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Homeless people face inequalities with end of life care, says CQC report

03 November 2017

Homeless people face considerable inequalities when it comes to end of life care, a new report by the Care Quality Commission (CQC) has found.

The paper, published by CQC and the Faculty for Homeless and Inclusion Health, found that the average age of death for homeless people is just 47 years, and their end of life care needs and preferences differ considerably from those of the rest of the population.

Voluntary organisations such as Pathway and St Mungo's, GP practices, housing projects and hospices also provided specialist input and case studies for the report, which aims to encourage cross-sector conversations and improvements to address the inequalities faced by this vulnerable and excluded group.

Leading homelessness palliative care researchers, Dr Caroline Shulman and Dr Briony Hudson said:

“Enormous pressure is currently being placed on hostels who struggle to support people with very poor health, due to a lack of alternatives. Options for place of care and multidisciplinary working are key to improving quality of life for people experiencing homelessness, especially towards the end of their lives.”

“We are delighted to see the examples of good practice and joint working highlighted in this report, and there are many lessons to be learned from them.”

Professor Steve Field, Chief Inspector of General Practice, said:

 “As a GP, I have seen how the lack of appropriate and sensitive services can mean that homeless people are denied the compassionate healthcare, dignity and respect that they deserve at the end of their lives.”

“What is encouraging, is that there are services and healthcare professionals who are working to address the barriers to healthcare that stop people whose voices are rarely heard from accessing the high quality health care they deserve.”

“This report and the research it draws on make it clear that by working together, healthcare services and the wider system – such as housing, social services and the charity sector – have a vital role to play in improving the quality and co-ordination of care for homeless people as they reach the end of life. We have seen how collaborative and flexible working across traditional boundaries, as well as education and skill-sharing, provide a real opportunity to break down the barriers that prevent equal access to compassionate care for all.”

“The conversations that need to happen, and that this paper will inform, have the potential to help shift the experience of homeless people with end of life care needs into a space where their circumstances do not dictate a denial of appropriate care.”

Speaking in response to the report, Antonia Bunnin, Director of Hospice Support and Development at Hospice UK, said:

"We look forward to exploring the ideas shared in this thoughtful paper. “A second class ending” provides valuable insights on the complex barriers that prevent many homeless people from experiencing good care at the end of life. We agree that a “concerted collaborative approach” is needed to  remove these barriers and to champion an equality-led approach.”  

“Hospice UK is working with Homeless Link and other partners to better understand how end of life care providers can address the needs of homeless people, and identify effective practice examples, such as those mentioned in the paper. We will be producing some tailored resources in early 2018 to support hospices, other health professionals and commissioners in ensuring high quality support for homeless people."

To read the full report visit A second class ending: Exploring the barriers and championing outstanding end of life care for people who are homeless

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