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St James's is one of the hospitals trialling the scheme. Eamonn Farrell/

'It's about creating a system that's kind': HSE piloting scheme for homeless patients in hospitals

It comes as new stats show over 2,000 cases where a homeless person has been discharged from hospital in the past seven years.

A NEW SCHEME funded by the HSE will aim to improve the healthcare and supports offered to homeless people when they present to hospitals for treatment.

It comes as new statistics show that there were over 2,000 cases where homeless people were discharged from Irish hospitals over a seven-year period.  

Doctors say that due to the way the stats are calculated, this figure could be far greater while opposition TDs have said the HSE and Department of Health need to roll out effective outreach and after care services for homeless people upon leaving hospitals.

No fixed abode

In a parliamentary question, Minister Simon Harris was asked the number of patient discharges from hospitals in which they were discharged to no fixed address, i.e. homeless.

The query was referred to the HSE, which provided details on the numbers of patients discharged for each year from 2011 to 2017 who provided “no fixed abode” as their area of residence. Data for 2018 is not yet confirmed.

The numbers do not definitively indicate the exact number of homeless people who were discharged from hospital, as the numbers could indicate repeat cases.

The numbers rise over time before plateauing and falling again.

  • 2011 – 226 patient discharges where their address was listed as “no fixed abode”
  • 2012 – 247
  • 2013 – 232
  • 2014 – 448
  • 2015 – 435
  • 2016 – 335
  • 2017 – 343

Overall, this adds up to 2,266 patient discharges over this seven-year period where the patient listed their address as no fixed abode when leaving hospital.

The figures were released to Sinn Féin’s health spokesperson Louise O’Reilly. She told that health is a significant factor for those who are homeless.

“Health needs have to be addressed in tandem with housing,” she said. “You cannot treat someone’s health needs only to discharge them onto the street, inevitably their problems will recur and escalate because they do not have a roof over their head.”

Pilot scheme

The HSE has already sought to identify the particular challenges facing homeless people when leaving hospital, providing the funding for a pilot project to develop an approach and finalise a protocol that would address the specific needs of such patients.

Dr Clíona Ní Cheallaigh is an infectious diseases and internal medicine physician at St James’s Hospital. This pilot project is being initially rolled out at St James’s and the Mater Hospital in Dublin.

She told that official stats in this area do not paint a full picture.

“It’s much higher than that,” Dr Ní Cheallaigh said. “We’d often have cases where someone who is homeless will give an old address. Or you’ll have people giving the hostel they’re in as an address.”

She said that the HSE funding would go some way to create a coordinated method of providing healthcare tailored towards those who are homeless.

The physician said: “People who are homeless can often be really sick, and being homeless can make their illness worse.

It’s basic things. There was one man recently who had cirrhosis. He was staying in a hostel which was closed during the day. He wasn’t taking the tablets he was prescribed because he had no access to a toilet during the day. 

Dr Ní Cheallaigh said the pilot scheme was about ensuring that homeless people requiring healthcare are given it in a dignified manner, and offered the right supports when they exit the healthcare system.

“We’ve a multi-disciplinary team,” she said. “We aim to find the right place to discharge them. We meet with those who run the hostels in Merchants’ Quay, and the doctors and nurses they interact with. It’s about everybody talking to each other to try to get the best results we can.”

The physician said such a coordinated response is needed due to the complex and complicated needs that this portion of the population has. 

When a person presents in an emergency department who is homeless, the scheme will see them referred to this team where they can put the correct supports in place.

They also provide items such as toothbrushes, toothpaste, shaving cream and razors so that people have the chance to bathe. 

“It’s all about treating people they way they should be,” Ní Cheallaigh added. “People may feel ashamed that they are homeless. They may feel ashamed over an addiction, or over abuse they’ve previously suffered.

There hasn’t been a coordinated approach before. There’s been good practice, but it’s just about pulling that together. People are kind. But it’s about creating a system that’s kind. I hope we can roll this out nationwide in the future. 

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