Isabel Aitken's piece, submitted for the Orwell Prize for Reporting Homelessness, explores the lives of Tarek, Patrick and John, who are all living in the same hostel.

Nine Elms in South London is said to be the biggest regeneration zone in Europe. Walking through it is a Blade Runner experience. Unpaved roads lead to gleaming towers. Residents swathed in Gucci and Prada shuttle in and out of newly built skyscrapers while cement mixers bearing the names of foreign companies mark out territory for the next buildings to go up. If you haven’t been through the area in a few years, you might struggle to recognise where you are. Amongst the buildings that have been raised to the ground to make space for the developers’ vision is a former hostel called Sutherland House. 

When plans were drawn up for an apartment block overlooking Vauxhall bus station, Sutherland House was found to be in the way. Negotiations took place and the developers made an offer: they’d knock down Sutherland House but they’d build a new hostel a few miles from the original site, on less valuable real estate. This new building opened a few years ago and now houses 50 residents. I worked there for a few years as a support worker. It’s where I met Tarek, Patrick and John whose stories follow.

Tarek’s story 

At the beginning of the pandemic in 2020, Tarek – charismatic, clever and in his late 20s – had been awaiting the results of his asylum claim for two years. He finally got the news that his claim had been successful on the same day Boris Johnson appeared on the television to announce the first lockdown. Within 24-hours Tarek’s image of starting a new life in London flickered into vision and then dissolved again. With his fluent English and good people skills, he’d been hoping to get a job in hospitality. For now though, he was stuck inside.

By the time the country started emerging from the Covid pandemic, Tarek was severely mentally unwell. He had been through a tortuous asylum process unable to work or study and was now living alone in a new country with next to no support. The consequence was a growing drug problem that would eventually lose him his accommodation. He was found in a disturbed state on the street by police and taken to hospital where he was given brief psychological treatment and ultimately referred to an assessment centre and then on to the new hostel in Nine Elms.

This area of London was known to him for its queer party scene. As a gay man who’d moved from a country where homosexuality is punishable by death to one where it’s legal, this was a corner of London that held allure. It had also come to geographically represent  his addiction to chem sex drugs which were accentuating intense paranoia and starting to dominate his life.  

Living in the hostel is a brutal experience. The incessant sound of trains merges with music blaring out from people’s rooms and shouts of distress and anger. The rooms are small and the corridors are fraught with tension and sometimes violence. People can use drugs and alcohol in the building as long as it’s not in communal areas; there are also harm mitigation measures in place such as a needle exchange. The downside of this is that residents are constantly pursuing each other for money or drugs and the most vulnerable are liable to be exploited by their neighbours. With 50 people suffering from depression, psychosis, drug induced highs, seizures and crippling withdrawal symptoms living cheek by jowl, problems arise all the time. Hostel staff are regularly on the phone to emergency services and police and paramedics are regular visitors. 

As a result, Tarek’s relief at having a roof over his head quickly dissipated. He reported being bullied and said his trust in others was slipping away, an experience accentuated by the drugs he was using. He felt himself to be an outsider in the building, which he was in several ways. He had been street homeless for only a couple of weeks; now he was living on a corridor with people who had been living in hostels for years. They all knew each other; many had grown up together. Tarek came from a different place with different problems.

As a support worker, one of your principal roles is to help people move on from the hostel. As staff are reminded in training, the hostel is not a “forever home”; people are expected to make use of the help available and be ready to move into more independent accommodation within a year. The depressing fact, however, is that there’s often nowhere to go. 

A graduate with a Masters degree, Tarek had an unusually efficient approach when it came to organising his “move on” plan. He was determined to get out of the hostel as quickly as possible so – despite concerns around his continuing drug use and chaotic behaviour – we explored the possibilities. 

One option was private renting, but most landlords wouldn’t consider Tarek’s application because his income came from benefits. His beloved cat Polly was an added problem because virtually nowhere would accept pets. Those estate agents who were willing to consider his application insisted he needed to have a housing officer at the council. These agents were demanding a so-called incentive fee which councils are sometimes willing to pay, on top of the deposit, essentially to bribe the landlord into accepting the prospective tenant, reducing the number of homeless people on the council’s caseload. Tarek didn’t have a housing officer and the charity running the hostel wouldn’t pay the incentive fee. 

A second option was The Clearing House. This is a service run by the charity St Mungo’s to which people who have experience of homelessness can apply for a flat. The Clearing House offers good quality housing in partnership with about 50 housing associations across London. The tenancy is yours for a couple of years minimum and allows you time to get on your feet. For Tarek, though, the threshold for acceptance was too high: the feedback on his application stated his drug use was too big a concern and he should reapply when he’d cut down. 

