A second class ending - end of life care for people who are homeless

There is huge variation in the quality of care that people receive at the end of their life.

Homeless people face significant health inequalities: the average age of death is just 47 years. Their end of life care needs and preferences also differ considerably from the rest of the population.

We worked closely with the Faculty for Homeless and Inclusion Health, and draw on their research findings, to co-produce this discussion paper 'A second class ending: Exploring the barriers and championing outstanding end of life care for people who are homeless'. It follows up from our 2016 report 'A different ending'.

When we published ‘A different ending’, we also produced 10 short briefing papers on end of life care for specific groups. This included a short paper looking at end of life care for homeless people where we encouraged commissioners and providers to recognise and address their end of life care needs, and to take action to understand and meet the needs of homeless people in their local area.

As well as the Faculty for Homeless and Inclusion Health, we collaborated with other experts in end of life care for homeless people. Voluntary organisations such as Pathway and St Mungo's, GP practices, housing projects and hospices have also provided specialist input and case studies.

We intend this paper to stimulate cross-sector and multidisciplinary conversations and ideas, encourage innovation, and ultimately drive improvement to address the inequalities faced by this vulnerable and excluded group. There are many areas for improvement highlighted in this report which have the potential to address the challenges faced by homeless people and other marginalised groups.

Leading homelessness palliative care researchers, Dr Caroline Shulman and Dr Briony Hudson said: “Enormous pressure is currently being placed on hostels who struggle to support people with very poor health, due to a lack of alternatives. Options for place of care and multidisciplinary working are key to improving quality of life for people experiencing homelessness, especially towards the end of their lives.

We’re delighted to see the examples of good practice and joint working highlighted in this report, and there are many lessons to be learned from them.”

Professor Steve Field, Chief Inspector of General Practice, said: “As a GP, I have seen how the lack of appropriate and sensitive services can mean that homeless people are denied the compassionate healthcare, dignity and respect that they deserve at the end of their lives.

“What is encouraging, is that there are services and healthcare professionals who are working to address the barriers to healthcare that stop people whose voices are rarely heard from accessing the high quality health care they deserve.

“This report and the research it draws on make it clear that by working together, healthcare services and the wider system – such as housing, social services and the charity sector – have a vital role to play in improving the quality and co-ordination of care for homeless people as they reach the end of life. We have seen how collaborative and flexible working across traditional boundaries, as well as education and skill-sharing, provide a real opportunity to break down the barriers that prevent equal access to compassionate care for all.

“The conversations that need to happen, and that this paper will inform, have the potential to help shift the experience of homeless people with end of life care needs into a space where their circumstances do not dictate a denial of appropriate care.”