Published: 01/12/2005 Volume 115 No. 5984 Page 12

A third of all homeless people in London have a condition which comes as a direct result of sleeping rough, a report says.

The report for homelessness charity St Mungo's out last week found that rough sleepers have a death rate 25 times that of the general population.

St Mungo's director of health programmes Peter Cockersell said a third of those questioned had a condition caused by sleeping rough, such as pneumonia, tuberculosis, trench foot, frostbite and wound infections.

For many these problems were complicated by chronic chest, heart or circulatory problems. At the extreme they found people with cancers and end-stage liver disease.

Of the 1,461 people questioned, two-thirds had one or more physical health problems and a third who needed treatment were not getting it.

Amanda, a 30-year-old woman who slept rough for five months this year, said she was forced to lie to GPs. 'I just had to invent an address so I could get treatment for asthma - it just adds to that feeling that you are a nobody, worthless.' Mr Cockersell says that with a severe winter forecast, urgent action is needed to protect the homeless.

'We need a London strategy because homeless people move around so much and PCTs have different policies. We also need some form of 'sickbay' arrangement similar to those in France and Holland, run by a homeless agency or even a strategic health authority.

'It acts as a halfway house for homeless people coming out of hospital that ensures they do not go back onto the streets where the health problems started in the first place.' St Mungo's praised Camden and Islington primary care trusts in north London, which have pioneered primary care for homeless people, taking GPs and nurses to homeless drop-in centres and hostels.

This month PCHP is opening a surgery in a 93-bed St Mungo's hostel in the West End of London. The residents will all be able to register as NHS patients, with Dr Kristinn Tan and nurse Camille Warren. The surgery is part of a package of support and rehabilitation that slowly tries to bring homeless people back into mainstream life.

Dr Tan and Ms Warren see patients with multiple health problems plus drink and/or drug addiction and a mental health problem.

Dr Tan said: 'Sometimes you think you have seen it all and then someone comes along with cancer or liver disease and you think: 'Wow, what is keeping them going?'.' She said part of the problem with caring for the homeless is that many doctors deal in stereotypes. 'Sometimes you need a locum and the minute you say It is for the homeless they say, 'oh no, drugs, alcohol, trouble'. But once they come in they find these are real people living under extreme stress and they need help.'