The reluctance of many homeless people to seek healthcare because they feel their health problems will remain undiagnosed or untreated is putting lives at risk, claims Tricia Hughes, director of The Big Issue magazine in Scotland.
Ms Hughes cites the recent case of 35-year-old Big Issue vendor Sammy Irvine who was taken by magazine staff to the accident and emergency department of a Glasgow hospital with abscesses on his legs. After a brief examination he was sent back to the hostel where he was living. Just 48 hours later he was rushed back into hospital, where he died.
"Homeless people are being given a second-rate health service and are dying as a result," says Ms Hughes. "The health problems faced by homeless people are horrific and the NHS is not geared up to dealing with them."
The Scottish executive's recent announcement that it is to appoint a health and homeless co-ordinator to champion the health needs of Scotland's homeless is welcomed by Ms Hughes.
"But, at the end of the day, it is just one post," she adds. "We will need an exceptional individual to take up this job if it is ever going to make a difference to homeless people dying on the streets."
The health and homeless policy co-ordinator's post is intended to help primary care trusts and health boards to develop strategies to meet the specific health needs of homeless people. The postholder will also be responsible for spreading good practice and creating training programmes.
An existing Scotland-wide homelessness/health network already brings together health workers who deal with the homeless - primarily from primary care trusts - and has been sharing good practice on an informal basis. The new co-ordinator role is seen as providing more structure to this approach, as well as giving more direct access to the Scottish executive.
Shelter Scotland, which has welcomed the new co-ordinator initiative, estimates that on any given night there are between 500 and 1,000 rough sleepers in Scotland, compared with a figure of around 1,200 rough sleepers per night across England.
Dr Laurence Gruer, a consultant in public health medicine with the Greater Glasgow health board, believes the number of rough sleepers in Scotland could be greatly reduced.
A 1998 health board survey in Glasgow found just 55 people sleeping rough in the city. Dr Gruer says the biggest cause of homelessness in Glasgow stems from the 6,000-plus people a year who are forced to stay in a hostel because they have no home of their own.
Recent figures reveal that 70% of Scotland's homeless who live in hostels are in Glasgow, adds Dr Gruer. Homeless hostel dwellers tend to be men (85%), some 60% of whom have severe alcohol dependency problems. A further 25% (75% of whom are aged 25-44) have drug dependency problems, mainly heroin addiction.
A high percentage of homeless suffer from depression, anxiety and panic attacks. The lack of a good diet often leads to gastric problems and many experience difficulty accessing the services of a dentist, chiropodist or optician.
Although many homeless are technically registered with a GP, this is usually in the area in which they used to live. In any case, they often find it difficult to make an appointment with a GP because of the chaotic nature of their lives, says Dr Gruer. Others find it difficult even to register with a GP, using a hospital accident and emergency department when necessary, which is often inappropriate for ongoing health needs.
In an attempt to improve access of services to the homeless, a new £1.2m city-centre facility in Edinburgh called Access Point provides housing advice, social services, benefits information and healthcare. A GP and practice nurse are available 8.30am-5.30pm Monday-Friday on an open referral basis. Funding for the centre was provided by Edinburgh city council, Lothian primary care trust and the Rough Sleepers Initiative.
In Glasgow, a healthcare team with the remit to deliver services exclusively to the city's homeless is being provided by the Greater Glasgow primary care trust. The team offers chiropody, dentistry, dietary services, physiotherapy, well woman services and psychiatric services. Funding has recently been identified to create a team of doctors, nurses and social workers to work in the city's hostels, specifically helping homeless people with drug and alcohol problems.
"Unless you deal with the drug and alcohol problems effectively you cannot help people extricate themselves from their homeless situation," says Dr Gruer. He adds that the health and homeless co-ordinator should be able to ensure resources are efficiently targeted rather than being frittered away by fragmentation and duplication.
