London Pathway

 

Big Issue vendor André Rostant speaks to key figures in London Pathway – a project to give homeless people appropriate healthcare whilst using ex-homeless people to facilitate it

“The NHS is set up to be comprehensive, universal, and free at point of care regardless of the ability to pay,” says Dr Aidan Halligan, the passionate chairman and mouthpiece of London Pathway, a charity that seeks to radically improve the treatment homeless people receive within the health system.

“But the poorer the patient, the more expensive the cost of treatment and the worse the outcomes,” he adds, “which can be seen in how rough sleepers’ average age of death is in their mid-40s.”

Breaking the Cycle

But as Dr Halligan says, “The homeless do not die for lack of a house.” Trapped in a cycle they are more likely to suffer mental and physical illness, and the effects of drug and alcohol misuse. They are four times more likely to arrive at hospital, where staff under pressure may thoughtlessly take and destroy their clothes or possessions, discharge them to recuperate at a home they don’t have, or treat them shabbily simply for being homeless.

Teamwork

Based at UniversityCollegeLondonHospital, The London Pathway provides hospitals with a team of a specialist GP, two nurses and a Pathway care navigator. The team searches out homeless patients admitted to hospital and ensures clinicians treating them are aware of any issues arising from homelessness. For example, some clinicians working with intravenous drug users are reluctant to administer pain relief drugs. “Having a doctor on the ward who knows about opiate addiction means the consultant or surgeon has advice from someone who knows for example that they would have a very high tolerance, needing more to get the same pain relief effect,” says Pathway chief executive Alex Bax.

The care navigator particularly builds a relationship with the patient, initially ensuring basic needs such as clothing, books, or pay cards for access to television, phone and internet while in hospital, but also establishing with the patient their next steps after hospital, and discussing benefits, social care, and housing.

The one essential qualification for care navigators is that they have personally experienced homelessness. Dr Halligan says: “Even the most compassionate nurse cannot at times bridge the lack of trust with homeless people, because they’ve been in places no one else has been.” Enter the care navigators, with their first-hand experience and understanding. “The amount of trust that’s engendered is phenomenal, and once we’ve got homeless people’s trust we can start getting them back to where they need to go,” he says.

As trained, paid Pathway employees, care navigators are also role models for homeless patients that challenge the assumption homelessness is a one-way, downhill journey, and that there are jobs where their skills and experience are valued.

The Price of Dignity

That assumption is certainly shattered by Stan Burridge, now 47, who spent a childhood in and out of care institutions and decades sleeping rough. Now at Pathway, he provides research, guidance and promotes patient involvement. “I am able to contribute to something that will become a benchmark for homeless care in the future,” he says of his work. “It means a lot to me.”

While patient dignity and empowerment are the kernel of Pathway’s philosophy and success, it was only by putting an economic case that UCLH was swayed. “We showed that it cost this hospital eight times as much to treat a homeless person as a non-homeless person,” Dr Halligan says. The potential savings to all hospital trusts make adopting Pathway “a no-brainer.”

Tears

One of Pathway’s key benefits is the relationship between staff and patients. “Staff joined up to do a job like this, to help the poor and most needy, but at times they are too overwhelmed by money and targets.” Pathway, Dr Halligan says, has helped staff to “rediscover their lost values”; to “get their tears back”.

Ultimately, the Pathway team seeks nothing less than to see professional homeless support teams an integrated part of Britain’s health team.

 

Health