Commenter Angharad discusses Kevin Rudd’s homelessness white paper which didn’t get much discussion because of its timing, but deserves some because of the importance of the issue. -MB
A few days before Christmas, Kevin Rudd launched a white paper on homelessness The Road Home with far less fan fare than the climate change white paper a few weeks earlier.
The white paper was, on the whole, well received by the homelessness policy community [disclaimer – I was close to the action on this one]. It sets out a strategy and identifies targets like “halve overall homelessness by 2020” and “offer accommodation to all rough sleepers who need it.” It’s been signed off by COAG and has a substantial increase in funds. So far, so good and it has as a better chance of succeeding than anything currently in place.
But the Australian Medical Association is not happy and says it won’t work. In particular, they don’t like this commitment in Chapter 3:
Under the National Partnership on Homelessness, state and territory governments will implement a policy of ‘no exits into homelessness’ from statutory, custodial care and hospital, mental health and drug and alcohol services for those at risk of homelessness.
The AMA says this can’t work and the President is reported to have said “doctors would discharge patients even if they had no place to go or risk banking up an already stretched system.” No matter that the impact of homelessness on an already ill person’s health is to be more severe than other! What the AMA has failed to do is to think through the problem and in the process has bizarrely argued that the hospital system should only be for people with acute needs. (Tell that to the cosmetic surgeons!) Now, discharge someone into homelessness and there’s a fair chance they will be a repeat customer in the not to distant future.
In fact, the AMA should have welcomed the White Paper with its focus on prevention of homelessness in the first place. It’s well known that street homeless people “overuse” casualty departments because that’s all many of them can access in the way of health care. And well known that the ill-health of homeless people is exacerbated by the homelessness, whether it be respiratory ailments or mental health or like one guy I met recently on the Town Hall steps who had chronic leg ulcers that required him to elevate his legs for lengthy periods – difficult to achieve when you are sleeping rough. If we can prevent someone ever getting into that situation in the first place, the health system will be a whole lot better off.
Instead we got a knee jerk reaction and the only public bagging of a significant advance in homelessness policy by an organisation that should care about homelessness but had nothing positive themselves to offer. What they are implying is that there is nothing you can do about homelessness so just ignore it. Disappointing.
“What the AMA has failed to do is to think through the problem and in the process has bizarrely argued that the hospital system should only be for people with acute needs. (Tell that to the cosmetic surgeons!) Now, discharge someone into homelessness and there’s a fair chance they will be a repeat customer in the not to distant future.”
The AMA hasn’t argued that “the hospital system should only be for people with acute needs” at all. They’ve pointed out that acute cases are the admission priority within the public hospital system and that “bed-blockers” (inpatients who don’t require acute care but don’t have an appropriate post-discharge facility to go to) are a perennial systemic challenge. As I understand it, they’re saying that the Government’s policy paper is deficient on any transparent remedy for this and that it won’t “work” without it.
Sounds like a reasonable proposition to me – one that could do with a constructive response.
Could you break down for us where the funding is going ? Specifically how much new building will occur?
Is there a timetable for the completion of some portion of the new housing?
I can understand the less than sympathetic of the Dr’s Association as well though-they will be left to cop the abuse from others whose relatives may receive less than optimal care when critical care resources are diverted to housing the indigent and consumers.
You can see the headlines now – ” Car accident victims die in corridors as homeless occupy beds!”
Do you really think it is reasonable for hospitals to become the dumping/ resting/ rehabilitataion compound because the housing and mental health care depatmenst can’t get their acts together?
The problem needs long term thinking not more turf wars between competing departments.
I imagine it would be quite frustrating, for doctors who care, to be represented by Rosanna Capolinqua. The game is always about her personal plans to stand for a seat in parliament on behalf of the Liberal Party and what she says about anything has to be seen in that context.
It is fantastic that something is finally being done about homelessness and the medical fraternity has a big role, as has Centrelink. The harsh breaching regime on welfare recipients introduced by Howard needs to be scrapped. I believe that part of the governments proposed changes have already been blocked by the opposition just when the dole queues are doubling and homelessness likely to skyrocket.
Geoff, “Sounds like a reasonable proposition to me – one that could do with a constructive response” – actually, that’s what the whole white paper is about and it received a constructive response.
No-one is saying that from the 1st of January 2009, hospitals or any other institutions should be a dumping ground for homeless people. It is absolutely true though that people who leave any institution and go straight into homelessness are likely to turn up again in another part of the system – with massive costs to themselves and to society. Fixing the problem will be cost-effective. But you can actually go a long way to fixing it by stopping people becoming homeless in the first place. There are plenty of preventative actions that can be taken, for instance working harder to keep people housed in the first place. An example is a a mental health support service that assists people with severe mental health to stay housed and 2 key outcomes: reduction in hospital admissions and retention of housing.
