Medical royal colleges and homelessness charities call for doctors to receive mandatory training in keeping homeless patients off the streets

The Royal College of Physicians (RCP), along with seven other medical royal colleges and homeless charities, has called on the Government to urgently address the needs of homeless people treated in the NHS.

The organisations made their call in a collective response to the government’s consultation on the Homelessness Reduction Act (HRA), which includes a duty to refer homeless patients in Accident and Emergency departments to their local housing authority.

Since its implementation in 2017, it is still unclear whether the HRA’s mandate that hospitals must refer homeless people on, is having any real benefit. Anecdotal evidence suggests implementation is at best patchy, with most frontline staff receiving no training at all about the duty to refer.

The RCP’s call to government along with The Royal College of Midwives, Royal College of Nursing, Royal College of Psychiatrists, Royal College of Obstetricians and Gynaecologists, Crisis, Pathway and Doctors of the World included:

  • Collect and publish actionable data on the implementation of the HRA (2017) to get a clear understanding of whether the act is working and, if it is not, what needs to change.
  • Provide mandatory training resources for staff subject to the duty to refer. Such training should include:
    • how to identify both homeless patients and those at risk of homelessness
    • how to approach the subject with patients and gain consent
    • what information to include to provide a useful referral.
  • Tackling wider structural barriers, such as a lack of affordable housing options, and funding for local addiction and alcohol support services, which make it much harder for local authorities to support individuals into sustainable housing.

Homeless people visit A&E at 60 times the rate of the general population, and they are much more likely to have multiple long-term health conditions. In 2010 it was estimated that homeless patients cost the NHS £85 million a year. Since then, the number of recorded visits by patients of no fixed abode to A&E departments in England has almost tripled.

Professor Andrew Goddard, president of the Royal College of Physicians said:

“We were really excited when the Act was introduced but the government needs to know that it isn’t being fully applied.

“This is mostly due to the lack of training in hospitals, making it incredibly difficult for doctors to know where to refer homeless people on to, or how to identify those who may be particularly vulnerable to rough sleeping.

“We know that before people become homeless, they tend to have more frequent interactions with the health and care system. This means the NHS has huge potential to identify and treat homeless patients and prevent those at risk from becoming homeless in the first place.

“The government’s focus on our homeless population is certainly welcome, but we now need to see words become actions.”

This year The Royal College of Midwives (RCM) published new guidance for midwives on supporting pregnant women who are homeless or at risk of becoming homeless. It was launched in March at Ingleside Birth Centre in Salford by the Mayor of Greater Manchester, Andy Burnham. It is designed to help midwives and maternity support workers (MSWs) to better spot the signs of homelessness and pregnant women who could be at risk of becoming homeless.

The guidance recommends midwives ask women about their housing situation, if they feel a woman is at risk, at least four times at certain points in their pregnancy – first appointment with the midwife, at 28 weeks, at 36 weeks and on discharge after birth.

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