She had treated them, perhaps referred them on to social services or to other doctors, but hadn’t seen their lives up close.
Then lockdown happened.
One day a week, she began to visit the B&Bs they were living in to do outreach work on behalf of the local charity Shared Health. What she found shocked her, even after eight years as a qualified doctor, including practice at the Royal Manchester Children’s Hospital.
No face-to-face services had been reaching the families, she says. Health problems, from bed-wetting to anxiety, were mounting up. Children who should have been crawling or talking weren’t. Some had no access to hot food.
Leering men were hanging around on the same doorstep near the teenage girls who were trapped there.
The parents themselves were happy just to see her, she adds. To see anyone.
“They’re just so grateful that someone wants to give them help,” says Dr Cockman of visiting families during the lockdown.
“They will say ‘are you serious, you’ve brought food? It just feels like nobody cares about us”.
“It was only then that I realised the children weren’t in school and no community services were going out to see them.
“It’s the Swiss cheese model, where you keep falling through the holes and barely anyone on the frontline knows about you.”
The M.E.N. has documented Greater Manchester’s family homelessness crisis before, but during lockdown, the horrendous situation facing these parents and their children has been compounded.
While councils here did move hundreds out of B&Bs and into temporary housing when the pandemic escalated, others remained in establishments – some of them the same ones we first raised questions about 18 months ago – with no cooking facilities, no communal or outside space and no face-to-face visits from health or homelessness professionals for several months.
Shared Health has distributed 2,000 hot meals to homeless families in Manchester alone during the pandemic.
Yet while the protection of rough sleepers has been high on the agenda for politicians here and nationally during the pandemic, little has been said about the situation facing these families.
Shared Health, which was set up by the philanthropic Oglesby Charitable Trust to tackle health inequality here, is worried.
It wrote to a raft of key authorities in Greater Manchester last month, including the mayor’s office, warning: “There is an absence of discussion and detail on a national level about the impact of Covid-19 on families who are homeless. We are gravely concerned about this ‘hidden homeless’ population, whom the pandemic has made invisible.”
Children ‘already barely visible to the state support system’ before Covid ‘are no longer receiving visits from community services and are not in school to access early help support systems’, it wrote.
One health visiting team spoken to by the charity in May had not seen the families they were supposed to check up on for two months. B&B staff were increasingly having to handle problems usually dealt with by the state, such as safeguarding, usually with no training.
“Zero B&Bs have access to safe communal spaces and staff questioned had no knowledge of how to make safeguarding referrals,” added the charity, following a snap survey it had carried out of six hotels used by councils.
“We are concerned numerous homeless families across Greater Manchester are receiving no outside support to safeguard their health and welfare. This is leading to a health and developmental crisis amongst Greater Manchester’s homeless family population.”
Safeguarding is the charity’s biggest concern and has been for some time. Since the end of last year – coincidentally around the same time the mayor’s report into the failed Operation Augusta grooming investigation was being finalised – it has been warning against placing families in hotels with single adults. In some cases they include men recently released from prison. The B&Bs are often used by several local authorities at a time, as well as by paying guests, meaning councils don’t necessarily know exactly what mix of people are in there when they refer a family in.
A dossier of case studies on safeguarding in these hotels, based on the charity’s interviews with hotel staff, families and health visitors at the back end of 2019, makes for grim reading.
It found children at risk of physical attack and injury, violent behaviour, drugs and sexual exploitation.
In one incident last October, a man was continually harassing some children playing together at a hotel. He then picked up a seven-year-old boy and threw him against a pillar. The child injured his back and hand, becoming nervous and anxious afterwards.
“This incident alone should be cause for immediate action,” the charity told the authorities in November.
Health visitors told them of a mother with severe mental health problems, whose children were running in and out of bedrooms occupied by men also living there. The hotel didn’t make a safeguarding referral but instead threatened to evict her.
Another mother, fleeing domestic violence with a 13-month-old baby, was harassed by a man with possible mental health problems, obsessively pushing notes under her door.
The charity also spoke to hotel workers themselves, who are often at the sharp end of the crisis.
One happened to have a medical background, so took it on herself to make judgements about who should be allowed in when families were staying there. Some councils continued to pressurise her to take new referrals, so she would just pretend the hotel was full.
Another, a hotel manager, went to even greater lengths. She had heard so many harrowing stories from people staying in her B&B, including drug addicts and people just released from prison, that she herself had to receive therapy and decided to take herself off for mental health training.
She started sharing information with the manager of another nearby B&B also used by councils for homeless families.
