The London Network of Nurses and Midwives in Homelessness is organising a conference in May 2016.  The theme is ‘How Safe is the Safety Net?’. We will be looking at how the current system works with vulnerable women; migrants and those with complex needs.

In the run up to the conference, we have profiled three case studies of people we have worked with; people who can often get lost in the net. See below:



Serena is 24, and has learning disabilities. When we first met her she had 2 children who had been taken into care. Serena had been in foster care herself, but had left her foster care placement at 16 to be with her boyfriend, who then abused her. This led to a series of unsafe relationships. Her current partner was an older man who used heroin and crack.

Serena came to London from Manchester after losing her local authority accommodation as a result of rent arrears which had built up due to benefit sanctions and loss of housing benefit. She and her current partner said that they were being threatened in Manchester and could not return there.

We saw Serena first on a street outreach shift.  She was 36 weeks pregnant, begging outside a London supermarket along with her partner, and a dangerous dog. They said they got more money begging than from benefits.

Serena was pregnant when she left Manchester, but her team in Manchester did not know this. Apparently she had made threats to previous Social Workers, and had been ‘lost to follow-up’. No alert was put out on Serena. Enquiries at the Local Authority also revealed that she was considered ‘intentionally homeless’.

In London she had no local housing connection. Relationships with enforcement teams on the street in London had also broken down very quickly on account of difficult behaviour.

Serena is actually one of the lucky ones. She came into contact with an outreach health care professional who immediately referred her to the local safeguarding team, who then provided a swift response. The professional then worked tirelessly to join the dots in terms of pooling information. Serena was also fortunate that the local London borough agreed to house her, although she only accepted this after her partner was coincidentally arrested and imprisoned. Serena gave birth safely, but her baby was taken into foster care.

And now?  Serena is in a homeless hostel bed, but needs a period of intensive trust and relationship building, assessment of her cognitive state, trauma counselling, assistance with contraceptive choices and long term support to make positive choices. Will she get this? With services stretched to the limit, and Serena’s history, it is unlikely that she will get the level of support required, and she will probably slip through the net again.

At the conference we will be asking what we can do to make the net good enough to catch her.  How can we raise the profile of people like Serena? Should there be a troubled individual’s initiative like the troubled families initiative? How can we help?



Paul previously lived and worked legally in the UK for many years, but for the past 14 years he has been a visa overstayer. He has had 1 application and 2 appeals to stay in the UK on Human Rights grounds turned down. Paul does not want to return to his country because there is nothing for him there – his family are all in the UK. He has not accepted the offer of being returned voluntarily.

Certain tabloid newspapers really do not like Paul. However Paul is known to the Home Office, and they have not made any attempts to detain or deport him when he reports to immigration every six months as required.  Some may say that the Home Office are ‘allowing’ Paul to stay.

Paul is 70 and destitute. He has deteriorating chronic health problems that have led him to be in hospital 4 times in the last 2 years. After one ITU stay (for ketoacidosis), he was turned down for by 4 GP practices, as he lacked a residential address, or adequate ID. Fortunately a mainstream practice well known for supporting homeless clients did eventually register him.

Paul sleeps on buses and in churches, and uses day centres to eat. Although he needs daily support for his health, his transient lifestyle make this extremely hard to deliver. Paul appears to be deteriorating, and has been recently turned away from a night shelter because his support needs were too high. At the same time, repeated referrals to No Recourse to Public Funds teams have found that he does not currently have care needs.

Homeless health care professionals both in and out of hospital will be familiar with Paul.  Frustratingly, they meet people like Paul on a regular basis. Professionals are left in the unenviable position of trying to plug the gaps, and willing these people to go over the care needs threshold so they can get the help they obviously need. Nobody is denying the immigration status of these people, but if the Home Office don’t step in, the end result is that health care professionals watch them deteriorate on the streets.

At the conference, we will be discussing how best we can help Paul.  Should the Home Office take responsibility for people like Paul who have multiple health needs? What is the role of health care professionals? Where is the safety net?



Vincent is 46, and has had problems with alcohol for as long as anyone can remember. He also suffers with mental health problems, hears voices and has tried to commit suicide 7 times. Vincent has never been taken on by a Community Mental Health Team as his problems are seen to related to his  substance misuse.

Vincent also has a history of short prison sentences for petty crime and anti-social behaviour. His last short sentence followed 8 months of relative stability living independently in private rented accommodation. Vincent was then placed on remand for an alleged harassment charge. Whilst on remand for 3 weeks he missed a rental payment, and was evicted. Vincent was discharged from prison homeless. He tried to access more accommodation in the private rented sector, but failed as he had no deposit and no references.  He spent the next few months alternating first sofa surfing and then rough sleeping.

Vincent also has a chronic distressing skin condition. Unluckily (or luckily)  this period of stress and homelessness exacerbated the condition, and he had to be admitted to hospital for a period of systematic treatment. Once in hospital Vincent stressed that he would rather go back into prison that face another night on the streets, and was willing to re-offend to achieve this.

Vincent was supported by a hospital discharge team to present at a Local Authority with a prepared priority need case, and was granted temporary accommodation immediately.

Sadly, we all know people like Vincent. Not easily categorised; not easily housed or helped.  But in great need.  Many people experiencing short sentences are discharged homelessness, and many of these have multiple vulnerabilities. How can this revolving door be stopped? Is it time to have homeless teams within prisons?

At the conference, we will be discussing how best we can help Vincent.  Should the Justice system ensure that people like him are never discharged homeless? What is the role of health care professionals? Where is the safety net?