15th March 2019
In 2012, a study by The Housing Link and St. Mungo’s identified that two thirds of homeless patients were discharged from hospital straight back onto the streets. Despite it being included within the Care Act (2014) that provisions should be made available to adults on the basis of individual wellbeing (s.1), and the more recent Homelessness Reduction Act (2018), it appears that homeless people are continuing to fall through the net when they come into hospital. This was illustrated recently by an article in the Guardian (13/03/19) which reported figures obtained under freedom of information requests from 89 NHS trusts. It reported a shocking increase in the number of hospital discharges of people with no fixed abode. These figures have risen by 29.8% from 6,748 in 2014 to 8,758 in 2018. This has increased simultaneously alongside official estimates of the number of rough sleepers in the UK, which has risen 132 per cent since 2010 (Fitzpatrick et al 2017), and follows concerns about growing numbers of homeless deaths.
(Photo courtesy of Photographer Brendan)
A lack of planned hospital discharge may result in a revolving door of hospital admissions. In many ways, practice in this area appears to have gone backwards. Several decades ago, when I was a hospital social worker, I spent much of my time ensuring that those of no fixed abode could be safely dischaged into some sort of housing provision. Patients would not be discharged without this assurance. In the intervening years a focus on delayed discharge payments, and a reduction in welfare provision, as a result of austerity, has resulted in increasingly dehumanised systems of health and social care provision. Those experiencing homelessness often have multiple and complex needs, resulting in ‘deep social exclusion’, yet health and social care policy and practice may be creating further challenges for those already experiencing multiple disadvantages.
To move beyond a system where being of ‘no fixed abode’ is deemed acceptable, would require a concerted effort to work effectively across agencies. Furthermore, it would require improved interprofessional communication and improved funding to offer meaningful support. At a political level there needs to be a genuine and sustained interest in an improved supply of secure and affordable housing. We must also listen to the voices of the most disadvantaged in society, to develop a more humanised understanding of what being homeless is really like. A recent project at Bournemouth University used arts based methods to engage with the lives and experiences of a group of homeless people (Fenge, et al. 2018). Their words acted as a powerful reminder of the importance of listening to people, and to not ‘have people show concern then not even listen to your answer’. However, with Brexit continuing to dominate political and public debate, we risk the most vulnerable groups being silenced as they bear the brunt of austerity politics and a failure to join up policy.
Fenge, L. Cutts, W. and Seagrave, J. (2018) Understanding homelessness through poetic inquiry: looking into the shadows, Social Work and Social Sciences Review, 19 (3), 119-133
Homeless link and St Mungo’s 2012. Improving Hospital Admission and Discharge for People who are homeless, St Mungo’s and Available from https://www.homeless.org.uk/sites/default/files/site-attachments/HOSPITAL_ADMISSION_AND_DISCHARGE._REPORTdoc.pdf
Marsh and Greenfield (13/03/19) NHS data shows rise in homeless patients returning to streets- The Guardian Available from https://www.theguardian.com/society/2019/mar/13/nhs-data-shows-rise-in-homeless-patients-returning-to-streets?CMP=share_btn_tw )