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New health standards aim to improve care of homeless people

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5194 (Published 06 December 2018) Cite this as: BMJ 2018;363:k5194
  1. Jacqui Wise
  1. London

NHS trusts and clinical commissioning groups must do better to improve the healthcare of homeless and other excluded people, says a new report that sets out standards for the best practice.1

The standards, which have been endorsed by 14 UK medical royal colleges and health bodies, recommend that health services for the most excluded people focus on compassion and continuity of care. These marginalised groups include homeless people, vulnerable migrants, sex workers, Gypsies and Travellers, and people in contact with the criminal justice system.

The standards build on a joint statement from the Faculty for Homeless and Inclusion Health and the Academy of Medical Royal Colleges. They call on clinicians at every level to work together to improve the healthcare of homeless and other excluded people, not just through medical treatment but through advocacy, interprofessional working, and engagement with the wider health system.

The report says that homelessness and other expressions of social exclusion are associated with extremely high healthcare costs coupled with appalling outcomes. For example, the annual cost of unscheduled care for homeless patients is eight times that of the housed population, and homeless patients are overrepresented among frequent attenders at hospital emergency departments. The average age of death among homeless patients is 43 years for women and 47 years for men.

The report includes specific standards for particular groups and settings, including primary care, secondary care, mental health services, inpatient psychiatric services, psychological services, substance misuse services, dentistry, podiatry, eye care, and palliative care.

The standards for primary care say that all patients should be offered drop-in clinics where their presenting problem should be dealt with first but that they should also be screened for dental problems; bloodborne viruses; smoking, drug, and alcohol problems; tuberculosis; and mental health problems. Efforts should be made to reach excluded groups to include them in vaccination programmes. GP receptionists should be the patients’ champion, ensuring that their most vulnerable patients can access care.

In secondary care, all patients presenting to emergency departments should be questioned about their housing status and all rough sleepers identified on arrival. All hospitals should have a system in place to support homeless people before they are discharged.

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