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Threefold rise in homeless people visiting A&E

GPs also report rise in homeless patients

Jo Carlowe

Monday, 21 January 2019

The number of visits to emergency departments by homeless people in England has more than trebled since 2011.

This is the finding of an investigation by the British Medical Association (BMA), leading to the BMA to declare that society’s most vulnerable people are being let down by the system.

Recorded visits to hospital A&E departments by patients classed as having no fixed abode rose from 11,305 in 2011 to almost 32,000 last year.

The BMA investigation suggests health and social care cuts are driving the problem. To make matters worse, the homeless patients are presenting with increasingly complex physical and mental health conditions.

Some of the hospital trusts with the largest increases in A&E attendances by homeless people since 2011 include:

  • Kings College Hospital NHS Foundation Trust London – 1,563% increase.
  • South Tees Hospital NHS Foundation Trust – 1,125% increase.
  • Royal Devon and Exeter NHS Foundation Trust – 847% increase.
  • Stockport NHS Foundation Trust – 310% increase.

Admissions from emergency departments to hospital wards have also rocketed – from 3,378 in 2011 to 9,282 in 2018.

The figures for attendance to A&E and hospital admissions represent a bill to the NHS of an estimated £47m over eight years, according to the BMA. However, the Association suggests the true cost to the health service is hidden due to shortcomings in the NHS’ mechanisms for recording homeless patients. In addition, many hospital trusts did not respond to the BMA’s request for figures.

As part of the investigation, a survey of GPs in England found that over a quarter said they too had seen an increase in the number of homeless patients during the last five years, with almost a fifth reporting that their surgery was having to devote greater time and resources to homeless patients than they did five years ago.

Ambulance services have also experienced a significant increase in demand from homeless patients. However, only two of the country’s ten ambulance trusts responded to a request for figures as most said they did not keep the data.

Commenting, BMA public health medicine committee chair, Dr Peter English, said: “If this was some disease causing all these problems it would be a much higher priority but because victims can be blamed and stigmatised it is easy for government to ignore. The growing numbers of rough sleepers and vulnerably housed people in our society is a continuing tragedy. To stand by silently as our NHS faces increasing strain and our society becomes increasingly unequal would be unacceptable.”

As well as the evident physical toll, the investigation explored the link between homelessness and mental health. It found that cuts to substance and addiction services, lack of mental health provision, inaccessibility of GP services, and the rising prominence of new psychoactive substances such as mamba or spice are all contributing to the growing crisis.

BMA mental health policy lead, Dr Andrew Molodynski, said: “There is a considerable link between homelessness and mental health as sadly, homelessness can be both a cause and consequence of having poor mental health.

“Without a home, it becomes even more difficult for people to seek treatment for their condition, many of whom have multiple and complex needs. They are ultimately sentenced to a life on the fringes of society without ever receiving the care they need.

“Failure in access and the provision of mental health care, starting from child and adolescent services, means that all too often vulnerable young people and adults, some of whom do not have a support network, are at risk of ending up on the streets.

“The government must do more to end this tragic cycle. As well as addressing the current shortcomings in the provision of mental health care, there must be a wider approach that looks at prevention and the wider societal issues at play. Society is failing to protect far too many vulnerable individuals and that must change.”

An NHS England spokesperson told OnMedica: “The NHS Long-Term Plan recognises that there has been a considerable rise in people sleeping rough in recent years and that 50% of rough sleepers have a mental health condition. To tackle this, the NHS will invest £30m extra on meeting the health needs of rough sleepers by ensuring that the parts of the country most affected by this issue, have access to specialist homelessness NHS mental health support when a homeless person presents at an NHS setting, as well as continued access to integrated outreach services.”

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