Changing the outlook for homeless people

One in 200 people in the UK is without a home and increasing numbers are sleeping rough. In response, the RCN has called for national action and a ‘broader approach’ to meeting homeless people’s needs.

One in 200 people in the UK is without a home and increasing numbers are sleeping rough. In response, the RCN has called for national action and a ‘broader approach’ to meeting homeless people’s needs

  • The number of people sleeping rough in England has doubled since 2010
  • Homelessness takes a high toll on people’s mental and physical health
  • Innovative nurse-led programmes are bringing healthcare to people on the streets

The RCN is calling on all four UK governments and the NHS to agree a rapid plan to make routine care and treatment for homeless people more easily available during the cold winter months.

The numbers of people sleeping on the streets is increasing. Picture: iStock

RCN general secretary and chief executive Janet Davies points out that specialist homelessness mental health teams have been subject to major funding cuts and some have disappeared entirely. The college wants ministers to do whatever it takes to prevent people from being discharged from mental health hospitals onto the streets and to invest more in specialist care for homeless people.

RCN joins forces with The Big Issue

Ms Davies, writing on the RCN website after the announcement of a partnership between the RCN and The Big Issue magazine, suggests that with better training on the causes and consequences of homelessness, healthcare professionals could take a ‘broader approach’ while they tend to immediate needs. ‘Nursing staff are ready to play a big part in making this winter and the year that follows it a much-needed moment of change,’ she adds.

The three-year partnership with The Big Issue includes the college becoming the sole sponsor of the red tabards worn by the magazine’s vendors.

The number of people sleeping rough in England in 2016 increased by 16% on the previous year to 4,134, according to charity Homeless Link. The figure, from an analysis using Department for Communities and Local Government data, has more than doubled since 2010, when it was 1,768.

Insecure and inadequate housing

But people sleeping on the streets are only part of the picture, with many, including families, stuck in hostels, temporary accommodation and in insecure or inadequate housing.

'The trap of homelessness is tightening thanks to decades of failure to build enough affordable homes and the impact of welfare cuts’

Polly Neate, chief executive, Shelter

Shelter published a review in November that revealed the number of people who are homeless has increased by 13,000 in a year to 307,000. The charity combined figures on people sleeping rough, in temporary accommodation as well as using social services statistics to discover that one in every 200 people in the UK has no home. The highest rates were recorded in the London boroughs of Newham – where one in 25 people is homeless – Haringey, Westminster and Enfield. But areas outside the capital also had high rates, including Luton, Birmingham and Manchester.

Shelter says that in England, where more people are affected, more than a third of those living in temporary accommodation will still be homeless in a year’s time.

The loss of a private tenancy is the most common cause of homelessness, and this number has soared since cuts to housing benefits began in 2011, the charity says.

Impact of welfare cuts

Chief executive Polly Neate says that the devastating trap of homelessness is ‘tightening thanks to decades of failure to build enough affordable homes, and the impact of welfare cuts’.

Homelessness takes a high toll on people’s mental and physical health. The average age of death of a single homeless person is 30 years lower than the general population at 47 years, and this is even lower for homeless women, whose average age of death is 43 years, according to Public Health England. Almost three-quarters of homeless people report physical problems, and 80% have mental health problems, according to Homeless Link. In the previous six months, a third had visited an emergency department and more than a quarter had been admitted, according to its survey of almost 2,600 people. There are also high rates of drug and alcohol abuse among this vulnerable cohort.

The Queen’s Nursing Institute's homeless health programme has been funding many innovative outreach services led by nurses for the past decade.  

‘Homeless people are the most high-risk group in terms of health, and their life expectancy is reduced by about 30 years’

David Parker-Radford, QNI homeless health programme manager  

Among the projects funded is the basing of a health team at a homelessness hostel in Lambeth, London, to reduce demand on secondary services. Hospital admissions fell by 75% and ambulance call-outs were reduced by 50% for the 34 patients cared-for in the pilot. The team subsequently received mainstream funding. Another project involved so-called ‘wet clinics’ which were offered at two homeless drop-in centres in Bristol. These allow patients to drink alcohol at the centre in an attempt to reduce barriers to seeking care.

QNI homeless health programme manager David Parker-Radford says there are now about 1,500 people in the QNI’s homeless health network, about half of whom are nurses. ‘Homeless people are the most high-risk group in terms of health, and their life expectancy is reduced by about 30 years,’ he says.

The good news is that highly skilled nurses are now doing ‘amazing work’ with homeless people. ‘Historically people who are homeless do not trust doctors, so that can be a barrier. Nurses are more focused on caring, empathy and holistic care, they are easier to relate to and they build trust. This means they are well placed to provide the care that people need.’

Nurse-led care for homeless people

Nurse-led clinics in four hostels and a day centre are helping homeless people in London access much-needed care and support.

Justine Sanderson, lead nurse for the homeless health peripatetic nurse service in Hammersmith and Fulham, provides a wide range of services for the residents and rough sleepers she sees.

This includes health assessment for new arrivals, blood tests, prescribing, treating wounds and intravenous ulcers, providing sexual health advice and supporting access to GPs and dentists.

Ms Sanderson, who is employed by Central London Community Healthcare NHS Trust, also signposts to a wide range of other services, including drug and alcohol teams and mental health services. Liaising with other health professionals and training hostel staff and residents on health issues is another important aspect of the job, she says.

Reducing the need for emergency care

Ambulance call-outs have fallen by 20% since she started working with the hostels two years ago. An example of how residents can avoid hospital can be seen in the care of a woman who had been admitted four times in a year before the service began for abscesses caused by intravenous drug use. She has subsequently had six more abscesses, but Ms Sanderson has been able to manage them effectively without the need for secondary care.

‘Their lives are quite chaotic so I bring as much as I can to them without taking their independence away,’ Ms Sanderson says. ‘It is almost old-fashioned work, I am at the heart of this community and I have time to see and do the problem-solving. I love the fact I am trying to make the NHS available and accessible to people who have been a little bit forgotten.’

Erin Dean is a freelance journalist

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