Homelessness

2002 RCGP statement on homelessness and primary care

The RCGP recognises that:

A home is more than a physical structure. It is a sense of belonging and of personal affirmation. The best way to improve the health of homeless people is to provide appropriate and secure housing.
Homelessness extends beyond the familiar images of people sleeping on the streets. It encompasses hostel-dwellers, travellers, families in B&B accommodation, people in squats and those in temporary or overcrowded accommodation such as asylum seekers and many refugees
All people have a right to equity of access to primary care services and to receive services which will enhance their dignity and independence
Individual professional advocacy is important in homelessness at all levels, from the consultation where the quality of the practitioner-patient relationship is paramount, to local, regional and national arenas
New service models must be developed which utilise the complementary strengths of generalist and specialist expertise. Interdisciplinary working and multi-agency partnerships including social service are vital to the development of effective services in order to avoid costly duplication of effort and dangerous gaps in care. The focus should be on inclusive practice, needs not diagnostic labels and solutions not problems
New ways of thinking and working are challenging and should be underpinned by explicit support and valuing of the workforce charged with implementing change

At an individual practice level the RCGP recommends that:

Primary care practitioners should provide a welcoming and sensitive service to homeless people and enable them to access the full range of health and social services required to meet their needs
Homeless people should be registered permanently wherever possible and integrated into all health prevention and promotion activity within the practice
Housing agencies could be encouraged to hold advice sessions in a primary care practice setting

At an individual primary care trust level the RCGP recommends that:

In view of the impact of homelessness on health, homelessness issues should be recognised as part of the core PCT agenda
PCTs should acquire a good understanding of the numbers of homeless people in their area and the problems they face, as well as the range of local agencies equipped to meet their needs. This information will be vital in both the planning and delivery of services for homeless people
PCTs should provide resources for ongoing and substantive support for homelessness services and develop diverse, well-resourced and locally appropriate services
PCTs should encourage multi-agency links that are both viable and adequately sign posted to encourage integrated services
Agencies should work together to develop shared protocols and operating procedures that aid integrated working and co-ordinated care for homeless people
PCTs should develop IT support and computer codes that will enable the recording of degrees of homelessness and the status and security of housing provision
PCTs should work with local authorities to provide social, educational and employment opportunities for homeless people. Information about these opportunities should be made available to primary health care teams
Specialist opinions from appropriately experienced psychiatrists should be readily available to practitioners working with homeless people
Funding should be provided in recognition of the work involved in preparing medical reports for housing agencies

At national level, the RCGP recommends that:

Political support be offered to those working in the field of homelessness Resource allocation methods should reflect the real costs of providing primary care for homeless people,
The new GP contract negotiations should address structural barriers that may affect the permanent registration of homeless people. These include the removal of perverse incentives such as deprivation and target payment anomalies,
Planning for electronic transfer of patient records should address the needs of mobile populations within the appropriate constraints of consent and confidentiality,
A collaboration should be developed with the National Treatment Agency to explore ways of improving services for homeless people with drug dependency,
A national web-site for homelessness should be set up to act as a living interactive resource for individuals and agencies involved in the area,
The RCN and the RCGP collaborate to acknowledge the aspiration of nurses in the field of homelessness to be recognised as a specialism. It has a core curriculum, training opportunities and qualification.

When considering the education and learning priorities in working with homeless people, the RCGP recommends that:

Service users are actively involved in planning service configurations, delivery, and education and learning initiatives. Workforce confederations and PCTs work together in partnership as learning organisations to develop appropriate education and learning opportunities at all entry levels. The extent and pervasive nature of negative stereotyping is recognised as an important barrier to good quality primary care. Appropriately focussed education and learning initiatives are developed in this area. Education and learning initiatives around homelessness issues should be multidisciplinary in nature. Education and learning opportunities should include diversity training, methods of risk assessment and dealing with complex needs such as alcohol and substance misuse and mental illness. Continuing learning and professional development should be focussed on the interfaces between different agencies.

When considering the care of homeless children, the RCGP recommends that:

The UN Convention on the rights of the Child 1989, endorsed by the UK Government, which gives all children the right to the highest level of health possible is recognised and acted upon at all organisational levels,
The causes of child homelessness are recognised, acted upon and that appropriate education and learning opportunities are available for practitioners in the field. These consequences include family difficulties, domestic violence, immigration and asylum seeking, abuse and substance misuse,
The consequences of child homelessness are recognised, acted upon and that appropriate education and learning opportunities are available for practitioners in the field. These include adverse physical health, poor uptake of immunisation and preventative services, increased accidents, developmental delay and malnutrition. They also include psychosocial effects such as over activity, aggression, poor sleep patterns and increased risk of child abuse.

When considering refugee homelessness, the RCGP recommends that:

Training in homelessness issues should include aspects specific to refugee homelessness
Extra resources are made available in areas of high refugee homelessness including particularly adequate interpreting and translation services
Agencies work together to promote positive images of refugees and asylum seekers

Dr Helen Lester, Dr Iona Heath, Dr Nat Wright, Dr Paul Thomas, Fiona van Zwanenberg, on behalf of the RCGP Health Inequalities Standing Group.