For the last 7 years we have captured the experiences our homeless clients were having when visiting our local hospitals. A common issue was being discharged as street homeless with Discharge Notifications that stated ‘Discharged to own home’, but with the listed address as ‘NFA’, ‘Street homeless’ or even simply ‘Care of Catching Lives, Homeless Day Centre’.
Many were taken by ambulances from Canterbury to hospitals in other towns and, once discharged, reported they had no choice but risk bunking the train back to Canterbury to return to their belongings left in tents, which meant potentially receiving a fine. In some cases people reported that they had decided to walk back. Many clients began turning down paramedic support for fear of this happening.
On one occasion a young male in his 20s turned up to our centre in an ambulance with hospital pyjama bottoms on. He had admitted himself due to suicidal feelings and presented us with a Liaison psychiatry action plan which stated: ‘presenting with suicidal ideation’, ‘voices told him to come to hospital for help. Plan- discharge from Liaison psychiatry team and homeless referral to charity- Catching Lives’. However, no communication had reached us before he appeared on our doorstep and it was immediately clear he needed statutory mental health support which we simply could not provide at our daycentre.
We began to speak to hospitals about our concerns, and it was immediately clear that those working on the wards (the ‘front-line’ staff) had enormous compassion and concern for those who were likely to return to the streets when they left hospital, and the vast majority were working tirelessly to try and avoid this. Many were going the extra mile, and, through their hard work and determination to help their patients, in most cases suitable support was being provided to people.
However, as Catching Lives exists to support those who ‘fall through the net’, we decided to make it our mission to do all we could to ensure that all homeless people receive the support they need to avoid street homelessness when leaving hospital. When speaking to hospitals we made sure to explain that our goal was to ensure better communication, awareness of issues, and collaborative working existed between us, the hospitals and others that were involved in supporting our clients such as the council and social services. The purpose of highlighting these issues was to help us work together constructively not simply to criticise and complain.
The first hurdle was the fact that the issue was simply not being recognised, after all if the NHS records were checked it would simply state these individuals were ‘discharged to own home’ as there was no way to record it any other way.
It was clear that many staff simply didn’t have the time to manage with such high numbers of patients with complex needs who needed the support of multiple services. Many did not have the time to contact these other agencies or simply didn’t know what support may be available to someone.
For example, a male in his 60s had attended hospital after a heart attack and when he arrived at Catching Lives staff immediately called the council. Their response was that he should “urgently make his way to the council for an assessment”. Once he did so he was immediately placed in emergency accommodation. Therefore, if the hospital had spoken to the council during the two weeks he was on the ward, he could possibly have gone straight from hospital to accommodation rather than being discharged with nowhere to turn other than a homeless day centre.
The turning point came when Local nurse Nikki Davies and local GP Dr Emma Hill offered their support to Catching Lives. On top of offering direct support to our clients at our daycentre they reached out to their many contacts within the local NHS hospital trust and CCG, including safeguarding and urgent care leads, and overtime many meetings were scheduled to discuss our concerns. Eventually other agencies, such as local council housing departments, joined these meetings and it was wonderful to see everyone acknowledging the gaps in provisions which could be tackled by working together.
During this time we also strengthened our links with the homeless adult safeguarding practitioner at the local hospitals and helped to educate local GP trainees by inviting them to spend a morning with us to learn about the support needs our clients have and have run workshops with trainee nurses at Canterbury Christchurch University. We also continue to work with General Practice staff in a bid to reduce the barriers our clients face when trying to access their services, for example difficulties booking appointments without a phone.
In 2021 the local CCG commissioned the independent health charity Pathway to conduct a needs assessment of local health services and their ability to support homeless patients. Whilst this report recognised that much good work was already happening it made several recommendations, including the need for improved planning around discharge of people who are homeless, improved co-ordination and communication between hospital and community services, and improvements to accommodation options for people discharged from hospital.
Shortly after this report, a pilot scheme was launched at QEQM in Margate to ensure a dedicated team, featuring a specialist GP, dedicated homelessness nurse and a housing specialist are on hand to identify people who are homeless, at risk of becoming homeless, or in temporary accommodation, and anyone else who finds it difficult to access health services.
We have been delighted to see the positive steps that so many are taking to improve services for the most vulnerable in our society and proud to have played a part in this. Thankfully issues such as those reported above are becoming less and less frequent, but we know the fight is far from over.
Staff and volunteers at Catching Lives will continue to support all homeless people who arrive at our day centre having fallen through the gaps in services; those who have nowhere else to turn.