It’s in the NHS’s interest to ensure homeless hospital patients are discharged into suitable accommodation, a task in which hospital social workers can play a key part, says Helen Mathie, policy manager at Homeless Link.
It’s 9pm on a Friday night. There’s a man in the bed at the end of the ward. He’s been told he can go home. Except he can’t. He’s homeless. And two things are certain if he’s discharged now: his return to the street will cost him his health; and, in weeks or months, his readmission to the ward will cost the hospital dearly.
Research this week from Homeless Link and St Mungo’s found that most homeless people who end up in hospital are discharged without making sure they have accommodation to go to. They are sometimes discharged straight on to the street, often without their underlying health problems being addressed.
Some people who took part in our research described mistrust and prejudice encountered in some hospitals – from one person being referred to by nurses as ‘a tramp’ to another being turned away by security guards when he was coughing up blood.
This isn’t about apportioning blame. The fact is that being homeless, especially sleeping rough, damages your health. Every day, the NHS feels the strain of that. When we surveyed homeless people in 2010, 40% of homeless people said they had used A&E at least once, and nearly a third were admitted to hospital, over a six-month period.
It’s expensive but, with the right practices in place, some of those costs are avoidable – as is the damage to homeless patients’ health caused by discharging them into inappropriate (or non-existent) accommodation.
(Image: Phanie Agency/Rex Features)
When NHS services have a practical homelessness policy in place, the picture is very different. At University College London Hospitals (UCLH), where they have a dedicated London Pathway team, the housing status of patients is routinely checked on admission. Homeless patients are assessed and a care plan is drawn up, in partnership with other agencies, for life after hospital.
By personalising their services and working with other agencies in the community UCLH has reduced total bed days relating to admissions of homeless patients by one third, and made savings of £100,000.
It isn’t only large urban areas that will benefit. Many other health agencies have developed working schemes, including in the Wirral, York and Hastings. Hospitals can and do take action – but it needs to happen more widely.
Of course there’s always going to be a debate around who should be responsible. Should discharge co-ordinators lead on it? During our research, some were adamant that it isn’t their job. Or considering the specific health needs of many homeless people, perhaps projects need a clinical lead, as is the case at UCLH.
Or is there an argument for hospital social workers to pick up the baton?
Most homeless people don’t have social workers and don’t qualify for community care services. But given the often complex requirements of this patient group, social workers might have the most informed knowledge on how best to support them. And with housing support now increasingly within the remit of social care departments, this could be a workable option in many areas.
It isn’t the job of the NHS to solve homelessness. No one is suggesting that. Any approach has to be based on joint working. Great progress has been made in the practice of discharging other vulnerable patient groups, such as elderly people – and by taking practical steps similar improvements can be made for homeless people. The difference this can make is immense.
So what about our man in the bed at the end of the ward? Time’s moving on. It’s 9:15pm and nursing staff need his bed. What happens to him next depends on the hospital’s policy and practice. If he’s lucky, someone will already have worked with him to try and plan for his departure – and the place he’s going to will know he’s on his way and will be able to support his recovery. But if there’s no policy in place, what happens to him next is anybody’s guess.
Thanks for this piece. I think it’s really sad that homeless people can be released without a safe accomodation plan. I have heard a lot of discussions in London about the general lack of housing for people in need. I wonder how you feel we can increase these housing spots for those who need them?
Helen – lack of housing is a big problem for these clients as well as so many others who don’t have appropriate accommodation. Some patients leaving hospital do have somewhere to go (eg they might have a place in a hostel) so its about making sure they can return there safely if its appropriate to do so. But i agree, there is a far bigger call for affordable housing in general and ensuring there are accessible options in both supported accommodation and private rented sector depending on what is right for that person.