In the end, Tarek did move out of the hostel but straight into a smaller one up the road. This was registered as a positive step in the council’s audit for that quarter – he had met the target by moving on within a year. In reality, it felt like a reshuffle; nothing much had changed. Living in hostel accommodation of any kind, Tarek cannot work. He cannot work because of the immediate impact this will have on his housing benefit, making it impossible for him to afford the very high cost of hostel accommodation in central London. This leaves him and many others like him caught in a trap not of their own making. 

Without work or occupation, his life remains unstructured and unfulfilling; his drug habit serves to fill the emptiness, becoming ever more difficult to break. He feels his drug use won’t improve until he has more stimulation and activity in his life, yet making friends and finding community are very hard without the means of meeting people. 

Hostel staff use the term “vulnerable adults’ pathway” to describe the system of housing options available to people who’ve been homeless. The trouble is that “pathway” more often translates in practice as “production line”: people are moved through a system that’s one size fits all. Most people’s recovery isn’t linear and rarely maps onto the pathway prescribed. The result is that sometimes it’s hard to see people’s lives improving and to wonder if the system is working at all. 

Tarek says that the experience of the asylum system, lockdown and homelessness have changed him irrevocably: ‘No matter how strong you are, it takes something from you; it breaks you a little bit. Even if you survive it, you're never the same.’ 

Patrick’s story 

In the years just prior to the pandemic there were waves of people dying on London’s streets. Patrick was working long days as a mental health nurse assessing people who were sleeping rough, identifying needs and what could be done to help. 

Patrick’s work in community mental health nursing had started in 2012 in Liverpool where he grew up. From the start, he’d been drawn to working with people in the community rather than on the ward. He appreciated being able to meet patients on their own terms, supporting them with choices about their housing, work and social life. His commitment to community care held strong for him and kept him motivated. 

After a few years he moved to London and joined a homelessness outreach team.

When Covid struck, an already demanding job got even more difficult. Most people started working from home. At one point Patrick was the only mental health nurse working in homeless outreach in his borough. Yet his greatest psychological challenge came from another source: in March 2020, the government announced a new policy they called ‘Everyone In’. The point of the policy was that no one would be left out on the street. Everyone would be housed in hotels and provided with meals and healthcare. Within a few months 37,000 people were helped by the scheme, according to government figures. The policy should have been a cause for celebration but, despite its obvious benefits, Patrick felt increasingly unnerved and disorientated. 

During the years prior, he had struggled, sometimes without success, to get people into accommodation when some were literally dying on the streets. Why all of a sudden was it possible to house those people who had been left unhoused and unprotected before? ‘Even now, I really can't quite get my head around the shift that we saw from what had been before,’ he reflects. As it happens the policy lasted just a couple of months before it was withdrawn (research by Shelter found that fewer than a quarter of the people helped by the scheme got access to more permanent accommodation of 6 months or more). 

Despite exhaustion, Patrick had no choice but to keep working through the pandemic, helped by the support of NHS colleagues who met to share their experiences in online groups. In 2021, he took on a new role working in hostels for people with a combination of substance misuse and mental health support needs. When Tarek arrived at the hostel in Nine Elms, Patrick started working with him and their relationship continues. 

Deeply committed, Patrick tries to uphold the principles that brought him into this work in the first place. He meets people where they are at; he listens; he gives his attention, reliably making his presence and support known; he monitors the medication people are prescribed and how it’s interacting with their substance use. 

Patrick does an extraordinary job that most people wouldn’t have the resilience, the patience or the empathy to keep doing. But his vision for the job is fraying at the edges. The ability to connect with people, not as patients but as fellow human beings, and to support them through their lives is becoming ever more difficult. 

Decisions are often made, not by those working on the ground, but by senior administrators in government or the NHS or outsourced to private entities focussed only on numbers in a spreadsheet. In this way, major policy changes such as ‘Everyone In’ can come and go overnight with no apparent thought for those left behind. Patrick says he’s still disorientated from what happened during the pandemic. The feeling won’t go away.

John’s story 

Since the end of the pandemic and the abandonment of ‘Everyone In’, homelessness figures are again soaring back to, and beyond, pre-pandemic levels. With this rise comes the increased rate of death that Patrick witnessed on the streets of London in 2018.

