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Opinion

What the NHS bed shortage means for patients who are homeless and have nowhere to go

A former member of a scheme to find accommodation and healthcare for homeless patients reveals the realities of the job amid the NHS crisis

Medically fit for discharge but without a suitable move-on destination, around one in seven patients in the UK are currently languishing in hospital.

Typically in wait for a care home or supported accommodation, this cohort are now gracefully known as ‘bed-blockers’ among the media. Bed-blocking, however, is not solely caused by the ongoing crisis in social care.

Since 2010, the number of rough sleepers across the country has increased by 165 per cent. Unsurprisingly, this trend has started to spill over into rising hospital admissions.

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The problem that wards are now met with is that, as most hospitals have become perpetually full, there is a decision to be made between discharging someone to the streets or delaying a vital operation.

Caught in this fraught position, the former option is most often chosen. Hospitals simply lack the infrastructure to deal with socio-economic issues, and medical professionals lack the capacity and expertise.

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Because street discharges have started to creep up, the deaths associated with them have ballooned.

This used to be the status quo until recently, when a patient died on the doorstep of a central London hospital and the story made the news. No checks were made regarding the patient’s social or housing situation. No issues were flagged, and once his treatment was finished, he was discharged without any consideration as to where he would be going. Alarm bells rang and eventually, it was decided that something had to change.

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A product of these developments, I worked for a team representing the new in-hospital homelessness service being trialled across the NHS. Our chief objective was to source accommodation and primary care for those who would otherwise be making their way to the streets.

And while this alone can be a gruelling task, the real test is to do it in line with each patient’s estimated discharge date. Referrals often come late, with little to no flexibility, regardless of what the predicament is.

The complex and sometimes mind-shattering circumstances that afflict each patient leaves a feeling of incredulity at what the NHS must now contend with – not least because it is up against a backdrop of swingeing cuts.

We saw gang-warfare victims with colostomy bags, unable to return to the borough in which the incident occurred. Former psychotherapists suffering with crystal meth addictions, desperate to rehabilitate. Refugees, having fled squalid conditions and bullying in their Home Office accommodation, arriving at hospital with nowhere else to go. Domestic-violence survivors asking for sanctuary. Trafficked car-wash workers needing an interpreter to translate their predicament and aren’t even sure when they came to the UK.

One morning a man was admitted at 4am with complete retrograde amnesia. The nursing notes revealed the patient did not know who he was or where he had come from. Medical attention was no longer required, but on this occasion, the patient could not be discharged until he had somewhere to go.

Then the bi-daily ‘extreme capacity alert for surgery’ notification popped up on our computers. The ward matron called to say there were patients waiting for urgent treatment and that he did not need to be there any longer. The unidentified man could not be relocated to any other ward because they were full too.

The registrar chimed in demanding answers. I told him we had only just had the patient referred, but we’d get to it immediately. He said we had until the end of the working day before he’s out. And like this it goes on.

By an anonymous NHS worker

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