It’s also true that hospitals and other institutions could do better case planning and coordination with people they assume are homeless or at risk of homelessness and have a strategy in place when the person leaves. Prisons in particular could do this much better (or in fact, do it at all in most States).
Murph “The problem needs long term thinking not more turf wars between competing departments.” couldn’t agree more. I encourage you to read the White Paper. The solution is partly housing, but housing alone won’t fix homelessness. Violence plays a big part of the homelessness experienced by women and children. Family break down is a major contributor to youth homelessness. I don’t think we should just give, say, a 16 year old a flat and say – problem fixed, not homeless any more. Rather, it’s more effective to work with the young person and their family to look for a solution that means the young person is safely accommodated with support, often with their family if issues can be worked out.
Having said that, there is a swag of money for housing in the National Affordable Housing Agreement- not as much as many would have liked but still an improvement. The White Paper is a policy paper so wouldn’t normally have detailed expenditure.
http://www.homelessnessaustralia.org.au/site/mediacentre.php
“Homelessness Australia provides informed, incisive public comment on homelessness and related issues and reflects the views of our members”
For more info about homelessness in Australia, check out this site, you could access the files on the right of the home page to get relevant material and just to give you an idea here’s an excerpt from the ‘Its not who you think it is” file.
“FACT: One in every 42 children under the age of five accessed a homelessness
service with a parent or guardian in 2006-2007.
FACT: On any given night, 450 people across the country are turned away from
refuges because every bed is full.
FACT: The single largest group of people who experience homelessness are
women escaping domestic violence.
There is no “typical” homeless person. Children, women, families, young people
and the elderly were among the 189,000 Australians – 69,000 of them under 18 -
who used homelessness support services in 2006-2007.”
This is one Rudd Government initiative I wholly support. I have no doubt that on my low income if I wasn’t living in a rural area with relatively cheap rent, but in one of the big cities I’d probably be homeless.
Its utterly disgraceful, but expected, that the Libs would block the removal of Centrelink’s breaching rules so heartlessly introduced by the Howard Government. So how are Xenophon and FF voting on this?
Like most other issues, I guess homelessness isn’t monolithic. There are people who desparately want a proper roof over their heads and a “normal” life, then there are the rough sleepers. There was an article in the AGE about them the other day. I suppose we are supposed to go “tsk, some people just can’t be helped” but what if there was a kind of rough sleeping accomodation – I don’t know – something more open and less enclosed to address the fears of enclosed spaces such people have. I guess that might leave the authorities open to accusations of allowing shanty towns – it’s a problem.
It is an odd statement from Dr Capolingua. There is a point about avoiding consequences to public hospitals to be made, as Geoff has above, but she has made it with her customary callousness. I cannot think of a situation where an inpatient has been discharged to a situation thought to be unsafe EXCEPT where they were competent to make a decision and discharged themselves against advice. The same is not true for Emergency Department stays but most departments have a full-time person managing the safety of discharge destinations, often a physiotherapist or OT but with social work backup.
Her point about a hierarchy of need is, as quoted, neither true nor well judged for public consumption.
Helen, a good point that there isn’t an homogenous group of people who are homeless. Even within rough sleepers, there are those who are chronically homeless and those who are rough sleeping because there is no alternative but they desperately want to a home. There’s some really successful models of aged homeless accommodation – in Melbourne Wintringham hostels does a great job of providing aged care for older homeless. Rudd announced an increase of capital funding for one aged care facility for older homeless a year for the next four years which is a start. They are expensive to build and the normal capital grants program for aged care isn’t enough when the clients don’t have any $$ assets they can bring!
Thanks Angharad
i totaly agree with the project and the sentiment that accompanies it, far too little has been done to address this issue of late. When i worked in detoxs i found few processes as disspiriting as exiting clients into homelessness. However i think that the Govt is on a hiding to nothing if they think that they can implement a no exits to homelessness from drug and alcohol services. far too many exits from detox and rehab are too sudden for any planning to take place.
Excellent post, Angharad, and full of insight. It seems to me that Australia would be admirably well positioned to eliminate or at least greatly reduce homelessness. Has any thought been given to a low-cost semi-rural hospice system so that people at risk of exiting hospitals into homelessness can be placed in a lower-cost non-acute care environment which provides for their basic needs and prevents the future problems Angh. describes? Given Australia’s geo- and metropolitan layout and a culture already predisposed to socially-provided medical care, this seems doable, and the savings as Angh. points out are obvious.
Helen and A. are quite right: there is no such population as “the homeless” — there are eight or twelve or twenty subgroups which all commonly experience homelessness as a symptom of a greater problem, whether it’s mental illness, domestic violence, substance issues, or other. By treating the subgroups discretely (and esp. by early treatment of the more easily treatable) you can reduce the aggregate over time, freeing up more resources for the more difficult and expensive subgroups.
