Beleaguered sadness, increasing desperation and the invisible population of our streets

You probably feel guilty when you see a homeless person, but don't know what to do for the best. Now, you can call Streetlink and they will work with local services to get the person off the street and into accommodation.

Two weeks ago, I was walking to work, head down, lost in my thoughts. Suddenly an angry, exasperated voice burst through my reverie.

"Mate! Go the other fucking way."

I looked up. It belonged to a policeman. He was a yard or two away from me, on the other side of some blue tape, which had been used to cordon off an alley I walk through to get to the tube station. I'd managed to stumble into the middle of what appeared to be a crime scene.

I stuttered an apology, and turned off down another alley. But my route to the tube meant I had to walk past the taped-off area from the other side, by the main road.

There were four or five officers there, and behind them, an engrossed crowd of 20 or so people. The officers were surrounding an elderly figure on the floor, and one of them was on his knees, frantically applying CPR to the chest. It was one of the homeless people who sometimes congregated in the alley. I walked past them most days, but they never seemed to notice me. And I, like most people who've lived in London a long time, barely noticed them.

It was bitterly cold. I looked at the officers. They gave off a strange mix of detached professionalism and beleaguered sadness. It struck me how young they all were. The officer kneeling over the body pumped at the chest with increasing desperation. The others watched him intensely. I, and the rest of crowd, were gripped by a strange consensus. None of us could help. In twos and threes, we drifted away. About suffering, they were never wrong, the Old Masters.


Like nearly half of all adults (according to research recently carried out by Homeless Link, the umbrella organisation for rough sleeping charities), I feel guilty when I see a rough sleeper, but I struggle with the perennial problem: you give money, you know it might well go on drugs or drink. So you do nothing; and feel bad.

Tucked away behind Shepherd's Bush Market is a shelter run by the charity Broadway. At 10am, a crowd of rough sleepers gathers outside. The mixture is diverse - many have the familiar scarred faces and tattered clothes of long-term drink or drug addicts; others are less conspicuous. There's a mix of ethnicities - most seem to be British, but there are some eastern Europeans and a couple of African origin. Once they're let in, they have access to a range of services from a hot cup of tea to medical help, various classes and counselling with drug and alcohol problems. Next to the centre is a hostel, where those who are getting ready to move back into permanent accommodation can stay.

I was here to learn about a new initiative to help rough sleepers, and I was introduced to Shaun Collins, a 53-year-old man, originally from Grimsby, who was one of its first beneficiaries.

Back in 2010, Shaun was a skilled labourer on construction sites. He met a girl, and a year later they were married. A few months after that, she told him she wanted to separate. It turned out she'd been living in the country illegally and had only married him for a passport. He was devastated. He moved out, first into a bedsit and then in with a friend. It didn't help: Shaun's friend was a big drinker, which didn't help him given how depressed he felt. He drank more and more to numb the pain, and ended up sleeping in a church yard in Barking. Pretty soon he was drinking just so that he could get to sleep outdoors.

One night three men approached him. They were wearing hoods and scarves over their faces. They tried to rob him, but he didn't have any money, so they to the floor and kicked him repeatedly. After they'd finished, Shaun phoned for an ambulance, which took him to Newham General Hospital. One of the paramedics asked Shaun what he'd do next - Shaun told him he was going back to the church. Upon his arrival, a man and a woman met him; they told him they had somewhere warm for him to stay.

The place was No Second Night Out in Islington. "It was so much better," says Shaun. "It was warm, there was tea, coffee, soup, a television - I was there for three weeks. Then they moved me into a staging post while I tried to sort out a permanent place. In the churchyard I was constantly depressed. Now I can finally see some light at the end of the tunnel. Once I've sorted out my divorce I can get my head together and get back to work."

Shaun received the help because the ambulance driver had called StreetLink, a new hotline which enables members of the public to connect with local advice and services. The London version of this service, set up in April 2011, led to nearly 2,000 calls being made to the helpline and 415 rough sleepers being helped off the streets and into accommodation in the first six months - a rate of success four times higher than traditional services.

This week it was launched nationwide. The idea is simple: save the number (0300 500 0914) in your phone, and call it when you see a rough sleeper. You give the telephone worker a description of the person and their location. They will then get in touch with the council or a local homeless service to visit the person and provide support. If requested, StreetLink will give the person who made the call an update on what's happening 10 days later.


