Croydon adult homeless living in hostels need stronger support from GPs says report
Croydon GP practices need to enhance their services to adult homeless people with complex needs according to report by Healthwatch Croydon.
Our study, The Experiences of Homeless People using Health Services, published today, recorded the experiences of homeless people who were referred by the council into support hostels in November 2017. It found that adult homeless, particularly those with complex needs, were not supported by GP practices as well as younger homeless in similar accommodation.
Croydon has a significant number of homeless people in the borough. In the Director of Public Health Report 2017 (p30), 2,285 people were described as homeless or in temporary housing. Healthwatch Croydon, the local champion for better health and social care, focused on those who are homeless but are in support hostels.
Working closely with Evolve Housing + Support, a homelessness and community support charity based in Croydon, they spoke to 78 of their service users, which they describe as customers, about their barriers to accessing healthcare and equitable treatment. This represented 27% of their customers.
What they told Healthwatch Croydon raised the following issues:
Registration: A quarter of those asked had difficulty getting registered or did not get registered. It was primarily adult homeless who experienced the most difficulties, particularly if they had complex mental health needs. A proportion were registered outside the borough.
Access to services: Over a third of those asked could not say they had got access to services. Adult homeless are less likely to be able to gain access to services compared with young homeless people. This increases significantly if adult homeless have a complex range of mental health issues as well.
Being listened to: Two-thirds of those asked did feel that they were heard, but over a third said no, or gave an alternative answer, suggesting that they were only partially listened to. Once again adult homeless recorded higher numbers, although some younger people also felt they were not listened to effectively.
Involvement in decision-making: There was a significant number who wished to have more involvement in decision-making. Many younger customers felt they had been listened to and did not need more involvement in their care. However, a significantly number of adults with more complex needs felt not listened to and wanted more involvement with care decisions.
Given choices: Nearly half of the respondents said they were not given choices or could not say they were fully given choices over their care. This may be reflected by their understanding of their rights to have a choice.
The report makes the following areas for consideration by GP providers:
Stronger relationship between hostels and nearest GPs: With youth homeless services, local GPs were supportive in registration and service, this best practice needs to be carried on to adult homeless and particularly those with complex needs.
Training with working with homeless: GP surgeries based near of hostels could benefit from working with local homeless organisations to better understand client needs and train staff accordingly, including registration. They could also access free e-learning training modules from the Healthy London Partnership.
Effective signposting on GP registration: All hostels, GP surgeries, GP hubs and hospitals to have adequate information about rights of registration with staff able to signpost to relevant services at point of use. The Healthy London Partnership also have materials tailored for homeless people.
Jai Jayaraman, Chief Executive of Healthwatch Croydon said: “This report is a snapshot of the experiences of some of the hard-to-reach and unheard people. We are encourged to see good practice in terms of services for younger homeless. We would like to see this reflected in services for adult homeless, particularly those who have complex needs, as they report that they are not experiencing the same standard of care. Simple standard processes, such as registering homeless at GPs, training health professionals about working with homeless patients and encouraging the homeless to register for GP services would make a big difference to the care they receive”.
Dr Tom Chan, Medical Director of NHS Croydon Clinical Commissioning Group said: “We welcome Healthwatch Croydon’s report on the experiences of homeless people in accessing healthcare in the borough. We are committed to meeting the healthcare needs of this vulnerable group of people and will highlight the findings of this report to local GPs. We will ensure that GPs have access to the resources and guidance available to them produced by Healthy London Partnership’s Homeless Programme. The Healthy London Partnership is CCG-funded and has, to date, delivered thousands of cards to shelters, day centres, food banks, drop-in centres and other organisations across London reminding those who find themselves homeless that they have the right to GP services.”
Lee Buss, Deputy CEO at Evolve said: “We welcome this report from Healthwatch Croydon which serves to further illustrate some of the challenges for homeless people around access to healthcare services. In a recent survey of the street population as part of CR Zero 2020, the campaign to end chronic rough sleeping in Croydon by 2020, 21% of the people surveyed reported having either a mental health issue or brain injury that would make it hard for them to live independently and 44% reported not seeking medical help when they are unwell. Evolve’s approach to supporting our customers is centred on personalisation, flexibility and reasonable tolerance, and the survey of the street population indicates that this is the best approach for complex people – we urge partner health services to adopt a more personalised and flexible approach to working with homeless people, in order to give them a fighting chance at becoming independent.”