“The managers keep a blacklist of people they will not accept as return residents, because she states that the councils will try and send back in people who have previously been evicted,” the charity told Greater Manchester’s health and social care partnership.
“The manager described incidents they have had of single people shouting and screaming in the hotel at night, a resident who defecated in the room and trashed it, a man beating up a woman and a resident who was attacking students in the local area.
“The reception desk is now surrounded by a protective screen following a violent attack on a staff member at the hotel.”
The M.E.N. understands all those case studies were from hotels in Manchester, although they will have received referrals from a range of boroughs, not just the city itself.
Asked about where it has placed families during lockdown, Manchester council said it does now have one family-only hotel, but added that on occasion there is no choice but to place children alongside single adults, including during the pandemic.
It has had no safeguarding referrals through from any of the B&Bs it uses under lockdown, although it admits hotel staff have not necessarily had training to spot issues unless they have taken it upon themselves to go and get it. Support workers in its own homeless team, who are trained in safeguarding, had to ‘pause’ face-to-face visits due to Public Health England advice during the pandemic, but continued to speak with families remotely.
However, at least one of the hotels Manchester town hall is using for families is the same as one investigated by the M.E.N. in 2018, where a pregnant single mum told of us feeling unsafe and of finding drugs in her baby’s pram.
The hotel is notorious in the local area. A quick check on Trip Advisor shows paying hotel guests still complaining of repeated police and ambulance call-outs, of people passed out on the floor outside.
Dr Cockman says on one hotel visit during lockdown she was eyed up herself by men hanging out on the doorstep.
“Safeguarding is the biggest worry,” she says. “When you think what happened in Rochdale, you walk into some of them and you’ve got men standing outside and also teenage girls standing outside. There’s no control.
“The parents have lots of responsibilities and you could have several teenagers all in one tiny bedroom. Then you’ve got males stood outside and young teens, incredibly vulnerable, with access to men giving them attention.”
Manchester council said parents are reminded that they are responsible for their children when they move into a hotel. It told the M.E.N. it was ‘a bit of a leap’ to connect the men’s attitude towards an adult woman with a risk to children, adding it would never place ‘known sex offenders’ in accommodation which could put others at risk.
The charity remains worried.
Shared Health’s research has focused on Greater Manchester specifically and Manchester in particular, given the scale of the city’s crisis. Manchester currently has around 1,700 homeless families, the same as at the end of 2019, before the impact of the looming recession. But the charity’s findings are not unique.
A paper for the Lancet medical journal in May warned young children in temporary accommodation during the pandemic are in an ‘invisible plight that might not seem obvious to most people because they’re not on the streets’. Yet they were potentially among the most susceptible to viral infection due to underlying health conditions such as asthma, while unlikely to be able to self isolate or socially distance. Their findings match with those of Shared Health, including around the risk presented to them by the virus itself.
“Many families have to live in a single bedroom with shared kitchen and toilet facilities, causing overcrowding and making self-isolation impossible in confined space,” wrote a group of researchers from University College London’s public health department at Great Ormond Street Hospital.
“Often, children have inadequate space to crawl or play and no access to fresh air. Second, no regulation on temporary accommodation exists regarding what is deemed suitable or how long someone can stay in temporary housing. With COVID-19, these children will stay in temporary accommodation for extended periods because no applications or services are being processed or provided.
“Third, handwashing and hygiene are reduced because of minimal access to soap, water, disinfectants, and bathrooms.
“Another issue is that no face-to-face contact with general practitioners and health outreach services is available, including health visitors, which limits routine checks such as early identification of need and risk.”
The Childhood Trust, a London-based charity that focuses on child poverty, published a report entitled Children in Lockdown earlier this month.
It reeled off concerns about the physical and mental health impacts on poor children during the pandemic, of food poverty and educational loss.
The report’s section on children in temporary accommodation during lockdown cites the Lancet’s research and echoes Shared Health’s findings 200 miles away.
Its author Laurence Guinness believes both the government and councils are in ‘denial’ about the broader crisis, before, during and after lockdown.
“The stress on children in these situations becomes toxic, because the child has no ability to resolve their problems for themselves and neither do the parents. The pandemic has multiplied that exponentially,” he says.
“The uncertainty, the economic deprivation, the lack of school contact and isolation creates even more stress, which if it isn’t toxic before, certainly becomes so. It is creating a situation where many, many children are suffering really poor mental health.”
Noting that children’s services budgets have been cut by up to 30pc over the past decade, he agrees councils are ‘in a difficult position’. But he says the system isn’t currently working for children.
