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Scottish Charity Register No. SC043760

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Out-patients help

May 18 2009
Evans Evans
A new set of guidelines have been produced to help homeless people being released from hospital
The Pavement has previously noted how important it is that rough sleepers take care of their health. As they live in temporary or insecure accommodation, they are more vulnerable than the rest of the population. They may have difficulty in accessing primary care, and often do not seek treatment until the problem is at an advanced stage. Hospitals and medical staff cannot always understand rough sleepers - they may discharge themselves because of anxiety about losing their already temporary accommodation; "home" will not include the care and treatment that patients should receive.

Guidelines released only a few months ago aim to solve a problem obvious in the following cases. Bart, who is in his mid-30s, arrived at the Broadway centre by ambulance with the line from a drip still in his arm. He had receiving emergency medical care for several weeks, but the hospital had declared him "fit for discharge". Bart explained he had nowhere to go: he was homeless. Staff had heard of the Broadway Centre, so brought him there, but it does not provide emergency housing and offers limited, basic medical services. Centre staff received no advance warning from the hospital, and as a result there was no bed in the hospital or in the Broadway centre for Bart, who had only a small plastic bag of belongings and wore clothes inappropriate for the weather. He had no medication, only a letter from the GP. Bart looked like he was going to have to sleep on the streets that evening and drastic action was needed. The Centre threatened to return Bart by taxi if the hospital did not collect him. After much discussion, the hospital sent someone to collect him, thanks, in part, to the staff's persistence.

Mary, 35, also used the services of the Broadway centre when she was discharged by the hospital where she had been treated for deep vein thrombosis (a result of prolonged drug use), which could have led to the amputation of her leg.

As these are not the only cases of rough sleepers needing special treatment, last December the Department for Health and the Department for Communities and Local Government (DCLG) issued a new set of guidelines produced in conjunction with Homeless Link (the national membership organisation for frontline homelessness agencies in England) and the London Network for Nurses and Midwives (LNNM). The guidelines - Hospital Admission and Discharge: People who are homeless or living in temporary or insecure accommodation - are aimed at health professionals and primary care providers to help them establish an effective hospital admission and discharge policy.

The document gives background information about homelessness and highlights, among other facts, that rough sleepers often self discharge for reasons such as ongoing or unrecognised mental health problems or alcohol/drug dependence. The document mentions nine steps which should be considered in developing a protocol, and recommends identifiying relevant organizations such as social services and voluntary agencies.

According to the guidelines, "[a] street outreach team or primary health or mental health team may have a keyworker, who can provide background information and support to the patient both during admission and following discharge. Identification of a patient's housing status, keyworking arrangements and special vulnerabilities at an early stage in the admission is vital to achieve an appropriately planned and timely discharge." The introduction stresses that "a better integrated health system can can help prevent or reduce homelessness. Previous documents also emphasise the need to change systems to be more responsive to patient's needs."

Early discharge of patients can only result in deteriorating patient health. The health services face the cost of treating the same patient over and over again, as Homeless Link executive Jenny Edwards pointed. Natalie Warman, of the LNNM, believes that these guidelines will begin to improve the quality of services delivered to the homeless, just as previous strategies have improved care to other vulnerable groups such as older people and children. According to Mrs Warnman, the feedback from colleagues has been encouraging.

But Alice Evans, head of policy analysis at Homeless Link, who was closely involved in drafting the guidelines, said: "it is too early to assess the level of improvement since the introduction of the hospital discharge guidelines for working with homeless patients. Our member groups - who've had to deal with past problems - are all pleased with the new guidelines. They are our eyes and ears, the ones who can best gauge the improvements."