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Homelessness (End of Life Care)

Volume 635: debated on Wednesday 7 February 2018

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to make provision about end of life care and support for homeless people with terminal illnesses, including through the provision of housing for such people; and for connected purposes.

Not having a roof over your head at night and being homeless on the streets must be frightening—cold, lonely, depressing. To be seriously ill, as well as homeless, seems to me to be beyond frightening, with people wondering when they will die, when the pain will stop and whether anyone will care or even notice. Yet homeless people are dying on Britain’s streets, in our parks, in doorways or, if they are lucky, in ill-equipped hostels.

Although it is difficult to give precise figures on how many people are dying like this, the evidence we have from those working on the homeless frontline is that it is happening time and again. Homeless people are dying alone in pain in Britain in 2018. Let us look at some of the figures we do have. The average age at death of a homeless person is about 47 years. Homeless people are attending at A&E departments six times as often as people with a home. They are admitted to hospital four times as often, and they are staying three times as long.

I have spent a fair bit of time since last June’s election finding out more about this horror, thanks to amazing organisations such as Pathway, St Mungo’s, Hospice UK and Shelter, as well as some new work by the Care Quality Commission and some hard evidence and research by a range of academics, especially at University College London and the Faculty for Homeless and Inclusion Health. Listening to these experts and reading their work, including many interviews with homeless people themselves, I have been genuinely shocked about the wave of suffering right under our noses that we continue to ignore.

These same organisations are also doing incredible work to tackle this suffering. There are charities, GP practices, hospices and hostels around our country that are helping seriously ill homeless people, and showing what is possible when groups of professionals, volunteers and researchers come together and resolve to find solutions. Yesterday, I visited the Royal Trinity Hospice by Clapham common to see how one of Britain’s amazing hospices has reached out to homeless hostels in its area to share the excellent palliative care it can provide.

My first message to the House today is a positive one: we can give decent end-of-life care to everyone, including the most marginalised homeless people, if we resolve to do so. We can as a Parliament say that no homeless person in this country, whoever they are and wherever they are from, need die on our streets.

I do not believe that legislation alone can ever deliver the lofty aims that we in this House often seek. The Bill alone will not be a magical cure. To reach the goal of good end-of-life care for society’s most marginalised people, we will need better integration of services and new types of accommodation—most likely including specialist hospice hostels—and we will need to train staff, in the NHS, in homeless hostels and in hospices. But the law can help, not least as a huge catalyst for change.

My starting place is the current housing law that states that somebody has no right to housing if they are “intentionally homeless”. That is a curious legal phrase—cruelly curious—because, in truth, very few people deliberately aim to be on the streets. In my experience as a constituency MP, the vast majority of so-called intentionally homeless people want nothing more than a roof over their heads. However, this intentionality test has survived at the legal centre of most decisions on homelessness for over 20 years. Today, I am saying that the test should disappear for homeless people who are terminally ill. In future, if a doctor diagnoses a homeless person with advanced ill health and certifies that they expect that person to die within the next 12 months, that person would have an automatic legal right to appropriate housing, along with an appropriate package of care and support for their needs.

In discussing the detail for this simple idea with housing lawyers and palliative care experts, we soon focused on what would count as terminally ill, because estimating when someone is going to die is hardly an exact science. Moreover, we hope that good palliative care will extend life. The test we went for therefore comes from the best practice that GPs are being encouraged to adopt for all their patients—namely, that they should set up a palliative care register. GPs add patients’ names to their palliative care register if they expect that they are at high risk of dying within the next 12 months. The trigger I am proposing for these new rights for seriously ill homeless people would therefore use a system that most doctors already have.

In many ways, what I am asking for is only a small change, but I believe that it could have profound effects on the lives and deaths of many homeless people. It would force housing departments in councils across England, and their social services departments, to act without question. I think that the Bill would add to the excellent work of the hon. Member for Harrow East (Bob Blackman), who piloted his Homelessness Reduction Act 2017 through the House. His Act will force councils to think harder and longer about preventing homelessness in the first place, and my Bill would force them to prevent people dying without a home.

The original idea for my Bill came from my wife, Emily, who is a housing lawyer specialising in social housing issues. In discussion with Emily and other housing lawyers, it became absolutely clear to me that the existing law does not go far enough. Dying homeless people need a new basic and automatic right to housing and care that their GP can trigger and that the council cannot question. The right that I am proposing is for appropriate housing, so the local authority will not be able to fob the person off with a bed and breakfast miles away. Indeed, under the Bill, the authority’s social services department would have to get involved, too, by liaising with the GP and other parts of the health service to ensure that the right care and support is there.

I do not want to pretend to the House that implementing this will be easy. Homeless people can present with some of the most challenging health issues imaginable: a wide variety of mental health problems, drug and alcohol addictions and severe respiratory conditions. The evidence also suggests that the homeless often lose trust in people—in the hospital doctors who had no choice but to discharge them back on to the streets and in the family members from whom they have become estranged. Their past use of the NHS can make it difficult to patch together a full medical history. They might have self-discharged from hospitals to feed an addiction, or because the institutional setting proved just too much for them. But it is the complex nature of the health and social needs of many homeless people that demands that we act. If we truly want to end health inequality in our country, we have to start with end-of-life care for the homeless, because the people this Bill is trying to help are currently experiencing the worst health care and outcomes of any group in our country.

Homeless people can find it difficult or even impossible to advocate for themselves, but with three quotes I want to let three homeless people speak to the House now:

“Bad death is being friends around you when you’re passing away. Well, death is never really good, but at least it’d be better with friends know, someone to hold your hand and whatever.”

“I think when you’re homeless and you’re out on the street so long, you’re surrounded by grief and death and a lot of stuff. It makes you cold. It makes you unfeeling towards people.”

“End of life? What end of life are you talking about? I’m on the street and nobody cares about me.”

Friends, please support the Bill. Let us show that we do care.

Question put and agreed to.


That Sir Edward Davey, Ms Karen Buck, Bob Blackman, Sir Vince Cable, Mr Kenneth Clarke, Caroline Lucas, Norman Lamb, Kate Green, Wera Hobhouse, Geraint Davies, Christine Jardine and Mary Creagh present the Bill.

Sir Edward Davey accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 16 March, and to be printed (Bill 163).