Every year, someone who is homeless is 60 times more likely to visit A&E than the general population. Not only do homeless people tend to have poorer quality of health, they often struggle to get access to the NHS through other routes like GPs, as most registration forms require an address and ID. This means going to A&E can be a homeless person’s only way of accessing medical care. But we all know navigating A&E can be challenging at the best of times. So what are some of the extra challenges homeless people might face, and what support is in place? A recent episode of Homeless Link’s Going Beyond podcast revealed some answers.

To be going to A&E, it’s got to be a bad day already. But for a homeless person, they’re likely to have many other things going on that will make the whole experience a hundred times worse. First of all, they probably don’t have anyone to go with them, and may have had to leave behind a pet who they might be worrying about. Then there’s getting there, which may involve walking long distances or trying to get some form of public transport, all whilst feeling unwell and probably hungry and tired. They may also need to bring their possessions with them, as they will have nowhere to keep these whilst they’re gone.

Wait times at A&E are long - generally over 4 hours - and during this time some homeless people who might struggle with addiction may be going through withdrawal. Neurodivergent individuals may also struggle, as waiting rooms tend to be noisy, bright, and chaotic: a perfect recipe for sensory overload. On top of all of this, many feel an element of fear due to the judgement and stigma they have experienced already, and are unfortunately likely to experience in an A&E environment where everyone is generally tired and stressed.

As a result of these added challenges, the self-discharge rate for homeless people is very high. This means many are leaving A&E’s before they have been seen or accessed treatment. The problem with this, as mentioned earlier, is that most homeless people struggle to use other NHS pathways to get medical care, and are unlikely therefore to receive any help at all.

So what support is out there for homeless people trying to deal with A&E? Sam Dorney-Smith, who was interviewed on the episode of Going Beyond, works for the charity Pathway, which is helping to improve access to healthcare for homeless and other ‘inclusion healthcare’ populations. Local NHS trusts and hospitals can work with Pathway to put in place Homeless and Inclusion Health teams within hospitals, specifically designed to help guide vulnerable individuals through the healthcare system and ensure they can access the care they need. Each team consists of a range of healthcare professionals and other experts, such as housing specialists. They are able to advocate for a homeless person's needs, especially where they may be complex and involve several issues, and help that person to engage with health services. They also work to ensure a homeless person is not discharged back to the street, but rather has a safe place to go and recover once they leave hospital.

There are nine Pathway teams set up around the UK, with several based in London, and the number growing each year. However, there are currently no Pathway teams anywhere in Cambridgeshire, despite the high numbers of homeless people in the area and a major hospital and medical campus located in Cambridge. Here at Ferry Project, we support our clients with accessing healthcare and registering with GPs, but there is no telling how many other homeless people currently slip under the radar and are still struggling to get the help they are entitled to. Hopefully in the future the NHS will expand their partnership with Pathway, and we will see some teams in Cambridgeshire.