Discharging a homeless patient from hospital raises ethical issues which are compounded when the patient is from outside the United Kingdom. This article begins with an extended case study of a 30-year-old homeless man from Lithuania describing his complex medical and social needs. It is best practice for all homeless patients to have their housing needs planned for prior to discharge, but this is made more difficult by the United Kingdom’s ‘hostile environment’ policy which creates a subclass of homeless people who are not eligible for support. This means healthcare professionals discharge patients back to homelessness, even when this is likely to adversely affect their health and dignity both directly and indirectly through impairing access to care for chronic conditions. Policies in health and social care which compel professionals to treat some patients with second-class care undermine the ethics of healthcare professions.
The UK’s 2014 Immigration Act aimed to create a ‘Hostile Environment’ for migrants to the UK. One aspect of this was the restriction of access to secondary care for overseas visitors to the UK, although it remains the case that everybody living in the UK has the legal right to access primary care. In this paper, we argue that the effects of this policy extend beyond secondary care, including preventing eligible people from registering with a General Practice (GP), although as an unintended consequence. This problem arises from misinterpretation of policy wording, misleading GP websites and gatekeeping behaviour from front-line staff, even though there are no grounds in the current guidelines or law to support this. Free access to primary healthcare among refugees and asylum seekers living in deprived populations is particularly important in protecting patient health, given the burden of ill-health in this population and the multiple barriers to accessing early intervention they face. The medical profession has a duty to communicate their rights to this patient group—their legal entitlement to access free healthcare, and the vital importance of doing so.
Purpose The authors’ interest in the discharge of patients with no fixed abode (NFA) arose through repeatedly seeing patients discharged back to the streets. In 2017, the Royal United Hospital (RUH) treated 155 separate individuals with NFA, making up 194 admissions. Given these numbers, the best practice according to Inclusion Health’s tiered approach to secondary care services suggests that the hospital should be providing a dedicated housing officer and a coordinated discharge pathway. As this is currently lacking, the purpose of this paper is to establish a Homeless Healthcare Team (HHT) and design a hospital protocol for the discharge of NFA patients with strong links into community support. Design/methodology/approach The literature review identified six elements that make up a successful HHT, which has provided the structure for the implementation of the authors’ model at the RUH. Findings Along the way, the authors have faced a number of challenges whilst attempting to transform the model into a reality, including: securing funding; allocating responsibility; balancing conflicting priorities; coordinating schedules; developing staff knowledge and challenging prejudice. The authors are now working collaboratively with invested parties from the third sector, specialist primary and secondary care health services and local government to overcome these barriers and work towards the long-term goals. Originality/value Scarce literature exists on the practicalities of attempting to set up an HHT in a District General Hospital. The authors hope that the documentation of the authors’ experience will encourage others to broaden their horizons and persist through the challenges that arise.
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