Clutching morphine and sheltering in a bus cease: the NHS patients sent from hospital to the street

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Gripping a bag of morphine handed to him by hospital workers, Antonio sheltered at a bus cease, chilly and shivering, as he tried to work out what to do.

It was three days after present process gruelling surgical procedure to take away his testicular most cancers and the 36-year-old had been discharged from NHS care with nowhere to go.

He was clutching a referral letter for the council’s housing group, given to him by hospital workers. When he arrived at the council workplace, he defined he had been homeless for the previous few months – however was informed they may not home him.

“They asked me: ‘If you are in so much pain and trouble, why did they send you here?’ and I didn’t know what to say,” Antonio, whose identify has been modified, tells The Independent. He was given a piece of paper with a telephone quantity on it and informed to name the subsequent day.

It was now late in the afternoon and the Salvation Army’s homeless day centre, the place he would normally go for assist, was closed. He had no possibility however to flip round and prepared himself for a evening on the streets.

Antonio’s story is, tragically, not distinctive. He is certainly one of 1000’s of individuals throughout England who’ve been discharged from NHS hospitals into homelessness in latest years, many whereas nonetheless battling severe well being circumstances.

Data obtained by The Independent, in collaboration with the Salvation Army, reveals at the very least 4,200 folks have been discharged from wards to “no fixed abode” in 2022/23.

According to the figures, which got here from FOI responses from round half of NHS trusts, there have been one other 1,461 events that individuals have been discharged in this manner, however the knowledge doesn’t replicate whether or not these have been particular person circumstances or repeat patients.

The surprising statistics present patients have been discharged from a vary of wards, together with maternity departments, stroke wards and normal surgical procedure. Some had just lately undergone therapy for problems brought on by HIV.

These patients might find yourself in B&Bs, sofa-surfing or in non permanent lodge lodging. But many will find yourself on the streets. Government knowledge launched this month reveals 82 individuals who left hospital in England in the final 85 days have been recorded as sleeping tough in December 2023. That quantity stood at 100 in October final yr.

MPs have now referred to as on the authorities to “break the link” between tough sleeping and discharge from public establishments – comparable to hospitals, prisons and asylum seeker inns – as the figures give a harrowing snapshot into the homelessness disaster going through Britain.

Shadow homelessness minister Mike Amesbury warned these most in want are “falling through the cracks” as care and housing companies weren’t working collectively.

‘It was the worst night of my life’ – Antonio

Antonio grew to become homeless in the summer time of 2023 after splitting up along with his girlfriend and struggling to discover a new place to dwell. With nowhere to keep, he gave up his job as a machine operator in a manufacturing unit.

He quickly grew to become a common at a homeless shelter run by the Salvation Army. It was the workers there who sent him to hospital when he informed them he was experiencing swelling and ache in his testicle.

Before going in for his operation, Antonio had thrown his sleeping bag over a fence close to the native Asda, the place he had been sleeping tough for a number of months, to hold it protected.

He appreciated the spot as a result of it was simply distant sufficient from the metropolis centre for him to be left in peace. He most popular to sleep alone, away from others who might steal his belongings or assault him – one thing he had skilled in the previous.

However, after being discharged, Antonio was too ailing to climb over the fence and retrieve his belongings. “It was the worst night of my life,” he tells The Independent.

Antonio determined to sit at the bus cease till he might discover assist in the morning. He was in appreciable ache however didn’t need to take the medication he had been given in case he fell into a deep sleep and couldn’t hold himself protected.

“It was very, very hard, the pain. They gave me maybe 10 days’ worth of morphine but I knew I needed to be awake so I could get myself back to yhe Salvation Army the next morning,” he says. “God bless there was no rain, but it was not warm at all.”

He goes on: “If you fall asleep somewhere that people walk past you never know what will happen to you. I couldn’t get to the place where I used to sleep, where no one would see me, so I was just sitting there waiting. I survived till morning.”

Jillian Franks, venture supervisor at the shelter, was ready to step in when Antonio turned up the subsequent day. She says she contacted the council’s social companies group, who have been ready to assist the place the housing group wasn’t, and they discovered Antonio a B&B for 2 nights.

Antonio is now dwelling in a care house and has gone by 5 rounds of chemotherapy. Caseworkers have helped him declare advantages and he’s sure he gained’t be going again to the streets.

Patients launched after therapy for strokes, HIV and swelling on the mind

According to knowledge uncovered by The Independent, of the 4,196 folks discharged from hospital to no mounted abode in 2022/23, greater than a quarter – 27 per cent – have been readmitted as a affected person inside six months of their discharge.

Shockingly, the determine is probably going to be a lot larger as solely 98 of round 200 NHS trusts responded to requests for info. The figures are additionally probably to be an underestimate as, the place trusts mentioned the variety of folks was lower than 5, we counted that as only one affected person.

