Homeless Patients Legal Advocacy Service
Organisation: Southwark Law Centre (SLC) and Guy’s and St Thomas’ (GSTT) Homeless Team
Location: London - branches in Lewisham and Southwark
Size: SLC have 26 FTE staff (mainly solicitors). Turnover is £1.5m
Populations served: Constitution enables SLC to take cases from across Greater London and focus is on South East London Boroughs.
Southwark Law Centre (SLC) provides specialist legal advice and representation, for those who cannot afford to pay for this in the areas of discrimination, employment, education, housing, planning and public law, welfare rights, asylum/immigration law, and support with the Windrush Compensation Scheme.
We prioritise the most complex cases which involve the prevention or the relief of homelessness, destitution, discrimination, and breaches of human rights
In 2020 (SLC) and Guy’s and St Thomas’ (GSTT) Homeless Team obtained funding from the Guy’s and St Thomas’ Samaritan Fund to provide advice and legal representation for homeless hospital patients. The project also involves providing training and second tier advice to the hospital’s homeless team staff members as, so that GSTT staff are better able to support this particularly vulnerable patient group.
By 2022 the funding had been picked up by the GSTT hospital Trust and a similar project initiated at Lewisham Hospital funded by the SE London Integrated Care Board.
The model is replicable in other acute health care settings. It could be rolled out on a sub regional basis.
Impact of the programme
Outcomes:
Patients who suffer from homelessness and other complicating factors will have better health outcomes through increased access to legal aid and onward support services
Frontline health professionals support workers will be better able to identify legal issues for homeless patients and provide earlier, more effective interventions
Measured by:
Quantitive data from SLC Case Management system and from the homeless team
Survey of hospital team members who had referred patients
Feedback from patients provided with advice and casework
Survey of hospital team members who had attended training or accessed consultancy support
Criteria for the hospital teams to refer a case to SLC include:
Unsafe discharge destination
Frequent hospital admission/attendances.
All of the clients referred to the Law Centre have been vulnerable adults with complex cases. Many have serious physical and mental health conditions. Many have been street homeless for a long time, and many are long term over stayers. We anticipate that many of these clients would not have been able to access legal representation without the homeless team referring them to the Law Centre. None of the clients were receiving adequate legal advice before being referred. In addition, it would be much harder for the Law Centre to work with these clients without the support of the health professionals in providing detailed referrals, medical records, evidence of homelessness and destitution, and other key documents.
The GSTT project independent evaluation showed the following key findings:
The project has enabled the hospital homeless team to support patients more effectively
Patients who would not otherwise have been able to do so could access quality assured legal advice from a single provider to address all their social welfare law needs
The partnership model of working helps patients to obtain better health outcomes
Use of high-cost hospital resources has been reduced.
GSTT Hospital data at the end of year one showed there was an 87% reduction in inpatient admissions and an 81% reduction in bed days in a sample of patients, comparing their use of hospital resources 6 months prior to support through the project and six months after.
Hospital data showed that support from the project enabled patients to make better use of outpatient appointments following discharge, showing a small increase in the take-up of outpatient appointments and reducing DNAs by a third. If this is considered alongside the reduction in inpatient admissions and reduction in bed days, it suggests that the project may enable patients to make better use of lower-cost health interventions.
How the programme was delivered
The funding from GSTT and from the SE London ICB (approx. £70,000 per post) enables SLC to employ two FTE solicitors who provide specialist legal casework and representation.
The casework is mainly immigration and housing with other issues such as access to welfare benefits being picked up by the wider SLC team. The SLC staff are authorised and regulated by the Solicitors Regulation Authority. The Law Centre holds the Law Society’s Lexcel which is its legal practice quality mark for client care, compliance and practice management and is assessed annually.
The two solicitors each have a caseload of around 30 cases at any one time.
Immigration matters can sometimes take several years to resolve if cases go to appeal. Home Office delays in even arranging initial asylum interviews adds to the problem. Although it will take time to reach a final successful outcome there are interim outcomes such as securing temporary accommodation to enable the patient to be safely discharged.
If an immigration application has been submitted the patient may be able to seek support from Social Services under the Children or Care Act. Knowing that someone is helping to resolve immigration status which the patient may have been trying to do for years can be beneficial to their mental health, in terms of decreased depression and anxiety.
In addition to the cases we actually take on the solicitors provide second tier advice and support for frontline health and social care professionals to assist them to progress cases. We provide this assistance in up to 100 cases per year.
Four training sessions per year are provided for the hospital teams covering areas such as Care Act assessments, basic overview of immigration law, NHS Charging, and support for those with No Recourse to Public Funds’.
Evaluations of the project were carried out in 2021 and 2022 by Vicky Ling Consultant.
Advice for others doing similar work
It is important that the casework is provided by a trusted and independent organisation. We act at all times in the best interest of our client which sometimes involves challenges to statutory bodies.
Immigration law very complex and can only be provided by a caseworker accredited at the correct level.
There are unfortunately unscrupulous providers of legal advice and it is not unusual for our clients to have seen up to 6 other practitioners over the years , often being charged for services and not achieving any resolution.
It is important to be able to provide an holistic person centred approach to the provision of advice. Many of the people we see have multiple legal advice needs. Because Law Centres generally provide a range of advice, immigration, housing, welfare rights and public law we can provide support across the range of areas.
For more information about the programme:
Sally Causer
sally.causer@southwarklawcentre.org.uk