A partnership that fights for homeless people to secure accommodation for treatment after leaving hospital has been shortlisted for the London Homelessness Awards.
Southwark Law Centre and Guy’s and St Thomas’ NHS Foundation Trust’s Homeless Health team have been shortlisted for the LondonHomelessness Awards for their innovative Homeless Patients Legal Advocacy Service.
The partnership project began in January 2020 and has since provided crucial support to homeless patients who once discharged from the hospital have no place to go.
From a clinical perspective, the risk of discharging patients into the insecurity of homeless living cannot be overstated. Melu Mekonnen, the housing lead in the hospital’s multidisciplinary Homeless Health Team, pointed out that in normal circumstances “once a patient is ready for discharge, they go home and carry on treatment in the community.”
For those patients who had no fixed address, or whose immigration status meant they had no recourse to public funds, it became difficult to continue life-saving treatment outside of the hospital. Whether it was having no place to store vital medication such as insulin, continuing a patient on dialysis, or even attending outpatient appointments, “clinicians were finding it really difficult to discharge” them. Not only did hospital staff find it difficult to fulfil their duty to homeless patients, but it also increased strain on both A&E services and bed space at the hospital, as patients’ conditions naturally worsened as they spent time on the streets.
Mr Mekonnen acknowledged that what was missing from the Homeless Health team’s otherwise holistic support for patients was legal advice.
After realising this, the team at Guys and St Thomas’ reached out to Southwark Law Centre. Mr Mekonnen explained “we did so because as a charity, the Law Centre has its clients at the heart of its work rather than making profit, meaning their support is sustainable.”
After securing funding from Guy’s and St Thomas’ Charity, the two organisations began advocating for homeless patients, taking on 21 complex cases within their first six months, exceeding their initial target by 40%. Van Ferguson, a solicitor at the Law Centre, explained that “the partnership works to secure accommodation for patients on discharge. This necessarily calls for time-intensive work to be done to resolve patients’ legal status to secure accommodation on discharge. An important element of this is using evidence from their hospital admission to prove a patient’s right to settled status, or their right to access public funds.
Patients, be they EEA Nationals or non-EEA nationals with no legal status and therefore no recourse to public funds, may have been living or working in the UK for 25 years. But without any documents to prove it they are excluded from gaining employment, accessing benefits or housing. There is a real danger that we are seeing an iteration of the Windrush scandal, especially in relation to long resident EEA nationals.”
Since brutal cuts to legal aid in 2013 decimated the scope of work Law Centres can take on, Mr Ferguson highlighted how the Service “bucks the trend” in the legal sector. “We dovetail with Melu’s team as a sort of fifth emergency service. We know time is of the essence due to the comorbidities and health needs patients face, and we normally have about six weeks to progress their case before they are discharged.”
While Mr Ferguson recognised that the service so far has just seen the “tip of the iceberg”, it has had a transformative impact on patients. 88% of hospital staff said that the Service has led to better outcomes for patients, and Mr Mekonnen agreed that “we have seen remarkable results, such as avoiding discharge delays, a decrease in A&E attendance amongst this cohort of patients, and a really high increase in attendance at outpatient appointments.”
If successful at the London Homelessness Awards in October, the two organisations will use the money to expand and grow the Service, so that “more homeless patients can be referred to a solicitor at the Law Centre.” Both Mr Ferguson and Mr Mekonnen however agree that systemic change is needed to address the deeply rooted exclusion of vulnerable homeless patients from living securely and accessing healthcare in the community.
“We need more integration of services,” Mr Mekonnen says, “you have to approach different services individually to fix one patient’s situation.”
For Mr Ferguson, the creation of a “legal advice desert” due to cuts, but also the technological complexity of accessing welfare support or immigration status encountered by this vulnerable and marginalised group of people who, in his experience are largely digitally illiterate, means that they have become excluded.
“Our immigration system presupposes that people have a house, have evidence of residence, and can follow complex instructions while using expensive technology. Coupled with a lack of legal aid, people have to wait until they are severely ill to engage with Melu’s team, essentially it is only a matter of luck that they engage with this service. If we want to say we live in a healthy democratic society with an effective legal system, everyone needs to be considered when these systems are created and operated, particularly the most vulnerable.”
For now however, the Homeless Patients Legal Advocacy Service has been rightly recognised by the London Homelessness Awards for its innovative, empathetic role in giving those people critical legal advice. By addressing this previously unmet need, as Mr Mekonnen acknowledges, “Southwark Law Centre are sustaining people’s lives.”
The London Homeless Awards, taking place on 14th October at Union Chapel, is being run in partnership with the Evening Standard’s Homeless Fund. To find out more visit: https://lhawards.org.uk/