Recording a affected person as having no mounted abode acts as a good indicator of the variety of homeless folks being handled however it’s not a excellent file. Some homeless folks might give an outdated deal with, typically out of disgrace, which implies they gained’t be recorded in the knowledge. Likewise, some folks may be recorded as no mounted abode in the event that they got here into hospital unconscious or in chaotic circumstances.

The knowledge reveals that:

The Independent approached each NHS belief named in the statistics. Further figures from native authorities for the similar yr present 2,910 homeless folks have been referred to councils from a hospital A&E, pressing therapy centre or in-patient care. An extra 1,160 folks have been referred from psychological well being in-patient care.

According to latest analysis from the charity Homeless Link, 24 per cent of homeless folks surveyed mentioned they ended up on the streets after a latest hospital keep, with a additional 21 per cent discharged into unsuitable lodging.

Although the variety of these discharged onto the street is down from its peak in 2017/18, MPs are calling on the authorities to pledge that nobody will ever be discharged from hospitals onto the streets.

In a January letter sent to ministers throughout the authorities, coordinated by the All-Party Parliamentary Group for ending homelessness, 48 MPs mentioned the authorities ought to “break the link between rough sleeping and discharge from a public institution”. They talked about prisons and asylum lodging, in addition to hospitals, as releasing folks onto the streets with out assist.

Responding to this investigation, a authorities spokesperson mentioned “no one should be discharged from hospital to the streets”, including that ministers have been working “to make sure that people at risk of or experiencing homelessness have a place to stay”.

Mr Amesbury mentioned the Tories have been “forcing more and more vulnerable people onto the streets of Britain” and promised that a future Labour authorities would “deliver the biggest boost to affordable, social and council housing for a generation”.

An NHS England spokesperson says: “All patients experiencing or at risk of homelessness should be referred to a care transfer hub, with clinical teams identifying at-risk patients as early as possible.”

‘I was in hospital for seven months – when I came out I was homeless’ – Rosie

Rosie, whose identify has been modified, ended up homeless after a severe harm from a fall landed her in hospital for seven months.

The 40-year-old had labored as a finance skilled for a personal medical clinic earlier than her admission. She ended up staying in hospital far longer than anticipated after medical doctors found some pre-existing circumstances.

Unable to sustain with the lease on her flat, Rosie had nowhere to dwell when she was discharged and ended up in a lodge for 2 months.

Discussions round her housing choices began months earlier than she lastly had to depart, with a devoted hospital discharge group working with the native council to strive and discover a appropriate house for her as she was now reliant on a wheelchair.

Even with that help, the council struggled to discover her a house and referred to as in tech firm Beam to assist. Beam works to crowdfund cash for folks referred to them by councils and charities. They helped Rosie discover a appropriate rented property to dwell in, which was wheelchair accessible and close to sufficient to the NHS belief that she goes to for care. Crucially, they satisfied Rosie’s landlord to take her on as a tenant, regardless of her receiving advantages.

But, even then, Rosie had to spend two months in a lodge after being discharged earlier than she might transfer into her extra everlasting house.

Alex Stephany, the founding father of Beam, says: “There simply is not enough temporary accommodation or social housing around and so councils need to find ways of supporting people to enter the private rented sector where the vast majority of housing stock is.”

Priority given to pregnant ladies, the disabled and mentally unwell

With councils struggling to finance the ballooning prices of non permanent lodging, homeless folks referred from hospital can typically be turned away if they don’t seem to be deemed to be in “priority need” for housing.

Housing legal guidelines state that councils have a obligation to discover lodging for people who find themselves homeless however provided that they’re classed as in precedence want, comparable to pregnant ladies, a particular person with dependent youngsters, somebody with a incapacity, victims of abuse or these with extreme psychological sickness.

To qualify as “vulnerable”, a particular person have to be “significantly more vulnerable than an ordinary person would be if they became homeless”.

Sophie Boobis, at Homeless Link, says a lack of joined-up working between well being groups and homelessness companies was failing patients.

She says: “Essentially you have to be more vulnerable as a result of your illness, or more at risk of harm, compared to the average person experiencing homelessness.

“So the threshold for need can be quite high, especially as most people on the streets will be experiencing some sort of mental health difficulties and in many cases high levels of trauma.”

She provides that tips on homelessness well being should not being constantly carried out throughout NHS trusts: “I think enforcement would really help, as would a greater understanding of homelessness within the health services.”

Nick Redmore, director of homeless companies at the Salvation Army, says that, even when hospitals refer homeless patients to their native council, they may typically be turned away, leaving hospitals with little selection however to discharge them again onto the streets.

