Homeless patient with lung cancer fears discharge to the streets

Every year, scores of people of ‘no fixed abode’ are admitted to Homerton Hospital for treatment – many without any contact details or transport, and with a catalogue of urgent needs.

But where they are to go on discharge is not always clear, leading to untold stress for those facing the prospect of returning to the streets.

For Paul Jarvis, 51, a personal tragedy led to a relapse into drug addiction and an extended hospital stay.

On the morning of November 19, 2016, the father-of-two woke up to find his partner Caroline Keane dead in the hallway of their Stoke Newington flat, having taken an overdose.

He said: “Everything was going really well. This came completely out of the blue.”

Mr Jarvis’s mental health took a sharp downturn. He began drinking heavily and taking Xanax, eventually falling back into using heroin and crack cocaine. In August 2017 he was evicted and began sleeping rough.

He said: “It was horrible, and scary sometimes, but nothing I hadn’t done before.

“I had this idea that everything would be alright, and it was those thoughts that kept me sane. But it was also those thoughts that deluded me, because it wasn’t the case.”

In March 2018 just after the week of heavy snowfall, he was admitted to the Homerton with broken ribs. A scan then revealed a shadow on his lung that turned out to be cancer.

Then in April he was admitted again for endocarditis, a bacterial infection in the heart.

Mr Jarvis said: “Every time I sneezed it felt like my chest was being ripped apart.

“I’d had my phone stolen in that period, and it was very hard to get hold of me because I was homeless.”

Between 2011 and 2013 a total of 288 people listed as of ‘no fixed abode’ were admitted to the Homerton with drug or alcohol-related problems.

The true figure is likely to be higher as some people, like Mr Jarvis, use old addresses to fill out the forms.

Initially a council officer told him to go after discharge to the Greenhouse, a multi-agency hub that offers housing advice. It was only when he refused to leave hospital that he was placed in a B&B in Waltham Forest.

But the place, he said, was “a building site. There was extensive work being done and dust everywhere; I was there for two days and started coughing up blood. They moved me up to another room which was harder for me to reach. I used to go to friends’ places to be away from there.”

After being re-admitted in July, he was given the name of a temporary accommodation worker at Hackney by the Citizens Advice Bureau. To date that named worker has not picked up the phone.

When he went to St Bartholomew’s Hospital for a heart operation, it was cancelled at the eleventh hour because his medical notes had not travelled with him. The surgeon, he said, went “ballistic” on discovering the Homerton had left him on blood thinners.

Once it had eventually gone ahead, the senior nurse and other staff at Barts tried to contact Hackney to find out where their patient was expected to go.

Mr Jarvis said: “On October 11, we called three times and I left messages. Absolutely nothing. No returned calls, to me or Barts Hospital.”

He has remained an inpatient at the Homerton and Barts while he waits for lung surgery, and is now in isolation with a suspected antibiotic-resistant bug.

In October he was visited by the discharge officer, who told him Hackney would not offer him anywhere else while he was in housing benefit arrears.

He said: “It keeps me up at night not knowing where I’m going to go. It’s frightening and I feel that I’ve been ignored at nearly every corner. My needs, current and future, haven’t been listened to properly.”

In May this year, a damning report by Healthwatch Hackney and City and Hackney Mind highlighted the link between homelessness and mental ill-health in the borough.

In its findings, it noted: “Hospital discharge is fraught with difficulty, with some patients discharged to unsuitable and unstable accommodation, increasing the risk of relapse and readmission.”

Temporary accommodation in Hackney

Last year the Gazette revealed the true extent of ‘hidden’ homelessness in Hackney, with 2,733 families housed in temporary acccommodation in September 2017.

The previous year, placing homeless households in B&Bs, hostels and private homes had cost the council £35m.

Many of these temporary homes are poorly-maintained or ill-suited to the needs of those living in them, resulting - as the Healthwatch report found - in the worsening physical and mental ill-health of their vulnerable tenants.

Single homeless people who contributed to the report cited a litany of issues, from bed bugs and cockroaches to drugs and prostitution businesses, in the places they were having to call home.

In response to Mr Jarvis’s story, a Hackney Council spokesman said: “As a result of the housing crisis, and the resultant lack of affordable accommodation within the borough and across London, we are sadly left with no option but to place some of the 13,000 people on our housing waiting list in temporary accommodation.”

“We are working with Mr Jarvis and the hospital to find a solution that meets his needs.”

“This happens all the time”: A local charity’s view

In previous years Mr Jarvis has worked for the Pilion Trust, which runs a winter shelter for homeless young adults as well as offering other support services for vulnerable people.

Chief executive Savvas Panas said the accommodation his old colleague had been offered was “an absolute quagmire”.

He said: “It’s an unfortunate place where they plonk everybody with drugs and mental health problems. He needs to be able to stay clean, and clean himself, and have a safe environment after surgery.

“If this is how they are treating a case like Paul’s, how are they treating those with less need?”

The charity, which has been running since 2007, deals with similar cases when homeless people are leaving hospital on a regular basis. Mr Panas added: “This happens all the time; it’s our biggest fight. Hospitals don’t link with social workers or benefits people. This is the most vulnerable type of person and all it takes is a phone call.

“The council’s remits and their definitions of what they are doing get woolier and woolier.”

A spokesman for Homerton University Hospital NHS Foundation Trust said the trust could not comment on individual cases, but said: “We always strive to provide the very best service for all our patients irrespective of their housing status.”