It can be done, and it should be done. Good luck to you Angharad as you seem personally involved in advancing solutions.
I’ve noticed a definite veering to the Right by the doctors’ union. Listening to the shrill comments that greet every initiative by the Rudd government, you’d swear it was the 1940s and Labor planned to bring in some kind of NHS. You’d think a government that is pumping large amounts of money into the health sector (instead of taking it out like the Howard Government) would get the odd thumbs up from the AMA. But understanding the professional upper-middle-class Tory is never easy.
I hope there’s a strong emphasis on mental health treatment in the government’s policy. Inceasing funding for mental health – nationally – is actually one of the things Morris Iemma can be justly proud of.
Doesn’t it feel good to have a government that actually cares about things like homelessness?
While I agree 100% about Capolingua as a public figure, I could understand the sentiment of just about anyone employed anywhere in the hospital system – I’m speaking just as a consumer but – I can quite understand that they’re so stretched and so stressed and so underfunded and so short of resources, as well as attracting people who are violent / drugged / under the influence of alcohol, that being asked to come up with an administrative solution to the homeless might be seen as the last straw. It’s not just callousness. Like public transport and education, it’s just decades of bloody government neglect making people stabby.
Just got to read this, a bit late. I’ll echo JPZ’s comments, and commend you for the post.
Just one note: cosmetic surgery is also often acute surgery. Ask a burns victim or the parents of any child born with a cleft palate.
You’d think more lobby groups would learn from the Conservation Foundation about lobbying techniques. More often than not, when the government comes out with an initiative on the environment, ACF doesn’t spew bile and say: this is pathetic and doesn’t go nearly far enough. They generally congratulate the government for moving in the right direction. They now have a minister inside the government to show for it. One of the things people who continually attack Peter Garrett for being a sell-out don’t understand is how his style was honed at ACF. I’d describe that style as being a grown-up and not chucking a tanti once a week. And I’m willing to bet that when he quits politics he’ll have a lot more to show for his efforts than the current leadership of the AMA.
If I were a doctor, I’d be upset about my compulsory fees going to that closed-shop of a Liberal attack machine at the moment.
GB- There are no compulsory fees to the AMA. They are a voluntary organisation that vehemently denies being a union. The functionally compulsory organisations are the colleges, who usually keep their collective mouths shut in such situations.
I stand corrected, Dr S. I’ve obviously got my wires crossed. I had somehow gotten the impression that membership in the AMA was mandatory, that it was necessary for a doctor to be registered.
I don’t agree about them not acting in a similar way to a union – except that the AMA is noisier and more powerful than most unions….and not subject to legal harassment. They’re a guild and they protect their turf pretty strongly. No doubt there are often sound reasons for that, and as a trade unionist myself I don’t begrudge them that, but I do begrudge right-wingers basically trying to outlaw the sweaty, beastly union I belong to, while passing over the AMA in silence.
Hypocrisy and classism, simple as that.
I don’t deny they are a union, they do. If one asks for industrial assistance the stock response is that they are not a union and will support you if you choose to make a complaint but will not make representations on your behalf to your employer.
They then will repeat the bit about not being a union.
As I have said before, the AMA is the representative of senior doctors in private practice. It exists to further the interests of that sub-group of medical practitioners. It also represents Hospital employed junior doctors but, at best, begrudgingly. When the interests of those junior doctors intersect with their senior colleagues, the hierarchy of interest is clear.
The AMA, somewhat like the Police Union, leverages the good reputation of its’ members to behave without scruples as their collective expression.
I can see the AMAs issue. Bed-block is an enormous problem in most hsspitals — I can see the idea of having people taking up a hospital bed while waiting for a housing service is an alarming one. And in some areas (Central Australia, for example) homelessness is so routine that putting the responsibility for tackling the huge problem onto the hospitals seems likely to only interfere with the hospitals role. Keeping the homeless there in hospital would quickly overwhelm the hospital, while making very little difference to the magnitude of the problem.
The overloaded hospital system should be only for those with acute needs, For most hospitals every person in hospital who does not have acute need is a person who does have acute needs kept waiting on a an emergency room corridot, or shunted to a different hospital. The goal of no discharge into homelessness is a desirable one — but it should be met by ensuring emergency housing services are adequate and work in coordination with hospitals, not by trying to keep people in hospitals if the services aren’t there.
The idea that hospitals can keep people there who are out of medical crisis and are there awaiting accomodation would be inappropriate (hospital beds are vastly more expensive than short term acccomodation in general) at the best of times, but when the hospitals are, in many cases, so devoid of excess capacity that they can’t properly perform their primarily medical functions, its simply untenable.
Not that I’d defend Capolingua in general. But she has a point on this.