The Homeless in London: Health Care (Hansard, 17 July 1991)

§ Baroness Hooper
My Lords, anyone not registered can attend a general practitioner and receive any treatment which the doctor considers is immediately necessary. He may also be accepted as a temporary resident. In addition, in central London there are a number of outreach schemes to meet the health needs of homeless people.

§ Baroness Masham of Ilton
My Lords, I thank the Minister for that reply. Is she aware that many homeless people of no fixed address never approach a GP? Is she further aware that those people may collapse from a heart attack, a stroke or from another serious injury or illness and then be taken to the nearest casualty department? As the Westminster Hospital may close, those people will be taken to St. Thomas's Hospital if they collapse in Westminster or Piccadilly. As that hospital comes under a different health authority, who would pick up the bill in such cases?

§ Baroness Hooper
My Lords, I agree with the noble Baroness that it is better economics for a patient to go to a GP for his health care rather than to be admitted to the casualty department of a hospital. That is why the initiatives to which I have referred in relation to the homeless in central London have been introduced. GPs are going to the crypt of St. Martin in the Fields and to St. Botolph's Church to provide help and advice to people with health needs.

§ Lord Murray of Epping Forest
My Lords, is the noble Baroness aware that over 50 per cent. of single homeless people do not register with a general practitioner? Is she also aware that a recent survey by the Policy Studies Institute shows that two thirds of single homeless people who have been in hospital are discharged without any consultation with staff? Will the noble Baroness do all she can to ensure that homeless people who are taken into hospital are, first, given advice on how to register with a general practitioner; secondly, that plans for them are prepared well in advance of their discharge from hospital; and, thirdly, that a leaflet is made available showing local hostels, DSS agencies, local GPs and other places where they may obtain help after leaving hospital?

§ Baroness Hooper
My Lords, counselling arrangements are in place in most hospitals to help people who are being discharged. In normal circumstances, to be registered with a GP a patient must be able to give a permanent address, but family health services authorities can and do adopt a flexible approach in respect of the address accepted, which can sometimes 191 be a hotel or a refuge. However, it is essentially the responsibility of the individual concerned to seek treatment in the first place.

§ Lord Thurlow
My Lords, does the Minister accept that a very high proportion of the homeless on the streets are schizophrenics? That being so, will she take steps to identify that very large section of potential patients requiring treatment and arrange for diagnosis and treatment?

§ Baroness Hooper
Yes, my Lords. In respect of people being discharged from hospital, arrangements are made to provide for contact after their discharge. In July of last year my honourable friend the Parliamentary Under-Secretary of State in the department announced a new initiative to provide services for homeless people in central London who are suffering from mental illness. Seventy-four new specialist hostel places are expected to be open by the end of this year and follow-on accommodation is expected to be provided through the Housing Corporation. That overcomes the problem of the need for an address, and medical care follows more easily.

Lord Winstanley
My Lords, is the Minister aware that very few of the children of families living in bed and breakfast accommodation are on a general practitioner's list? Does she accept that as a consequence a very small proportion of them receive their full course of immunising injections? Is that not a serious problem which demands the attention of the public health authorities?

§ Baroness Hooper
Yes, my Lords. As family health services authorities are responsible for the provision of general medical services for all the people living in the locality, family health services authorities are seeking to Provide the information that is required, in the languages in which it is required, so that it is readily available for people who need it. I reiterate that it is essentially the responsibility of the individual concerned to present himself or his children for treatment.

§ Lord Carter
My Lords, is the Minister aware that the report on the health of homeless families produced by the Health Visitors' Association and the BMA revealed a scandalous situation, particularly regarding the health of the children of homeless families? The report refers to infectious diseases, chronic diarrhoea, respiratory infections, scabies, and infestations of lice, fleas and bed bugs. Does the Minister agree that that is an appalling situation? What urgent action do the Government propose?

§ Baroness Hooper
My Lords, it is a difficult situation. The Government's reforms are intended to make the whole health service more efficient. There are a n amber of initiatives, to which I have already referred, in terms of primary health care projects. The Government further support a number of voluntary sector organisations which are doing very important and active work on the ground in this area.