“We need to acknowledge that and do something about it. To ignore it is morally indefensible. You can only take on these issues if you’re honest about them.”
Shared Health insists there are constructive solutions to be had, despite the crippling financial situation facing town halls. That includes proper safeguarding training for hotel staff, as well as officially giving homeless children the same basic rights to education and health support as children in the care system legally have already.
It also means – crucially – linking up Greater Manchester’s services so families do not suddenly find themselves in a hotel miles away without a GP or any means to get their child to school, with no school nurse noticing the changes in the child’s behaviour, nobody keeping tabs on what’s happening.
Manchester council insists the region does work in partnership and share information, but the charity says it has seen multiple examples of families placed miles away, slipping through the holes in the swiss cheese. The impact, it says, has been clear.
“One family I saw, the mum said ‘what can I do? My son started night-time wetting again’, says Dr Cockman of her visits under lockdown.
“A ten-year-old, so much older than you would normally expect. You’ve got a symptom there probably because of mental health and trauma.
“You see it in the irritable six month old, in tiny children, then you’ve got worrying behaviour in terms of bed-wetting that’s happening because of the recent trauma.
“The child who is slightly delayed walking may eventually walk on time, but that kind of impact on their body leads to problems for the rest of their lives.
“So for me, it’s the linking up of services. There was a problem pre-Covid as well. You’ve got these families plonked somewhere new and they’ve no longer got that link with their GP, or their paediatrician appointment.
“Then they haven’t got the resilience, at the lowest point in their lives, or may not even necessarily know that they’ve been kicked off the GP list. That’s where poverty hits.
“You’ve got the parents with money and capacity to argue for their appointment and you’ve got the parents who are struggling, who need to say ‘I need this appointment’, but there’s nobody speaking for them.”
It doesn’t have to be this way, she insists.
“We’ve got a massive health issue in a really solvable population. That’s the disappointment. If you intervene, you can stop it.”
She fears that if the Greater Manchester system doesn’t act quickly now, when there are fewer families in B&Bs than usual, it will miss its chance. In the same way it has galvanised to work on rough sleeping, this crisis will require authorities to make it a political priority.
One official spoken to for this piece notes Greater Manchester does not yet have the scale of the crisis facing London boroughs, but that means now is the time to act. Numbers here have already been rocketing for at least four years, they point out, arguing that the region should be buying up property for safe accommodation instead of relying on hotels, which often have competing councils over a barrel on price.
The approach to homeless families is a ‘litmus test’ for the wider system, they add.
And when recession hits and the government’s ban on evictions is lifted in August, councils already know the family homelessness tap will be turned back on, and hard. Already, hotels are seeing increases in referrals.
But Dr Cockman admits that even within the system itself, professionals are often unaware that these children exist. If she hadn’t started doing outreach during the lockdown, she would not have seen the situation for what it is either.
“I’ve never known a group that’s just been so off the radar of anyone,” she says.
What the authorities say
Shared Health’s findings were sent to Manchester, Salford and Oldham councils during the lockdown, as well as the Greater Manchester mayor’s office and the region’s devolved health partnership.
The M.E.N. approached them all for comment. The mayor was asked whether the issue was a political priority in the same way as rough sleeping and asked what he had done during his first term to address the crisis.
A spokesman for Mr Burnham said: “The mayor entered office promising to tackle rough sleeping in Greater Manchester and over the past two years, the number of people sleeping rough has fallen by nearly 50%. Increasingly this drive to end the need for rough sleeping has led through to the issue of family homelessness.
“The mayor has worked with the charity JustLife on the specific issue of family homelessness and recently they received a grant from the mayor’s charity so they could expand their work.
“Earlier this year the mayor heard powerful testimony from a mother of three children who had lived in temporary accommodation with her family. She raised issues around the standards of temporary accommodation and safeguarding.
“The mayor invited her to speak to the board that coordinates the response to homelessness across the city-region and work is now underway to see what more can be done do to set higher standards in temporary accommodation and improve support and protections for families who are homeless.
“The mayor would like to see families accommodated separately to single adults. Councils already make efforts to do this but occasionally this kind of accommodation is not available.
“Greater Manchester made every effort to support everyone who needed accommodation over recent months. The specific duty of housing homeless families is taken up at a local authority level.”
For clarity, the charity JustLife does not in fact work with homeless families, but with single homeless adults living in private temporary accommodation. This has been highlighted to the mayor’s office, but no response was received.
A spokesman for Manchester council said: “The safety and welfare of children in Manchester remains a priority for the council and its partners. We take our safeguarding responsibilities extremely seriously and as a result any issues raised would be investigated very quickly.
