleepers in hotels across the city region.
The Greater Manchester Health and Social Care Partnership (GMHSCP) – which helps to deliver the Making Smoking History programme – used this opportunity to deliver a nicotine management programme directly to residents living in these hotels.
Around 85% of the UK’s homeless population are smokers and with research showing that smokers who contract Covid-19 are more likely to die than non-smokers, this was an area of real concern.
The team from GMHSCP set about offering alternative sources of nicotine, such as vaping devices and e-cigarettes, to all the re-housed hotel guests who identified as smokers. Guests were given training about how to use these devices effectively and were provided with ongoing support from a team of outreach workers. The kits themselves were provided free of charge by an independent provider with no links to the tobacco industry.
Andrea Crossfield is a Population Health Policy and Strategy Specialist at the GMHSCP. She explains why it was important to seize the opportunity to engage with the city region’s homeless community in this way: “As soon as the lockdown began, significant numbers of Greater Manchester’s rough sleepers were housed in hotels across the region – something which has never happened before.”
“A local provider offered us a free source of e-cigarettes for residents to use. We ensured that all the devices had closed pod systems, so that they were secure to operate and also served to provide reassurance to the support staff and hotels who were working with the residents. We delivered on-site training to the support worker teams based at the hotels, as well as sending in our own staff members who initially handed out the devices to the clients and provided them with operating instructions.”
Guests were also given access to the Smoke Free Pro – Stop Smoking Now app which offers daily access to on-call stop smoking advisers. The app was commissioned by the GMHSCP as part of a shift from in-person to virtual support and allows users to log their cravings, get tips on dealing with them and see how their health is improving.
Darryl Quantz is also a Public Health consultant with the GMHSCP, who is supporting the Homeless Health Work programme. He explains why nicotine management support is a vital part of smoking cessation: “The science tells us that vaping is 95% less harmful than smoking tobacco. By using these devices, the risk of sharing cigarettes is reduced and thus the risk of Covid-19 infection transmission.. With the right tools and support, these alternatives to tobacco can be a powerful and accessible way to help address a key health concern in one of our most vulnerable communities.”
He also describes his determination that smoking remains at the top of the agenda as the country emerges from lockdown: “Tobacco needs to be treated as seriously as alcohol and drug use. As the exit strategies get underway for moving residents out of their temporary accommodation, we want to be part of those discussions and promote the wider smoking cessation work that is going on across Greater Manchester.”
“We have asked that this nicotine management and smoking cessation work is included in individual care plans for service users who have been in the accommodation – and, where possible, we will continue to provide support as we move into longer term housing arrangements.”
“The homeless community has been overlooked for a long time. If we are going to make a lasting impact, we need to be looking ahead to the future and making plans to deliver ongoing support where it is needed the most. This is a huge opportunity to make real and lasting change.”
Andrea also hopes that this type of support will continue to be prioritised as the nation moves to the next phase of the Covid-19 pandemic: “The controlled environment of these hotels provided an unprecedented opportunity for our team to engage with the homeless population in a safe space, and to kick start a programme of smoking cessation support which will hopefully have a long-term impact. With structure to their lives, including regular meal times, it created a more positive routine that helped efforts to stop smoking.”
“Thanks to this work, we now have some good training resources which can continue to be deployed in the future. We would also like to continue to explore more peer support work. We’ve seen instances where peer-to-peer engagement has worked very well in this group, across a range of substance misuse issues, so it's an area we want to continue to look at.”
The Making Smoking History programme aims to reduce smoking rates in Greater Manchester by a third by the end of 2021 – and it is hoped that GMHSCP’s work with the region’s homeless population will go some way to meeting this target.