Annual Report: 1998
West London Initiative on Single Homelessness

People sleeping rough have an incidence of a range of physical health problems two to three times higher than average. The 1996 report by Shelter "Go Home and Rest" found that compared to the housed population homeless people's injuries were 4 times more likely to be due to assault; that asthma was twice as common; and epilepsy 4 times as common. In another survey, active tuberculosis was found to be 200 times the national notification rate and rough sleepers between 45 and 64 have been found to have mortality rates 25 times higher than the general population. Homeless people also do not have the facilities to look after themselves when unwell and medical attention is often delayed resulting in complications even for common and minor illnesses. The same report by Shelter found that homeless people had twice the rate of infected wounds and that these infections were twice as likely to need hospital admission.

"Homelessness is a health problem because G.P. and primary health-care services function best where patients have a fixed permanent address, and because living in temporary accommodation complicates continuity of care" (Smith, 1993; Hogan, 1995). A 1995 survey (NHS HAS. op cit.) found that only a quarter of GPs (and four per cent of fundholders) would fully register a homeless person seeking treatment. One specialist housing association reported that in eight months, one of their hostels had 43 admissions to hospital, but had still been unable to arrange a G.P. for the residents. A 1992 study (Wake, 1992) found that homeless street drinkers had particular difficulty accessing services and often only received detox. treatment when admitted to hospital following an accident or other health crisis, but were then discharged without further support or referral. Homeless people find it difficult to adhere to often rigid appointment systems.  The 1996 report by Shelter "Go Home and Rest" also found that just 30% of the homeless attenders of A&E were known to be registered with a G.P, but it is estimated that up to 63% could have been. They compared this with a registration rate of 97% in the general population and this has important implications for homeless people's access to health care. It separates them from the rest of the population.

At the Roof, our aim is to provide an environment in which homeless people feel at ease in obtaining help and advice from health care professionals.We aim to provide a high standard of service and make the surgeries attractive to all guests. We achieve this by treating our guests with dignity, by being non judgmental and giving them time to talk through their problems. We also try to reduce unnecessary bureaucracy which many homeless people find intimidating when asking for help. Although the help we offer is limited by factors such as the length of time our guest stay with us, the unavailability of certain drugs and the complexity of the guests' problems,  in the short term we hope to be able to deal with common medical problems. Feeling relaxed and secure; being able to enjoy good food; regain some self respect, after a hot shower, change of clothes and haircut and being able to forget for a while the pressures of living on the streets, also improve our guests' mental and therefore physical health, so that if they have to return to their former environment they can hopefully deal with problems a little more easily. In the long term we intend that our guests will find access to health services easier. This change is achieved both by increasing the self-confidence of guests in requesting services to which they are entitled, and increasing awareness of homeless people's problems amongst health care providers in West London and elsewhere.

Several guests had outpatient appointments and several were given letters for a G.P.  We were also able to make contact with the community health services working with Brent rough sleepers initiative and their own nurse saw some of the guests for treatment and arranged follow up. Contacts with others in the field are invaluable. Arranging follow up for guests without an address is extremely difficult but is helped by contacting those who work with them throughout the year. Useful background information can also be obtained from them.