He says: “Forcing clinically vulnerable people to sleep rough can cause them undue pain and distress, reverse their recovery and be life-threatening. It also risks undoing the hard work of medical professionals and wasting NHS resources, as the high level of hospital readmittance shows.

“Despite the good intentions of hospital staff, these findings clearly show that the system is failing patients who are homeless. Living on the streets is no place for anyone let alone someone recovering from illness or surgery.”

Councillor Darren Rodwell, at the Local Government Association, says demand is outstripping provide for properties, including: “Councils are under mounting pressure to find suitable homes for an ever-increasing number of people and are doing the best they can under the current circumstances.”

He provides that extra help was wanted to allow councils to construct sufficient social properties for residents.

‘Some people come for help still wearing their hospital bands’ – Louis Juster

Some NHS trusts are attempting to discover a everlasting answer. At St Ann’s shelter in Westminster, 5 rooms can be found to home homeless people who find themselves discharged from Guy’s and St Thomas’ hospital. The lodging is funded by the NHS belief with help work supplied by the Salvation Army.

Louis Juster, who works at the shelter, says the centre demonstrated what can occur if there’s someplace “to catch those people” who’ve been failed by different companies.

One affected person at St Ann’s had been dwelling in a shed earlier than he was admitted to hospital with numerous well being problems, together with coronary heart failure, Mr Juster recounts. “He was not very well at all when he came here, to the point where he literally collapsed out in the courtyard out front. He was depressed for days on end sometimes, keeping to his room, and he had a couple of episodes of medication that were not quite right.

“Being here meant that he had people to talk to. It meant that when he did collapse, there were people around to call an ambulance and do first aid. I believe that on one of those occasions if he had still been in that shed, he would have just never woken up again. He would have died.”

According to analysis by the Museum of Homelessness, 1,313 folks died whereas homeless in the UK in 2022.

Mr Juster additionally works at a homeless day centre close to Oxford Circus, simply two stops on the tube away from St Ann’s, but the distinction is stark. “People come in relatively frequently – perhaps two or three times a year – with their hospital bands still on. They’ve been discharged perhaps a few days ago and they’ve already gone downhill to such a state that they need to go back in,” he explains.

Dennesse, the visiting nurse at St Ann’s, says patients come in with vary of diseases together with fractures, leg ulcers, pneumonia, frost chunk and diabetes. “There will be [illnesses] that are a direct result of rough sleeping and also things that are exacerbated by the rough sleeping,” she says. “One example of that is diabetes. There are also wounds from violence on on the streets.

“There was someone who was rough sleeping and someone stepped on them as a sort of power trip. One of his joints was hyperextended the wrong way.”

‘I was about to go back to the street – but then I was brought here’ – Charles, 68

Charles, 68, arrived at the centre in April 2023 after a four-week keep in hospital for untreated diabetes. Dressed neatly in a blazer and trousers given to him by the centre, he spoke to The Independent in St Ann’s lounge house – a small room with some sofas the place residents chill out and see the visiting nurse. The sitting room was close to his bed room, which he stored tidy – a wi-fi radio perched by his mattress so he might sit and pay attention to the information.

Charles had been tough sleeping in London when he started to get sick – his legs and decrease physique swelling up, with wounds and sores creating on his legs. “I was able to see a nurse at a homelessness day centre and they did my blood pressure and it was over 200, very high. They said I needed to go to the hospital immediately. When they saw me [the A&E doctors] they said no you are not leaving,” he explains.

Charles’s diabetes had induced different problems together with extreme blurred imaginative and prescient brought on by swelling behind his eye. He has since recovered his sight and when the time got here for him to be discharged from hospital, Charles defined to the workers that he had nowhere to go and he had no belongings to take with him.

“They said ‘There is a place, don’t worry’. They brought a cab and it brought me here. When I first came here I was so sick, I couldn’t do anything. I couldn’t even go to the kitchen to cook and one of the other men here, he cooked for me while I was not able to help myself.”

He provides sincerely: “These people, I will never turn my back against them, they helped me a lot”. Showing The Independent round the centre’s kitchen, he proudly opened a packed fridge filled with greens, which he eats to hold wholesome. He retains his prized packet of pounded yam in his cabinet and typically cooks his native Ghanaian meals for his fellow flatmates, he says.

He additionally has a care plan, printed out on a A4 piece of paper. A grid documented all the issues his caseworkers are serving to him with; acquiring a bus cross, registering for advantages, registering with a dentist, working to discover future lodging, amongst different issues.

“They are able to do all these things for me,” he says, gesturing to the sheet. “I was going to die – my situation was so bad. I had wounds all over my body – because I was sleeping rough. But they were able to help me. I will never forget them, never.”