Sir (Kingston and Surbiton)
(LD)
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 lonely...no friends around you when
you’re passing away. Well, death is never really good, but at
least it’d be better with friends around....you 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.
Ordered,
That Sir , Ms , , Sir , Mr , , , , , , and present the Bill.
Sir 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).
