‘Streets of Shame: Homelessness and the NHS – a Tome of Tragedies’ says BMA report

Banner of the BMA on the march celebrating the 70th anniversary of the NHS on June 30th last year

THE BRITISH Medical Association (BMA) has published ‘Streets of Shame: Homelessness and the NHS – a tome of tragedies,’ in which homeless people and health workers tell a vivid tale. It reports:

‘For two and a half years Samantha Moss and her partner Clayton Bradshaw slept under the cold, stone arches of Nottingham’s Trent Bridge.

In the shadow of the ballooning wealth of two professional football clubs, on the edge of one of the country’s most well-to-do leafy suburbs, the couple survived ice and snow, witnessing regular criminal acts and abuse, with the wind whipping off the water each and every day.

Wandering through the streets of West Bridgford – where the average house price is more than £330,000 – to the homeless drop-in centre that eventually helped find Samantha and Clayton a home, it is hard to believe such hardship can exist.

But it soon becomes clear that their story is just one chapter in a tome of tragedies.

When 44-year-old Samantha, a mum of five, speaks to The Doctor at the Friary Drop-in Centre – which sits in the heart of the largely Victorian suburb, a single-storey building that has the feel of an old temporary school classroom – it is busy and bustling.

Volunteers with cups of tea and plates of food duck and dive in every direction, piled-up boxes of clothes and food packages seem to reach the ceiling in one corner and 80 or 90 people in varying levels of physical and mental distress – some chatting animatedly, some dabbing at wounds on their legs or slumped with head in hands – occupy chairs and tables, waiting for refreshments or much-needed advice.

Samantha has been one of the luckier of this group in recent years, having been found housing eight years ago, while still returning to the drop-in centre for help, advice and company.

But today, her eyes are full of the sort of worry most people never experience.

“I am being evicted out of my house in January; my landlord is selling up and we’ve been told we’ve got until then to find somewhere. I’ve been to see housing aid but there’s nothing for us at the moment.”

Clayton, her partner since those days under Trent Bridge, who has depression and anxiety, adds: “The landlords all want so much money up front – a grand up front, five hundred quid up front.

“We’re only on jobseekers allowance. We’d got settled. We’d been in this place for two and a half years so it’s really stressed us out.”

Samantha is warm, chatty and eloquent but can hardly bring herself to recall what life was like in what must seem like a different world, sleeping on streets, in parks and under bridges.

“It was a long time, it wasn’t nice. You see so many dodgy things. You don’t forget – it stays with you.”

And asked to look to an uncertain future, she says: “It doesn’t bear thinking about. The streets are getting worse, too. People are getting robbed and stabbed all the time. There’s more people out there by a lot than what there was and they are having a harder time.’

Clayton adds: “I didn’t get much sleep because she (Samantha) is a woman on the streets so I thought I needed to stay awake to protect her. It was horrible. It was stressing all the time. When it was snowing it was the worst. It was so cold.”

Every night there are scores of people in Nottingham alone, facing these sorts of realities. Just a handful of years ago the number of people sleeping rough was in single figures. Now, it’s likely to be dozens.

Brendan O’Connor, another regular user of the Friary, was homeless for 10 and a half years until being found a flat six months ago. “You just haven’t got a clue,” the 49-year-old says when asked what life is like on the streets.

“I’ve had my head kicked in, I’ve been robbed, I’ve been abused – I could go on about the bad stuff all day. There’s not much I haven’t seen – I’ve seen people I know die.”

These are stories familiar to Ann Bremner, the general manager of the centre which provides a GP, food and drink, assistance with administration, IT support and a warm welcome – 30 years ago when West Bridgford was a deprived area, far from the mecca for young professionals with well-paid jobs it is now.

“People don’t see them as part of the community,” Ann says. “They don’t see them as people like I do. Everyone has had a previous life before coming here, and very interesting ones.

“There is an ‘us and them’ mentality in society.’

“There are lots of professional people here too – it doesn’t matter what abilities you have, you can become homeless or you can turn to addiction, and that is just oblivion. Life is valuable and we always believe that people can change or that we can give them hope.”

New research reveals a society in which homelessness is growing rapidly and the interaction between homeless people and the stretched NHS is soaring.

Figures collected through a series of Freedom of Information requests reveal that the number of recorded visits to England’s A&E departments by patients classed as having no fixed abode has nearly trebled since 2010/11.

In some parts of the country the numbers have risen by five or six times – and at one London hospital trust, King’s College Hospital NHS Foundation Trust, numbers are 15 times higher now than they were.

But what are the driving forces behind homelessness and the resulting demand on the health service?

Ask anyone in Nottingham – or indeed any other city in the UK – and the answers are consistent:

  • The virtual abolition of council housing over the decades
  • cuts to public health services like substance and addiction services
  • lack of mental health provision
  • inaccessibility of GP services
  • fragmentation of the health and social care system
  • and rising prominence of new psychoactive substances like mamba or spice.

Perhaps most importantly of all is the obvious lack of housing or suitable beds in the community and the over-arching impacts of austerity politics.

Stephen Willott, a Nottingham GP who sees homeless patients at the Friary and is clinical lead for drugs and alcohol in the city, told about what help the patients he works with need.

“It tends to be a lot of stuff relating to their being homeless – it could be mental health, or they have terrible foot care, a lot of it can be sexual health issues or to do with drugs and alcohol. Sometimes there are things we can do there and then but often it’s about making a plan.

Dr Willott says: “Everything has become a lot harder in times of austerity, without doubt. There are fewer direct access beds around, some of that is political and the fault of decisions made by councils, and there are funding cuts – the drug and alcohol service for example has had a quarter of its budget slashed in the county and that has a knock-on effect. Things have got harder.

“It’s still a case of trying to encourage and educate primary care to be an appropriate response to people with complex needs.”

Nottingham GP Marcus Bicknell, whose surgery welcomes homeless patients and allows them to register with the practice address, cites £7.5m of recent public health cuts in the area as having a devastating impact.

Describing the patients he sees, Dr Bicknell says: “There are some incredibly extreme behaviours. In recent times injecting a combination of crack and heroin called a snowball or screwball into the groin is becoming a normal behaviour on the streets, which is frightening.

“And I have a patient who chopped his earlobes off on mamba when he was psychotic. You see these most bizarre psychotic behaviours unique to these drugs, and our knowledge and understanding is still evolving and emerging.

“Public health services are so easy to cut – you don’t see such easy decisions being made about cuts to transport or library services.

“Addiction services have been hit hard, and the impact of that is serious. All the cuts seem to be in health and social care – that just can’t be right. It has a massive impact upon addiction services and eventually homelessness,” Dr Bicknell says.

BMA public health committee chair Peter English said: “Homelessness involves a whole constellation of problems: poverty, debt, lack of support services in substance addiction and a whole raft of health issues.

“Cuts to public health services play a part: we see the reports coming through about how the budgets for public health have been spent on other things – the difficulty often is that in local authorities, public health budgets are supposed to be ringfenced but money can often be spent on things like transport or roads because it might help air quality, and core services like addiction services lose out.

“We need compassionate arrangements for people rather than punitive attitudes from government, who think people should just take responsibility and then ignore these areas. The politics of this is important”.’

The BMA’s report states: ‘The health and social care system, particularly the structures created by the 2012 Health and Social Care Act under Jeremy Hunt, is often the problem when it comes to the experiences of homeless patients – and resulting costs for the NHS and society.

‘A fragmented system – where social care and individual health providers fight for their contracts and protect their own pots of cash – is not conducive to collaboration or finding the best outcomes for vulnerable, or difficult, patients.’