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Opinion

Royal College of Nursing: “Poor health is a cause and effect of homelessness”

As the Royal College Of Nursing begins its sponsorship of Big Issue vendor tabards, RCN chief executive Janet Davies says that homeless people face obstacles in accessing healthcare

A new emblem joins a well-known motto on the iconic vendor tabards this month.  Two large hands will sit above a reminder of the magazine’s founding principle: ‘a hand up, not a handout’. These hands – my organisation’s symbol to represent the everyday work and values of our nurses – could not have found a more appropriate organisation with which to partner.

In nursing, we see individuals – people with complexities and life stories – not passive ‘patients’; care should not be done to somebody but instead with them. A nurse’s role focuses on maximising potential and enabling independence – which is why we believe supporting the work of The Big Issue is so relevant for us.

Multiple underlying mental and physical health issues contribute to someone sleeping rough

One of the earliest lessons I learned when training as a nurse in Manchester in the 1970s was about looking for causes and not just treating symptoms. What lies behind today’s sharp increases in homelessness and rough sleeping is as varied as it is complex. But it is fair to say poor health cuts across the two as a cause and effect of homelessness. The many roots must be addressed but we can be doing a great deal more as a society for the people who are already in an unimaginable situation.

Frequently, multiple underlying mental and physical health issues contribute to someone sleeping rough. The longer they do, the greater the risk that those problems will worsen. But the barriers to accessing healthcare – getting through the door of the NHS in some form – must not be underestimated.

These obstacles can mean health problems remain untreated until somebody reaches crisis point, with a cycle of repeated A&E visits and overnight stays that fail to deal with underlying issues. For somebody who is homeless, hospital trips like this occur four or five times more often than for the rest of the population.

Rough sleeping makes it harder to access longer-term health support too, such as mental health services. Specialist homelessness mental health teams have been subject to major funding cuts and even disappeared entirely while other services struggle to support people who face multiple complex problems. For others, not having a GP means there is nobody to make the necessary specialist referral.

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In a new nationwide plan to address rough sleeping, backed by genuine investment in specialist homelessness mental health support, ministers could pull out all the stops to make sure people being discharged from mental health hospital have a real alternative to the street.

Specialist homelessness mental health teams have been subject to major funding cuts and even disappeared entirely

An innovative scheme in Leicester sees a designated nurse working in the community to make sure that discharge runs smoothly and that the support is in place to avoid a quick return to hospital. A healthcare assistant there too reminds people of upcoming hospital appointments and offers to accompany them.

Winter is fast approaching and the four governments of the UK and their NHS must agree a rapid plan to make routine care and treatment more easily available during these harsh months. Too many people mistakenly believe they need a proof of ID or address when registering with a doctor’s surgery. A lack of interpreting services at receptions or embarrassment around form-filling also play a part. The NHS must redouble efforts to let those without a fixed address know that GPs are able to make exceptions and make sure surgeries are left in no doubt.

London’s NHS, where the problem is greatest, printed tens of thousands of cards on registering with a GP and distributed them at shelters, day centres and food banks across the city and provided extra training for surgery staff. It stands as a very practical example to the rest of the NHS.

Once inside, every encounter with its one million professionals must be as meaningful as possible. With better training on the causes and consequences of homelessness and where support can be found, they can take a broader approach as they tend to immediate needs. Nursing staff are ready to play a Big part in making this winter and the year that follows it a much-needed moment of change.

Photos: Elliott Franks

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