“No concerns relating to potential child sexual exploitation have been raised with us by families, support workers, hotels or other agencies involved with children and their families living in B&Bs. Any concern which is raised irrespective of the source would be taken seriously and diligently investigated and action taken to ensure children are safe.
“Wherever possible we always seek to accommodate homeless families in family-only accommodation. We do have some accommodation which is family-only and we are working to increase this.
“But where only mixed accommodation is available, and it’s a choice between families having shelter or not, the only realistic option is to use it.
“Thanks to the hard work of officers in recent months we now have only 22 families in B&B accommodation. We know that the loss of a home is a great upheaval and we will always seek to ensure that homeless families’ stays in B&Bs are as short as possible.
“Guidance is given to anyone moving into such accommodation, and parents are reminded of their own responsibilities to ensure their children are not left unsupervised. We are clear in our duties and responsibilities and take seriously the safety of families, especially those with children.
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“We would never place anyone considered a serious risk in accommodation shared with families. In addition we recognise the need for advice and support and as a result there is a bespoke package of support is also in place to ensure that homeless families have access to the food, educational provision or other help they need.
“The pandemic lockdown has been an exceptional situation during which some things had to be done differently – for example in line with Public Health England advice support workers could not conduct face-to-face visits for some time and had to contact families by phone instead – but at no point was support not firmly in place.
“We take recommendations such as those from Shared Health on board but they have to be considered in context.
“None of these challenges are unique to Manchester and across Greater Manchester we are endeavouring to rise to them.
“In an ideal world we would never need to accommodate homeless families in accommodation which is not family only. In an ideal world we would not be experiencing a national homelessness crisis which the impact of the coronavirus situation is only likely to exacerbate.”
Councillor Tracy Kelly, Salford’s deputy city mayor and lead Member for Housing, said: “We recognise the difficulty of living in one room accommodation with a family particularly during the pandemic.
“That is why, when restrictions first began, we moved all our families into self-contained accommodation.
“We aim to avoid placing families in hotels or B&Bs but sometimes these are the only emergency options available at the time and any such accommodation would be carefully selected with safety always in mind.
“We would always aim to move them on into more suitable housing as quickly as possible.”
Coun Hannah Roberts, Oldham’s Cabinet Member for Housing, said: “B&B placements are only used in emergency situations so we can place a family in accommodation often at very short notice and when we have no other alternative available.
“It is always a temporary measure – to get a roof over their head when they need one – and we work hard to ensure they are found more suitable accommodation as soon as possible.
“Between 23 March-17 June 2020, Oldham Council placed 35 families into carefully-selected B&B accommodation – the majority of those were moved into temporary self-contained accommodation within a matter of days.
“Our residents’ safety is paramount and we work closely with partners, including our accommodation providers, to ensure robust risk assessments are in place. Our housing officers provide ongoing support and a personalised housing plan is devised for each family.
“We are already working closely with Shared Health as part of a pilot system and will work with them to progress their recommendations and ensure a co-ordinated approach incorporating healthcare, housing and education.
“Coronavirus has had a huge impact on housing provision – we’re seeing more people that need our help and the speed at which they move through this ‘system’ has vastly slowed down. This is only set to get worse as lockdown ends and the economic impact of the pandemic takes hold. I am also concerned that when the suspension of evictions ends, there will be a spike in the numbers of people losing their homes.
“Oldham urgently needs more and better safe, warm and modern homes for residents at a price they can afford.
“Now, more than ever, local authorities like Oldham need long-term and adequate funding from central government to help us tackle homelessness and ensure the most vulnerable in our society do not fall through the cracks.”
Greater Manchester’s Health and Social Care Partnership set up a committee to look at the issue in February off the back of Shared Health’s findings. It plans to meet with the charity again this week.
The partnership’s interim chief officer Sarah Price said: “We know how difficult it is for families with children in temporary accommodation in terms of the impact on their physical and mental health. The current pandemic has only made this even harder.
“We’re a partnership made up of all Greater Manchester’s NHS bodies and councils, as well as the voluntary sector and others, and our aim is to do everything we can together to improve the health of everyone living here. We particularly want to put an end to our more vulnerable people and communities suffering disproportionately poor health. We know this was the case before the pandemic, and it has been made worse by Covid-19.
“We’ve got unique devolved arrangements in Greater Manchester and an opportunity to come together to tackle some really challenging issues, of which this is clearly one. We’re meeting with Shared Health and other partners on July 1 to consider their recommendations and see how we take things forward better.”