Background: Homelessness is a local, national and global issue. The homeless experience “physical, mental and social” 1 problems and many are deeply involved with substance misuse. Despite the aims of the NHS to supply “good health care to all” 2, the homeless find difficulty in accessing health services.
Aim: Do the homeless have equitable access to health care?
Method: Review of white literature by searching MEDLINE, CINAHL, PsychINFO, EMBASE using the keywords homelessness, ‘and’ equity, ’and’ primary care, ’and’ stigma . The internet was searched using the same keywords. Grey literature recommended by Dr J O’Neill and librarians was also reviewed. Service learning visits to organisations in Liverpool, Chester, Birkenhead and St. Helens. An ex service user was interviewed informally, in order to gain a case history.
Results: The homeless face numerous barriers in accessing healthcare. Stigma, complex health problems and no address are just a few reasons for the low levels of registration at GP surgeries. Additionally, other needs such as food and warmth take a higher priority than confronting poor health. Despite this, progress has been made in primary care with more mainstream general practises caring for homeless patients, and the installation of general practices dedicated only to homeless healthcare. Homeless outreach programs targeting severe mental illness are effective, yet are excluding individuals experiencing anxiety and depression. It is evident the inverse care law continues to exist.
Conclusions The homeless exhibit complex medical problems which are not being resolved. The barriers preventing equitable access needs to be addressed. Doctors must be urged to maintain professionalism and not act on stereotypical impulses. Furthermore, a greater emphasis in “multi-agency cooperation” 3 is required, to ensure the full health potential of a patient is maximised.