After years of decline, the problem of homelessness is getting worse. According to Homeless Link, the number of people sleeping rough grew by more than a fifth last year. There has also been an increase in the number housed in temporary accommodation and in B&Bs, and as I wrote about recently, a 34 per cent increase in people housed in a different local authority.

The reason for this last issue is highlighted by the latest development in Shaun's tale. People have to be housed in the private sector due to a lack of social housing, but prices are high and quality is low. He says:

"When they gave me a list of phone numbers I phoned an agent up, and he put me onto a place in Hackney. It was terrible. There was a fridge and just two hob rings to cook on. There's five studios in the same building, the front door had been kicked in twice, it was filthy. They were charging £240 a week. But I only get £170 from a private pension."

Shaun went to the council's offices. "The man there told me I'd have to pay £55 towards my benefit and another £35 to council tax. That means the Government expects me to live on £71 a week. I said to the man behind the desk, I worked for 30 years, I'm going through a hard time - do you think £71 a week is fair? He didn't have an answer." Now he's waiting to hear back from another letting agent, whom he says has £100 of his money and isn't answering his calls. Broadway is working with him to resolve the issue.

StreetLink is a Government-funded initiative. I spoke to Howard Sinclair, Broadway's CEO, and put a question to him: if the likes of Shaun are successfully brought in from the streets but then find themselves confronted by problems like this, is the hotline little more than a sticking plaster?

"No," he says, "It's absolutely not. There have always been three prongs to the way we reduce homelessness. The first is prevention - helping with family breakdown, mental health, stopping people taking out pay day loans; these sorts of things. The second is getting people in housing as soon as possible, so that they don't end up in the entrenched patterns of behaviour that keep them on the streets. That's where StreetLink and No Second Night come in. And the third is helping people back on their feet once they've lost their tenancy. To invest in one simply isn't sufficient, but the Government - especially Grant Shapps and the Mayor's Office - still deserve big ticks for the funding they've given projects like StreetLine."

Sinclair is open about the difficulties people in Shaun's position face:

"We're seeing so much of what he describes in Hackney. In fact, Hackney Citizens' Advice Bureau recently found that only 10 per cent of private lets are affordable on local housing allowance, and only 10 per cent of those had landlords willing to rent to people on benefits. So one per cent of borough's housing is available to someone like Shaun. It won't be good housing. This is the result of successive governmental failures."

And he adds:

"On top of this, while we haven't seen that many obvious signs of cuts, like hostels closing down, there has been a real cutback in less visible services, such as floating mental health teams. The reality is that local authorities have to make cuts, and those are the easiest to make. For our clients it's not just about putting a roof over their head - it's about dealing with things like drugs, drink, mental health issues - so the stress caused by little things like increased transport and heating costs all interact. The group with which we work will all be affected by the changes to benefits - for you and me it's a fiver here and there: for someone on £70 a week it's four per cent of their income. The cost of not putting in preventative measures is far higher in the long term."

I ask how we can stem the increasing flow of people onto our streets. He feels the way StreetLink was implemented could be a model:

"Here local and central Government and the charities worked in partnership. A national helpline, but local teams to deal with the problem. That's how problems get solved: when the various sectors cooperate, identify the issues and play to their strengths. If I look back 25 years ago, I'd go out in Piccadilly and see people sleeping rough all over the area. Today you don't see the numbers you used to. Partly, that's because there's more money in the system. But more importantly, the various sectors had a common recognition of the problem, and there was leadership from successive governments. This Government has shown leadership on the measures required to help people who are on the streets. Now it needs to show the same on preventative measures."

I conclude by asking him the same question I always ask people who work in this sector. Would he give money to a rough sleeper? "No one has the authority to tell anyone else how to spend their money. But I know what I would do personally. I'd give them a hot drink, and some time for a chat." It's a response I think about later that day, as I walk through the now-empty alley that leads to the tube station.


A homeless man rests in the doorway of a branch of a Lloyds Bank in central London. Photograph: Getty Images

Alan White's work has appeared in the Observer, Times, Private Eye, The National and the TLS. As John Heale, he is the author of One Blood: Inside Britain's Gang Culture.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide