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Case Study – Paul

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 will be publishing a series of case studies of people we have worked with; people who can often get lost in the net.

For more information about the conference click here


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?

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