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Invisible homeless falling into healthcare gap

More careful assessment of the health care needs of homeless people is required, to assess whether they are being met by the NHS, according to a report from Health Action for Homeless People.

The report, Are you being served?, is the result of research with agencies working for homeless people, the casualty department of St Thomas’ Hospital in London, and homeless people themselves.

The authors monitored admissions of homeless people to the accident and emergency department over a one week period. They found that there is no agreed system for defining or recording homelessness, so official statistics render homeless people invisible.

At present, only those who say they have ‘no fixed abode’ are counted, ignoring those in bed and breakfast accommodation or lodging with friends.

Without better information it is impossible to estimate the overall effects of homelessness on health and the impact on health service use, says the report.

Many homeless people used emergency services in place of primary care. Many of those attending had minor injuries, and some had alcohol or mental health problems. The hospital’s drug and alcohol service was open only during office hours.

Although nursing staff at St Thomas’ expressed at interest in learning more about homelessness, several nurses were frustrated by social problems that were beyond the scope of health services to improve. They also felt that advice on accommodation and medication was likely to be ignored.

The report recommends that staff training is needed in the particular health and social problems faced by homeless people, and in raising awareness among staff of agencies which can offer advice or support. It suggests that a GP should be appointed to work in the casualty department to focus on the problems which would usually be dealt with in primary care, alleviating pressure on emergency staff.

St Thomas’ Hospital reacted critically to the report, claiming that ‘no attempt had been made to confirm the practicality of the recommendations’.