Homeless people should not be “penalised” by being discharged from health services if they miss appointments, draft guidance says.
Services should also consider making appointments longer and moving homeless people up waiting lists, according to the National Institute for Health and Care Excellence (Nice) and Centre for Homelessness Impact (CHI).
The guidelines aim to improve access to health and social care in England and Wales, and are aimed at councils, commissioners and providers of services, health and social care professionals, homeless people and their families.
They acknowledge that people experiencing homelessness are to varying degrees disadvantaged, with outcomes that are considerably worse than the general population.
Do not penalise people experiencing homelessness for missing appointments, for example by discharging people from the serviceGuidelines from Nice and CHI
They are often unable to access services because of barriers such as rigid appointment systems, short appointments, long waiting lists, siloed services, cost of transport and their experiences of discrimination, the guidelines say.
They say some services prevent people from accessing care again or dish out financial penalties if they miss an appointment – a “major problem” for homeless people.
Services should “show flexibility and understanding” and provide alternative ways of accessing care to improve outcomes, they recommend.
The draft document says: “Do not penalise people experiencing homelessness for missing appointments, for example by discharging people from the service.
“Consider seeking specialist help such as peer supporters or independent advocates to support the person to attend appointments and re-engage with care after missing appointments.”
It also recommends that services consider moving people up waiting lists for health and social care appointments, taking into account “that they may need higher levels of support and have disadvantages, including the risk of premature death”.
And commissioners should consider reducing caseloads and lengthening contact time for practitioners to sustain engagement.
People without an address should be able to register with a GP, the document says, noting that people were sometimes refused registration if they did not have an address or ID.
But the guidance also recommends that services be taken directly to people experiencing homelessness, in non-traditional settings such as the streets, in hostels and day centres.
And providers should consider having “open door” services, where people can self-refer, to reduce the likelihood of someone becoming homeless again due to unmet health and support needs.
It said there is evidence that people reported positive outcomes when they were able to develop a trusting relationship with a provider who paid attention, showed interest and had time.
However, many people reported experiencing discrimination and feelings of distrust, which led to reluctance to engage.
The draft guidelines are under consultation until November 3.