In 2021 there were a staggering 1286 deaths amongst homeless people in the UK. But particularly shocking is that 90% of those whose circumstances were known died, not sleeping in doorways or on park benches, but while living in accommodation provided for people who are homeless. 

According to Matt Turtle, one of the two founders of the Museum of Homelessness which documents these deaths, they ‘often occur in taxpayer funded hostels which… are meant to provide people experiencing homelessness with care as well as a safe place to live temporarily.’ 

-

When Sutherland House was knocked down and replaced with a new hostel nearby, many of its residents moved straight into the new building, amongst them – John. 

John was from Scotland and still had a strong accent despite his years down South. He once mentioned to me that two of his brothers were in prison for murder, which spoke of the toughness of his early years. Despite this, he was a gentle person; affectionate, curious and funny. 

Having lived in hostels for a decade or more, John was part of a community of hostel dwellers who knew each other going way back. He was a chain smoker and a drinker – consuming several large bottles of cider each day – but he rarely touched drugs. He would decant his cider into a small flask which he regularly topped up and kept close at hand. He was, by nature, social but as time progressed and probably due to  his waning health he spent more and more time alone.

He liked to watch reruns of legendary moments in Celtic football games or stream Celtic chants and songs on YouTube at deafening volume. He had a mischievous smile and would take great enjoyment in people’s reactions to his Celtic obsession. There were flags up all round his room and he had a Celtic duvet cover sent to him by his mother, who would sometimes call the hostel if she couldn’t get through to him on his mobile. John had a box full of letters and cards which they had exchanged while he was in prison. When they occasionally had a disagreement, it would leave him preoccupied and troubled until they’d made things up. John was sensitive and witty and had a disarming quality about him. He was also incredibly stoic and resilient, like so many hostel residents. 

By the time I met him, though, John wasn’t a well man. His mental capacity was impaired - probably due to alcohol-related brain damage - and he often struggled to keep track of his money. He would give his bank card to friends to buy him things and they would invariably go on a spending spree leaving him penniless until his next payment from Universal Credit came through. Staff knew what was happening and would try to compensate by giving him food donated to the hostel by local charities. But, for all the police reports and fraud investigations by the bank, we were failing to protect him. 

Colleagues were concerned that the hostel was not the right place for such a vulnerable person and negotiations were underway to get him a place in a care home. This plan seemed strange for a man in his 40s but was based on the complexity of his physical health problems affecting almost every part of his body. 

The social workers at the council, however, who are responsible for placing people in care homes, were not supportive of John’s case. The hostel staff faced an uphill battle trying to persuade the council to advocate for him. The care homes themselves didn’t seem open to having John either. Most of the homes we visited claimed that his needs were more than they could manage. 

One care home was ready to accept him; it was specifically for people with alcohol dependency. Until recently the home had been marked as inadequate by the Care Quality Commission. It seemed far from ideal but, living there, John would at least get three meals a day rather than the occasional ready meals he was eating at the hostel. 

The matter went back and forth with the council continuing to argue John was beneath the threshold for a care home placement. Regular meetings were held between the hostel, the council and other health workers. At first John said he didn’t want to go and questions were raised by some about whether he had the capacity to make a decision or not. Ultimately he decided he was open to it and, two years on from the first discussions about John’s placement, the council finally promised to fill out the paperwork. Further weeks went by. 

As we waited, the carers who were supporting John reported that he wasn’t eating much. This wasn’t unusual for John because alcohol consumption makes you feel full. He also lost half of his dentures around this same time making eating more difficult. He’d recently been in hospital for eye surgery, and then for his lungs, and he was having difficulty walking. He was completely reliant on others to bring him what he needed. John lived with chronic pain but he tended to play it down. When John started mentioning his pain more frequently, staff were prompted to make an appointment with his GP. 

Being homeless, your physical health suffers to a point that your life expectancy is in the 40s. Damage from addiction, malnutrition and head injuries all contribute. Accessing medical treatment is often very intimidating for people who feel that doctors don’t take them seriously or consider them worthy of care. John was suffering basic malnourishment on top of a long list of other health complaints. He needed substantial care, which he wasn’t getting at the hostel. 

John was found dead in his room one morning in the autumn of last year. The post-mortem concluded he’d died from disease in the heart and lungs. My colleague tried to resuscitate him but he had died hours before she found him. A public health funeral was held by the council and John’s ashes were sent to his mother along with his few possessions. She asked what had happened to his Celtic duvet; staff searched the building but it was never found. 

The stories above are based on real people and places but names and personal details have been changed.