Hospitals talk about the revolving door, patients who are admitted and then discharged only to reaper in A&E. In some cases this is caused by the sheer speed of through put, in others it is the lack of adequate support services at home and in some cases it is the lack of a home.
Homeless patients cost the NHS eight times as much to treat. Homelessness is one of those social problems that is everyone’s problem and no one’s problem. Everyone thinks it is a housing problem just a case of ensuring there are sufficient beds in hostels and council flats. Every one that is except the Housing department who point out that homeless people typically have multiple problems which are beyond their remit. People living on the street often have drug and alcohol problems. Understandably a hostel won’t provide a bed even for the night to someone who is drunk or under the influence of drugs. The staff have to consider the safety of other residents and alcohol and drugs are often associated with aggressive even violent behaviour. A high proportion of young people on the streets have been in care, in prison or in the forces which means they are known to other agencies but not necessarily still receiving support from them. They may also have mental health scars as a result of their experiences prior to ending up homeless. Many homeless people left school without qualifications severely limiting their job prospects and a significant proportion have difficulty reading and writing.
Once in hospital it is understandable that staff would want to fix the medical problem and discharge the patient as quickly as possible even if this is back on to the streets and even if it means that it is only a matter of time before they are back in A&E in a worse condition than before. So this is a clear case of the need for a multiagency response prior to discharge.
Local Authorities and PCT’s have in many parts of the country jointly funded “re enablement services” for older people which provide short term intensive support on discharge motivated by a desire to prevent bed blocking and unnecessary readmissions. So there is a model in place the problem is that in the current financial climate there is a very strong temptation to think short term, stick to core business and argue that it is someone else’s responsibility.
Blair McPherson is a former Director of Community services his latest book is called Equipping Mangers for an Uncertain Future published by www.russellhouse.co.uk