Intended for healthcare professionals

Feature Homelessness

“I didn’t want to be known”: finding healthcare when you are homeless

BMJ 2016; 355 doi: (Published 08 December 2016) Cite this as: BMJ 2016;355:i6511
  1. Anne Gulland, freelance journalist, London, UK
  1. agulland{at}

Access to primary care is vital to prevent the health of homeless people reaching crisis point. Anne Gulland reports on how GPs can provide a good service

When she was homeless Gerry Dickson did not see a doctor for five years, and it was only when she collapsed on the street and was taken to the emergency department that she got some medical care.

Dickson now works for homeless charity Groundswell as a case worker and says her experience is typical.

“I didn’t want to seek help because I didn’t want to be known or to be found, and that happens a lot. Some clients can have very serious health issues as health is not their number one priority.”

A report by homeless charity St Mungo’s estimates that the annual cost of hospital treatment for homeless people in England is at least £85m (€100m; $107m) a year.1 The report said, “Failure to support homeless people to get the healthcare they need when they need it, before they require urgent hospital treatment, comes at great cost to the health sector, and for homeless people themselves.”

A survey of 2000 St Mungo’s residents in August 2016 found that in the past year one in four had had an ambulance called at least once and one in five had attended an emergency department at least once.

However, emergency departments often do not record patients’ housing status: an audit carried out by the royal colleges of emergency medicine and physicians found that only 52% of departments did so.2

Anna Sussex, a sister in the emergency department of the University Hospital of Wales in Cardiff, conducted an audit of what she calls “frequent flyers”: anyone who presents four or more times …

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