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Power et al. highlight the importance of a co-ordinated approach to
health promotion for homeless people1. We agree that the homeless are a
heterogeneous group and we believe that the inadequate definition of types
of homelessness makes it fundamentally more difficult to provide these
vulnerable individuals with appropriate health care. Homeless individuals
can be characterised as:
1 Those officially defined as homeless by a local authority under
the 1985 Housing Act2, and staying in temporary accommodation. This group
mainly consists of young women with children, families from minority
ethnic groups and asylum seekers.
2 Single people in short-stay hostels. This group has a high proportion
of alcohol abusers and people suffering from mental illness.
3 ‘Rough sleepers'. This group suffers from a multitude of health and
social problems. Consequently, rough sleepers have been targeted as a
high priority group by the Government3.
4 Squatters, a group of ‘hidden homeless' about which very little is
known.
5 Travellers, which includes three distinct groups. New Age travellers
may not perceive themselves as homeless, but their politically-motivated
nomadic lifestyle leads to problems in their access to healthcare.
Gypsies, a minority ethnic group, today usually live in fixed locations,
but have a unique cultural heritage based on travelling. Transient people
without mobile accommodation, who are not culturally assimilated with
either of the above groups.
Primary Care is essential to the homeless if they are to receive
appropriate health care. The Personal Medical Services pilots, under the
National Health Service (Primary Care) Act (1997)4, provide an opportunity
to test different ways of improving access to appropriate health care for
the most disadvantaged members of our society. Fifteen pilots are
targeting different groups of homeless people. Power et al. do not
mention this important development. We are evaluating the pilot sites'
progress towards meeting their objectives to reduce inequalities in access
to appropriate health care. The main aims of this study are to decide
whether Personal Medical Services pilots are meeting their organisational
objectives, and whether the new organisational models of primary health
care delivery improve access to appropriate health care for the homeless.
Anthony J Riley
Research Assistant
Yvonne H Carter
Professor
Geoffrey Harding
Senior Lecturer
Martin R Underwood
Senior Clinical Lecturer
Department of General Practice and Primary Care
St Bart's & the Royal London School of Medicine & Dentistry
London
E1 4NS
1 Power R, French R, Connelly J, George S, Hawes D, Hinton T, et al.
Health, health promotion, and homelessness. BMJ 1999; 318:590-2. (27
February.)
2 The Department of Environment. The Housing Act 1985. London: HMSO,
1985.
3 Great Britain. Social Exclusion Unit. Rough sleeping report by the
social exclusion unit. London: Stationery Office, 1998.
4 Department of Health. The NHS (Primary Care) Act 1997. London:
Stationery Office, 1997.
Preinstalled company
Power et al. highlight the importance of a co-ordinated approach to
health promotion for homeless people1. We agree that the homeless are a
heterogeneous group and we believe that the inadequate definition of types
of homelessness makes it fundamentally more difficult to provide these
vulnerable individuals with appropriate health care. Homeless individuals
can be characterised as:
1 Those officially defined as homeless by a local authority under
the 1985 Housing Act2, and staying in temporary accommodation. This group
mainly consists of young women with children, families from minority
ethnic groups and asylum seekers.
2 Single people in short-stay hostels. This group has a high proportion
of alcohol abusers and people suffering from mental illness.
3 ‘Rough sleepers'. This group suffers from a multitude of health and
social problems. Consequently, rough sleepers have been targeted as a
high priority group by the Government3.
4 Squatters, a group of ‘hidden homeless' about which very little is
known.
5 Travellers, which includes three distinct groups. New Age travellers
may not perceive themselves as homeless, but their politically-motivated
nomadic lifestyle leads to problems in their access to healthcare.
Gypsies, a minority ethnic group, today usually live in fixed locations,
but have a unique cultural heritage based on travelling. Transient people
without mobile accommodation, who are not culturally assimilated with
either of the above groups.
Primary Care is essential to the homeless if they are to receive
appropriate health care. The Personal Medical Services pilots, under the
National Health Service (Primary Care) Act (1997)4, provide an opportunity
to test different ways of improving access to appropriate health care for
the most disadvantaged members of our society. Fifteen pilots are
targeting different groups of homeless people. Power et al. do not
mention this important development. We are evaluating the pilot sites'
progress towards meeting their objectives to reduce inequalities in access
to appropriate health care. The main aims of this study are to decide
whether Personal Medical Services pilots are meeting their organisational
objectives, and whether the new organisational models of primary health
care delivery improve access to appropriate health care for the homeless.
Anthony J Riley
Research Assistant
Yvonne H Carter
Professor
Geoffrey Harding
Senior Lecturer
Martin R Underwood
Senior Clinical Lecturer
Department of General Practice and Primary Care
St Bart's & the Royal London School of Medicine & Dentistry
London
E1 4NS
1 Power R, French R, Connelly J, George S, Hawes D, Hinton T, et al.
Health, health promotion, and homelessness. BMJ 1999; 318:590-2. (27
February.)
2 The Department of Environment. The Housing Act 1985. London: HMSO,
1985.
3 Great Britain. Social Exclusion Unit. Rough sleeping report by the
social exclusion unit. London: Stationery Office, 1998.
4 Department of Health. The NHS (Primary Care) Act 1997. London:
Stationery Office, 1997.
Competing interests: No competing interests