The efforts to get homeless people into emergency accommodation must not be wasted, as DDN reports. Homelessness has been long been regarded as complex, difficult, inevitable \u2013 and easy to ignore. The substance misuse sector has struggled to maintain outreach services in the face of disappearing funding and has tried to create care pathways with varying levels of success. A conference on homelessness and addiction last year (DDN February 2019, page 16), raised many questions \u2013 why don\u2019t we take notice of the evidence to stop \u2018thoroughly preventable\u2019 drug poisoning deaths with simple and cost-effective harm reduction measures such as naloxone? Why are we still discharging from hospital onto the street? Why are care pathways so fragmented? Why aren\u2019t we creating routes out of dependent drinking? Why is there no help for smokers? While COVID-19 has thrown everyone\u2019s life into disarray, there is one group of people who might actually benefit as a result. Things couldn\u2019t have seemed much worse for the street homeless population when housing minister Robert Jenrick announced \u00a3105m to provide interim housing to take thousands of rough sleepers off the street during the pandemic, including \u00a316m for people in emergency accommodation to access specialist help for substance misuse. The money is also aimed at helping rough sleepers to secure their own tenancies, as part of the government\u2019s commitment to \u2018end rough sleeping for good\u2019. \u2018I am clear that there can now be no going back to the streets as people begin to move on from the emergency accommodation...\u2019 Dame Louise Casey Dame Louise Casey, chair of the COVID-19 Rough Sleeping Taskforce called the \u2018Everyone in\u2019 initiative an \u2018extraordinary effort\u2019 and an \u2018extraordinary opportunity\u2019 to turn lives around if we get the next steps right. \u2018I am clear that there can now be no going back to the streets as people begin to move on from the emergency accommodation that has been put in place,\u2019 she said. In London the initiative has taken shape through the Homeless Drug and Alcohol Service (HDAS), commissioned by Public Health England and the Greater London Authority. The \u2019pan-London system\u2019 involves the South London and Maudsley (SLAM) and Central North West London (CNWL) NHS Trusts, working with Change Grow Live and Turning Point (who coordinate logistics), We Are With You and Phoenix Futures. A 24-hour phone line is manned by recovery workers from the pool of organisations involved. Dr Emmert Roberts is clinical lead for HDAS and told DDN how the service was commissioned for three months in March, extended for another three, and is looking likely to carry on for longer. A \u2018hodge podge of a system\u2019 at the beginning, it has had to come a long way in a short time, he says. \u2018It was chaos \u2013 getting people off the streets as quickly as you can. Once they were off the street, we could do more stuff.\u2019 \u2018We\u2019ve been working with local hotels to provide education and training to minimise risks relating to alcohol withdrawal, naloxone training and how to use e-cigarettes.\u2019 Dr Emmert Roberts The first challenge was to secure rooms in hotels, and this involved splitting the intake into three distinct cohorts. People with symptoms or who tested positive for COVID-19 needed to be isolated in \u2018COVID care\u2019 rooms. The next category was \u2018COVID protect\u2019 for those who tested negative but who had medical vulnerabilities. Everybody else was assigned a \u2018COVID prevent\u2019 room. Once this was achieved \u2013 which Roberts admits involved \u2018abject chaos\u2019 at first, because of the speed everything had to be put in place \u2013 there was a chance to tackle \u2018the whole suite of drug and alcohol issues\u2019. Anyone could call anytime from the hotels to ask for advice, and many of the calls related to alcohol withdrawals and prescribing issues. Harm reduction was a high priority, so naloxone was introduced and people were given a workbook of psychosocial interventions to complete in their hotel rooms as a way of bridging the gap left by lack of face-to-face contact. One of the big initiatives has been the opportunity to tackle smoking, with 2,000 e-cigarettes distributed alongside other nicotine replacements \u2013 a window to reduce tobacco harm as well as enabling people to stay in their rooms to avoid transmitting the virus. \u2018Harm reduction initiatives can really work well with this population, as well as preventing COVID spread,\u2019 says Roberts. \u2018It showed that there is willingness among people to reduce their tobacco consumption.\u2019 He hopes that funding being made available for a pan-London coordinator for tobacco harm reduction will improve access for people who are rough sleepers and help them to reduce their tobacco use long term. As Roberts stresses, each part of the initiative has been a learning curve, so supporting the hotels to house their guests safely has been paramount. \u2018We\u2019ve been working with local hotels to provide education and training to minimise risks relating to alcohol withdrawal, naloxone training and how to use e-cigarettes,\u2019 he says. The other part of the project that needed to be bedded in fast was the strategic working between the partners. Where there were normally \u2018turf wars\u2019 between services there had to be a change in approach, so that people could stay with their original treatment providers when they moved location to prevent them from dropping out. The proactive partnership culture was also helpful for feeding into health alliances \u2013 the GPs and nurses working in the hotels, as well as the homeless charities steered by St Mungos. Much of the time and energy has been taken up through facilitating new referrals into treatment, says Roberts, and \u2018a lot were people who have never been in the treatment services before or are generally hard to reach. We facilitate their involvement with local services and prevent any bad practice happening in the hotels, including dodgy detoxes and people not understanding about substance misuse.\u2019 While \u2018lots of things have gone well\u2019, the team is bracing itself for an \u2018uptick in homelessness\u2019. \u2018I don\u2019t know what the future holds and we\u2019re not out of the crisis yet so it\u2019s very difficult to know what we\u2019re going to return to or what the new normal is going to be,\u2019 says Roberts. \u2018I would hope that we\u2019ve learned some lessons about how we treat homeless people within our services \u2013 but given that we don\u2019t know what the lie of the land will be over the next few months, it\u2019s hard to know if this will have any lasting impact.\u2019 Getting people off the streets and into a safe place had to be done very quickly and in an emergency situation, so he is frank about it being \u2018chaos\u2019 at the beginning. But through bringing the health teams, homeless charities and substance misuse teams and hotel staff together, they have been able to help with all kinds of issues, including immigration and benefits. Each of the hotels in London has a resident homelessness sector organisation \u2013 mainly St Mungos \u2013 running the day-to-day life, with HDAS being the central coordinator for the substance misuse sector. \u2018It\u2019s been challenging and chaotic, but the fact we\u2019ve been able to come together and have city-wide input has been very useful,\u2019 says Roberts. \u2018The government has agreed to try to end homelessness by the end of parliament in 2024 and the work we\u2019ve done will hopefully help that.\u2019 He is painfully aware that \u2018the state of funding in the entire sector is quite dire at the moment, with over \u00a3250m of disinvestment over the past five years\u2019, and that \u2018this isn\u2019t going to rectify that\u2019. The abolition of PHE feels like another hammer blow. But there\u2019s no denying that being plunged into this emergency situation has already had some amazing results for individuals who were invisible before COVID turned our world upside down. \u2018This isn\u2019t going to be a substitute for the overall disinvestment,\u2019 says Roberts. \u2018But it might go some way towards improving access for this particular population.\u2019 And if you\u2019re one of the 5,000 people in London or 15,000 people nationally who have entered a housing support scheme for the first time, that could feel like a wide-open door.