Health Justice Partnership blog 2/3: Southwark Law Centre with Guy’s and St Thomas’ Hospitals

Blog 2 in a three-part series on Health Justice Partnerships

For almost four years, Southwark Law Centre (SLC) and Guy’s and St Thomas’ Hospital (GSTT) have been working together to support homeless hospital patients by resolving immigration and housing legal issues. For an overview of Health Justice Partnerships, including benefits and top tips, read Blog 1 in this series.

Background

In 2016, SLC received a small grant from Pathway homeless healthcare charity to give legal advice to the embedded homelessness teams at GSTT and Kings University Hospital (Kings). It quickly became apparent that many of the homeless hospital patients had legal issues preventing them accessing accommodation, particularly immigration issues and difficulties navigating homelessness law. We realised that while providing advice to hospital staff was helpful, what was really needed was legal representation for the patients themselves. We also realised that collaborative working would allow SLC to reach and support some of the most in-need members of our community who often wouldn’t have the ability to seek out and access legal advice independently.

Project Development and Evaluation

In 2020 SLC received funding from GSTT’s Samaritans Fund and launched the project, allocating one full time solicitor to work alongside the GSTT and Kings homeless teams. The project involved taking on 30 complex legal cases for individual patients each year, delivering quarterly training on legal issues for hospital staff, and providing ongoing ‘second tier’ advice for staff on how to resolve legal issues for patients that could be managed without a solicitor.

An independent evaluation considered client and hospital staff feedback and hospital data, and found that year on year the project reduced inpatient beds days for patients by 81%. A reduction was also found in A&E attendances, and an improvement in attendance at outpatient appointments. The evaluator’s reports helped us to successfully make the case to the Trust to fund the project on a rolling basis, and the project is now part way through its fourth year.

Specialist Legal Support for Patients

Working together with GSTT, SLC has been able to reach and support extremely vulnerable members of our community. Many people with insecure immigration status try to live under the radar and do not seek out support until they become ill and have no choice but to present at A&E. The below are just a few examples of the patients we have been able to support through the project:

K’s story

K is from Liberia. He was referred to us following throat cancer which resulted in his voice box being surgically removed. He had to breathe through a stoma and required an electronic device to keep his airways clear. He was unable to speak and could not have additional surgery to fit an artificial voicebox because he did not have immigration status in the UK. Using very good quality medical evidence and supporting letters prepared by K’s medical team and the homeless team at GSTT we made an application for K to remain in the UK on medical grounds. We also flagged the case with the Home Office’s homelessness team. The Home Office agreed to prioritise K’s case due to his serious health conditions and he was granted leave to remain with access to public funds in a matter of weeks (an exceptionally quick time compared to normal Home Office decision making). Following his grant of leave the GSTT homeless team supported K to access accommodation and benefits. In addition, he has been able to access surgery to give him an artificial voicebox and he is now able to speak again.

T’s story

T is a British national and long term rough sleeper. He had fallen from a height and fractured his leg. The hospital had referred him to his local authority for a homelessness application, but the council had not taken any steps to assess or accommodate him for a number of weeks delaying his discharge. We began legal proceedings challenging their delay as unlawful and seeking an urgent interim injunction. The council backed down and agreed to accommodate T in mid 2022, and he has been off the streets ever since. This security has enabled him to engage with addiction services, start work and regain contact with his children.

F’s story

F is a Tajikistani national with complex post-traumatic stress disorder and psychosis. His mental illnesses resulted in him frequently banging his head on hard objects, removing his clothes and drinking his own urine. He was a failed asylum seeker with no immigration status. SLC supported him to make a new application for asylum based on his mental health issues, and the inhumane treatment he would face on return to Tajikstan as a result. This involved careful work taking F’s instructions and drafting a detailed statement whilst taking care not to cause him significant upset which would trigger self-harm. The doctor involved in F’s care provided a detailed report of his condition, his symptoms and his inability to control these without specialist medical care. SLC also supported the hospital in pushing for F to be provided with specialist supported accommodation under the local council’s Care Act duties, which allowed him to be safely discharged. F was granted refugee status in May 2023, and he reports the security of his new status has hugely helped him with managing his mental health as he finally feels safe.

Our Ongoing Work

The project, now in its fourth year, is funded by the GSTT Trust on a rolling basis.

We have supported 82 homeless patients with legal representation since 2020, and we have had only 3 applications refused in this time. This is well above normal success rates for immigration and homelessness applications. We directly attribute this high grant rate to the collaborative nature of the project, through the hospital homeless teams helping us to access highly vulnerable people, supporting them to engage with their legal cases and providing detailed medical evidence.

The project has been rolled out to neighbouring Lewisham Hospital, where Southwark Law Centre also provides a solicitor to work with homeless hospital patients, and this new project has just received funding for a second year.

There continues to be unmet demand and more patients than ever are presenting at hospital without secure accommodation. We are continuously looking at ways to increase funding and scale up the project to support homeless hospital patients in South East London.

Ruth Mercer
Solicitor
Southwark Law Centre