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Pavement out-patients

May 21 2008
Are homeless patients second-class citizens? Are homeless patients second-class citizens?
With migrants forming such a large part of the homeless community, the Government needs to provide some level of support for people from all backgrounds Since the letter from Lisa Gray in Issue 28, we've been looking at homeless hospital discharge The Pavement has long reported the inadequacies of support offered to the homeless after they have been treated in hospital; and we are still receiving regular reports from our readers about homeless patients being treated like second-class citizens. Just last week, The Pavement encountered an injured man (pictured) outside the Accident and Emergency Department of Homerton Hospital in East London. He had intervened in an assault on his friend outside Broadway Market the night before and had himself become involved in the attack. He was hit hard on the head and fell unconscious before his attacker broke his leg in two places. Local police had, according to the man, been helpful in contacting an ambulance, but he claims that the paramedics dismissed his injuries as minor and suggested he make his own way to hospital with what they deemed to be "a minor sprain". The man felt that medical staff overlooked him because of his status as homeless, as he resides in a local authority hostel. In December 2006, after a series of high-profile deaths of patients who had been discharged from hospital only to have their conditions worsen in either in temporary accommodation or on the streets, Homeless Link published guidelines in collaboration with the Department of Health and the Department for Communities and Local Government on dealing with the homeless. The guidelines, entitled: Hospital Admission and Discharge: People who are homeless or living in temporary or insecure accommodation states: "The aim of this guidance document is to support hospitals, Primary Care Trusts, local authorities and the voluntary sector, working in partnership, to develop an effective admission and discharge protocol for people who are homeless or living in temporary accommodation. The overarching aim of the protocol will be to ensure that no one is discharged from hospital to the streets or inappropriate accommodation." Homeless Link, which was involved in the consultations for the guidelines, confirmed that this was a voluntary protocol, which is not connected with the National Institute for Clinical Excellence (NICE) or the General Medical Council, and, therefore, no action can be taken if a hospital is not following the guidelines. A spokesperson for Homeless Link added: "It is on our agenda to follow up which hospitals are using the protocol nationally and to highlight examples of good practice; however, at this stage, we are not in a position to say anything else about it. Also, local authorities should have a duty to scrutinise NHS services through their health scrutiny panels." According to the NHS, the guidelines have not been distributed directly by the NHS in London, but by the London Network for Nurses and Midwives, because it was deemed easier for them to communicate with frontline staff in wards and in A&E departments. However, the guidelines are merely suggestions for best practices, rather than hard-set rules which have to be observed by anyone treating homeless individuals. Hospitals are under no obligation to provide post-treatment support for those who face a recovery on the streets. But even when trying to offer support to their patients, hospital workers often become entangled in red tape and legislation, which they feel prevent them from doing their job properly. A medical caseworker from an unnamed central London hospital contacted The Pavement about her concerns for her patients. We have changed her name and those of her patients to protect their identities. Nurse S is treating two Eastern European men, called Dodek and Borys, for tuberculosis. They were diagnosed three weeks ago and stayed in hospital for initial treatment, before being discharged to return for continued medication as out-patients. But Nurse S discovered that the men were squatting in an underground garage with a group of four other migrants. The squat is dark, damp and cold, and the environment will only perpetuate their symptoms. She contacted The Pavement for advice when the local authorities refused to grant them temporary housing because of their status as Accession State migrants. Dodek is from Poland and Borys is from Lithuania. They have both been in the UK for over seven years and make a living collecting scrap metal from skips and selling it on. They do not want to be a burden on the hospital and are reluctant to stay on the wards any longer than is necessary. It is estimated that it costs the NHS - and therefore the taxpayer - approximately £500 a day to keep a patient on a ward. 'Bed-blocking' is expensive and often a last resort; but across the city, homeless people and migrants are kept on the wards because no safe alternative awaits them. A week in local authority housing would cost just £300 for the men and their partners, but as A8s they are not eligible. Nurse S has applied several times to the local council: "At first they told us no appointment had been made even though I had email confirmation," explained Nurse S. "I had to beg the manager to ask the couple a few questions, and eventually, three hours after their initial appointment time and with Borys' fever growing, he and his partner were granted an two-hour-long assessment for local authority housing. It only took the manager two minutes to make a decision," she continued. "She went out of the room for a quick chat with her colleague and came in and just said no." Nurse S explained that she had tried contacting St Mungo's for help, but they refused to offer temporary accommodation to the men unless the local authority paid for it and now she is at a loss as to what to do. "If they are left on the streets there is an increased chance they could develop multidrug resistant TB," said Nurse S. "By not providing an alternative form of housing for these people, the local council is affectively signing a death sentence." With migrants forming such a large part of the homeless community, and The Pavement already reporting how much additional pressure they are placing on the homeless charities in the city, the Government needs to provide some level of support for people from all backgrounds. Organisations such as The Passage are continuing to lobby the government to implement housing advice services through JobCentre Plus for Accession State workers to no avail. And whilst publishing guidelines has increased awareness in hospitals of the systems in place to support homeless people in the City, they will continue to endure second-class treatment until they are properly enforced.