Homeless people often ‘fall through cracks’ of health system

People in homelessness find the healthcare system difficult to navigate and often “fall through the cracks”, new research has found.

The peer-reviewed study, from Trinity College Dublin and published in the International Journal for Equity in Health, found a “high degree of fragmentation in mainstream health services impeding full access to healthcare”.

According to the research, health systems prioritise meeting their own objectives such as limiting costs and focusing on biomedical needs over social and mental health needs. Patients are expected to fit in with the schedules, locations, and culture of the health system rather than understanding and addressing full patient needs. As a result, patients with complex needs must seek health services elsewhere, such as specialist homelessness NGOs or they go without care altogether.

“When their care is effectively outsourced to responsive specialist practitioners and organisations the health system as a whole is blind to their particular needs,” the research found.

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The research is based on interviews with 12 people working on the frontlines of healthcare services in Dublin, ranging from doctors and nurses to social workers and senior healthcare planners.

“Patients lack pertinent information needed for future more adequate service planning. Incomplete information is also fed into high-level policy decisions, potentially leading to the de-prioritisation of the needs of socially-excluded populations,” the study found.

Dr Rikke Siersbaek, research fellow and research lead, said health systems must ensure accessibility for everyone, particularly those with the greatest difficulties in engaging with care. “Health services in Ireland are fragmented and often rely on individual practitioners with a particular interest in working with excluded people and independent NGOs to meet the health needs of socially-excluded populations who often fall through the cracks of the mainstream health system,” she said.

Dr Cliona NÍ Cheallaigh, associate professor in the department of clinical medicine at Trinity College and inclusion health consultant doctor in St James’s Hospital, said: “This study harnessed the experience and expertise of practitioners working in frontline services to develop a deep understanding of what we need to change in our healthcare system to ensure that everyone, no matter what their background, can get the healthcare they need.”

The researchers made eight key recommendations following their work, including the development of a national strategy to guide integrated co-ordinated health services to make the health system responsible for recognising and responding to social determinants of health with adequate funding and specific goals attached.