Background International evidence suggests there are barriers to homeless patients accessing healthcare, including palliative services, despite poor health outcomes and the average age of mortality in the UK homeless being 30 years younger than the mainstream population. The literature calls for in-reach palliative services to hostels, shelters and the streets to meet the palliative need. These conclusions arise from research with homeless staff, but the perceptions of palliative healthcare professionals had not been explored to see if this is achievable in practice.

Method A novel peer-reviewed online survey allowing quantitative and qualitative responses was distributed to 227 adult hospices listed with Hospice UK. Any palliative health professional working within these services was eligible to participate.

Results 129 palliative healthcare professionals responded. Participants included consultants, speciality doctors, nurses, clinical nurse specialists, social workers, physiotherapists, occupational therapists and counsellors. All 12 regions of the UK were represented. There was a wealth of palliative experience (two thirds had over 10 years‘ experience) but minimal training in palliative care specifically for people experiencing homelessness. Notable challenges to supporting this group included difficulty engaging community services (e.g. GP registration, safe provision of controlled medications), difficulties over discharge destinations from hospices if not an end-of-life admission, and challenging client behaviour. Respondents felt palliative care should extend support to this population through supporting homeless services as well as engaging the multi-disciplinary team. This may require flexibility to established referral pathways and ways of accessing palliative care.

Conclusion Flexibility and collaboration with homeless organisations and multi-disciplinary health care teams is imperative to ensure equitable palliative delivery to homeless populations. More training and education is needed for palliative care workers to understand caring for this population and for homeless staff to understand palliative care services. Further research is needed to understand how to achieve this care delivery in practice.