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Demand to improve healthcare for the homeless

Man sleeping rough on street, 16x9

‘Homelessness should not exist in this country – but as long as it does we will have homeless patients who deserve inclusion in our healthcare system with effective, integrated and dignified care.’

A standing ovation and rousing applause greeted this, the crux of David Clayton’s argument at this year’s BMA annual representative meeting.

The strength of feeling around the room was clear: the Glasgow soon-to-be foundation doctor 1's motion calling for the BMA to be ‘at the forefront of tackling this public health emergency’ was passed unanimously, and the association will now lobby for medical schools to include the healthcare needs of homeless patients in their curriculums, NHS bodies to explore integrated models of homeless healthcare, and for hospital trusts to provide clinical staff with clear admission and discharge guidelines and procedures.

The motion also urged action from the governments of the UK – calling for additional resources to support the primary medical care of these vulnerable people and to ensure that no person completing a prison sentence is released without having somewhere to live.

That this argument should receive so much support from members of the BMA representative body says much about the scale of the problem of homelessness in this country.


Nationwide disparity

Earlier this year an investigation by The Doctor revealed a massive increase in the use of NHS services by homeless patients.

Further research, featured in the June edition of the magazine, also revealed a vast disparity in service provision across the country – with only 20 CCGs (clinical commissioning groups) reporting having clinical leads for homelessness and just 15 areas saying they specifically hire or contract staff to work in homeless care.

Most revealing of all, the investigation – which asked every CCG in the country to detail the health services they specifically commission for homeless patients in their area – highlights a vast disparity in care offered to rough sleepers or the vulnerably housed across the country.

In 66 CCGs, specifically commissioned homelessness services were reported. In one case this is nothing more than a £500 annual budget for flu vaccinations, in others there are comprehensive GP and outreach services costing hundreds of thousands of pounds. But in 77 CCG areas there were no specific services detailed.

Dr Clayton (pictured below) said: ‘We like to believe that the NHS is universal but too many patients are still excluded from its care. We need medical education to equip doctors with the skills to care for vulnerable patients with complex health and social needs and to communicate in a manner which maintains patient dignity.

ARM 2019 Annual Representative Meeting Report Public Health Motion 85 Dr David Clayton

‘Hostile attitudes and healthcare interactions only decrease engagement with health services and perpetuate a cycle of exclusion. If doctors are to practice advocacy for this marginalised group, systems need to allow us to do so and fit the needs of those that they serve. Homeless people often have complex and interrelated health needs but can fall through gaps in service provision.’

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