Health Service for the Homeless by the Homeless in London

T

he average age of death for the homeless in England is 40.2 years. This premature age of death persists even when the homeless are given a roof. Homeless people do not die from the lack of a home, but from the lack of health.

They often have a triple diagnosis of physical ill health, mental ill health and addiction. Homelessness destroys lives, families and fractures communities. It breeds despair and anger, and contributes in a large way to the inequalities in our society.

We are seeking funds to develop a health service homeless healthcare initiative, which will respond to this ‘invisible’ patient group who have a high impact on our health service, while, at the same time, lacking a voice and any sort of representation.

A significant proportion of homeless people avoid the health service because they don’t find it welcoming, they cannot trust it and they are often made to feel inadequate. Winning homeless patients’ trust and communicating effectively with them are critical components to offering a successful healthcare service for the homeless

The initiative we are leading involves the formation of a group of “care navigators” recruited from the homeless community and trained through a specially designed skills acquisition leadership programme that will be provided at the newly opened Education Centre at University College London Hospitals. Homeless people welcoming homeless people who are sick into hospital facilities will help to win trust and enable more effective access to the health service.

Beyond welcoming and trusting through the care navigator initiative, it is critical that tangible support is offered. To this end, we are offering a step down/step up facility, which will allow access to a dedicated number of beds for the homeless, adjacent to University College London’s Accident and Emergency facility. This will be customised to meet the needs of the homeless community, immediately, effectively and in a caring and kind manner. As is so frequently the case, when homeless people admitted as emergencies are stabilised, they are often discharged back to the context that precipitated their admission in the first place. To avoid this vicious cycle, we would move from the step down facility of in-patient homeless beds (i.e. a hostel within the hospital), to a step up facility in the community where we would have a hospital setting within a hostel.

This would allow a migration of unhealthy homeless people from the acute setting through to rehabilitation in the community, alongside the acquisition of life skills, encouraging them back into a more supportive environment and in so doing, attempting to reduce what was previously an inevitable return to the A&E.

We also wish to identify from the individuals passing through the programme, potential trainers who could be developed to “train the trainers” among a wider population of previous homeless.

The NHS estimates that the homeless in the UK cost them close to £1b. This money could be better directed to other NHS frontline activities if the homeless had access to dedicated healthcare. The homeless attend A&E six times more often and stay twice as long as the non homeless. Having been treated they often simply return to living on the streets.

In addition to Professor Aidan Halligan, the project has been set up with the support of Lord Andrew Mawson, Lord Darzai and Archbishop Cormack Murphy O’Connor. Ashley Prime at the British Consulate General in Toronto has also agreed to join.

We have already attracted £150,000 public funding and are seeking to match that from the private sector.

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