Thursday, 18 February 2021
Covid-19 (Drug and Alcohol Services, and Homelessness): Statements
I thank the Leas-Cheann Comhairle, I welcome this opportunity to update the House on drug and alcohol services and health supports for people who are homeless during the Covid-19 pandemic.
Not everyone faces the same risk from Covid-19. People who use drugs or alcohol in a problematic way are at heightened risk due to underlying health and social factors. These are compounded for people who are homeless, who experience multiple morbidity and are at risk of premature death. There can also be risks associated with the consumption of illicit drugs or large quantities of alcohol. In particular, the ageing cohort of opioid users are vulnerable to Covid-19 because of a high level of pre-existing health problems and lifestyle factors. It is estimated that 19,000 people with opioid dependency and 4,500 single people are homeless, with a significant overlap between these two groups. The Department of Health and the HSE have prioritised these groups in our response to Covid-19.
The incidence of Covid-19 among people living with addiction and in homelessness has remained low during the third wave of the pandemic. Health Protection Surveillance Centre, HPSC, data for the period from late-November to mid-February show that, in addiction services, there have been nine outbreaks of Covid-19 involving 48 cases. Of these cases, three people have been hospitalised and, unfortunately, one person has died, which is most regrettable. In homeless services, there have been a further nine outbreaks involving 41 cases. Of these, two people have been hospitalised. These figures include staff in homeless services. By comparison, there were 3,076 outbreaks of Covid-19 nationally, while in residential institutions there were 186 outbreaks with 1,308 associated cases.
It is clear from the data that the impact of Covid-19 on people in addiction or homelessness has been much less than expected. This low incidence has been achieved by the actions of health and social care services, which prioritised these groups in terms of protection, detection and case management. These services are saving lives, perhaps not in hospitals, but by ensuring that people with underlying health conditions do not end up in intensive care in the first place.
What have we done during Covid-19 to achieve this positive outcome? What are the lessons we can draw for health policy? I wish to highlight three positive lessons. First, we have seen significant improvements in HSE addiction services during Covid-19. Specific measures were developed to ensure that all people in receipt of opioid substitution treatment could continue safely on the treatment during the pandemic, and that anyone who required opioid substitution treatment would receive it. Not alone did the existing 10,000 patients continue in opioid substitution treatment throughout the pandemic, but an additional 900 people were brought into treatment in the past year, an increase of more than 8%. Many of these new recruits have chaotic lives, including up to 100 who are rough sleepers or homeless.
Additional supplies of naloxone were also provided during Covid-19 to minimise the risk of drug overdose, and an awareness campaign was put in place in conjunction with the Union for Improved Services, Communication and Education, UISCE, the voluntary organisation representing service users. The Department of Health is providing an additional €4.2 million in 2021 to retain the specific actions taken to support increased access to opioid substitution treatment during Covid-19. I am delighted the gains that have been achieved in the crisis are now being mainstreamed within the HSE health services.
Second, I highlight the exceptional measures put in place to protect and support homeless people. The HSE appointed a dedicated team, including a clinical lead, to co-ordinate the Covid-19 homeless response for the large cohort of single homeless people in Dublin. The purpose of the team is to intensify the health supports provided to homeless people during Covid-19. I will share some headline figures from the team. A total 282 medically vulnerable homeless individuals are being supported in shielding facilities. A further 1,000 homeless service users in private temporary accommodation are receiving significant health supports. Sixty-five Covid-positive homeless users are in self-isolation facilities with another 105 service users who are suspect or close contact cases. Fifty-two staff members in homeless services who are Covid-positive have been supported since December, and up to 100 rough sleepers and homeless people have been put on opioid substitution treatment, OST.
In July last year, l, together with the Minister, Deputy Donnelly, met with the Minister for Housing, Local Government and Heritage to agree how dedicated funding and resources could be provided to deliver the necessary health and mental health supports required to assist homeless people with complex needs. I have made the health needs of homeless persons a key priority. The HSE winter plan is the first step in increasing funding for targeted health interventions for people who are homeless and in addiction. The Department of Health provided an additional funding of €5.5 million to meet the following objectives: continue the protective help measures for the medically vulnerable homeless population; expand GP services for people living in emergency accommodation in Dublin and regional centres; and provide continuity of care for homeless people requiring emergency hospital treatment. In budget 2021, the Government provided €11 million to extend these measures for the full year.
Further initiatives to meet the health needs of homeless people are also being funded, including a specialist mental health outreach team. More resources are only one component of the policy response, however. The other element is a co-ordinated approach to the complex health and social needs of homeless people between the HSE, the Dublin Region Homeless Executive, DRHE, and voluntary homeless and drug and alcohol services.
The third lesson I wish to highlight is the development of a long-term and sustainable response to chronic homelessness and rough sleeping. The Department of Health and the Department of Housing, Local Government and Heritage have prioritised a housing-led approach, with a vision of housing together with integrated wrap-around health and tenancy supports to assist people in maintaining a tenancy and improving physical and mental health. Since the start of the pandemic, additional Housing First tenancies have been established for individuals who had been sleeping rough or had been long-term users of emergency accommodation. A total of 208 tenancies were established in 2020. I am informed that altogether, 1,006 single persons exited emergency accommodation into homes in 2020 in the Dublin region. The Department of Health has provided an additional €1.125 million to provide health supports for 218 new tenancies under the Housing First programme in 2021. This will help achieve the national target for Housing First of 663 tenancies to be delivered by the end of the year.
The need for drug and alcohol services extends across the population. Problem drug and alcohol use is a societal issue that continues during a pandemic and, in some circumstances, can get worse as people struggle with lockdown. To better understand the impact of Covid-19 on drug and alcohol services, the Department of Health undertook a rapid assessment, involving an online survey of services, case studies and analysis of European data on drug use. The initial findings of this assessment were presented to the national oversight committee for the national drugs strategy, which I chair. They highlight how drug and alcohol services have been curtailed but have adapted to new ways of working to continue to support people affected by substance misuse.
As part of the Government plan for living with Covid-19, the Department of Health has developed a framework to support the restoration and continuation of drug and alcohol services in a planned and appropriate manner in line with public health advice.
Officials worked with drug and alcohol service providers to identify the guidance and supports needed. To support these essential services, I approved additional funding of €480,000. I recognise the vital role played by the drug and alcohol support groups and treatment programmes in reducing the harm of substance abuse and in supporting rehabilitation.
I advocate a targeted campaign to reach vulnerable groups that otherwise may not have equal access to the vaccine. Listening to and engaging with vulnerable groups are critical to building confidence in the Covid-19 vaccination programme. This will take time, resources, targeted communications and innovative delivery mechanisms. In particular, a collaborative approach to roll out the vaccine with the HSE addiction and inclusion health services, section 39 organisations and service users is required. While considering the vaccine allocation strategy for vulnerable groups, we must be aware that this is contingent on the supply of the vaccine into the country.
Covid-19 has brought into focus the health inequalities faced by people who are homeless and in addiction. I hope that Deputies have an understanding of the measures we have put in place to protect these groups, not just from Covid-19, but to enhance their health status on a long-term basis. The experience of Covid-19 has reinforced the need to treat drug and alcohol misuse as a public health issue. The national drug strategy, Reducing Harm, Supporting Recovery, provides the roadmap to a health-led approach to drug and alcohol misuse. I am overseeing a mid-term review of the strategy, which builds on the many innovative measures developed during Covid-19. I look forward to hearing the contributions of Deputies on these matters.