OUTSIDE the window of the cramped single bedroom, autumnal seaside winds howl, steadily picking the peeling paint away from the exterior of a once-grand Georgian town house, writes Pete Blackburn of the BMA.

There is no grandeur inside. A tiny yellowed fridge buzzes, door hanging open, as if it has been so for ever. A single hotplate sits uselessly next to a muffled radio and disorganised tumbles of stained clothes.

A man stares at the ceiling, lying fully dressed, unmoving, on a crumpled mattress; his feet wrapped in an uncovered duvet. Sometimes he responds to questions from his visitors, managing a barely audible “yes” or “no”. Sometimes he is unable to muster a response. Plans for a future GP appointment and another visit are discussed.

Just months ago, this man had the sort of life most would call normal. He had a job and a wife. Now, emergency accommodation in Brighton, dark and gloomy corridors with endless brown doors hiding barely habitable rooms, and visits from GPs, nurses and charity workers are his daily existence.

In Brighton, like much of austerity Britain, even those living “normal” lives can be a hint of misfortune – bereavement, loss of a job – from becoming another statistic in the hurtling growth of the homeless community.

who need this kind of specialist help – it’s work we shouldn’t be doing and it has an impact.”

This sort of strain is clearly problematic for patients – but it is hard for professionals, too. How do staff cope with the complexity, tragedy and emotion involved in such difficult cases?

“It’s a case of celebrating your victories and not just dwelling on the times when you aren’t able to do anything,” Dr Sargeant says.

The homelessness crisis is a situation the British Medical Association (BMA) declared a public health emergency at its annual representative meeting last year.

Last month, BMA emergency medicine lead Simon Walsh said rising homelessness was soul-destroying and that the needs of homeless people continue to be ignored.

On a national level, Dr Walsh is right. But here in Brighton and in a handful of other cities there is a blueprint which attempts to fill the gaps and wrap care around homeless patients – it may not be enough but it is something.

The Pathway model here comprises the Arch surgery in Morley Street and a team based in the hospital.

The team has urged commissioners to fund a step-down facility, where people who are fit to leave hospital but still need support or time to put plans in place, can go – but money has not been found.

Nestled between floors three and four of the Royal Sussex County Hospital, the small Brighton Pathway team, comprising Dr Sargeant, in-reach nurse Gregg Lock and advocacy and discharge co-ordinator Katie Carter, are on hand every time a patient who is homeless or vulnerably housed is identified.

They are ready to meet patients, find out about their history and try to give them any support they need.

On the day The Doctor visits, patients are worried the weather is turning more wintry and the staff are struggling under the pressure of rising demand which leaves more patients needing help but fewer beds in which to treat them.

Rushing the process is counter-productive, however. Discharging patients to the streets is short-sighted because they will end up back in hospital with further complications. Many would suggest it to be unethical, too.

“Most people don’t come into the NHS to put people out on the streets,” Dr Sargeant says.

“But if the system is under extreme strain that can have an impact. And there is an understanding that elderly people have to wait on a ward for a nursing bed or care package – but that isn’t the same for homeless patients even though they have many of the same, or worse, frailties.”

The system in Brighton, originally described as Pathway Plus, is now commissioned by the local clinical commissioning group.

Once people leave the hospital they are fortunate enough to be visited by a floating team of non-clinical support workers, as well as being registered with homeless GP practice Arch, or another local GP. This service, commissioned as part of Pathway plus, is run by the Justlife charity.

Simon (not his real name) was forced to flee to the Brighton area from a different part of the country after being the victim of an acid attack which left him nearly blind and fearing future violence.

Simon was helped with somewhere to live and was supported to overcome his fears – eventually gaining access to financial support and medical appointments.

Mr Gale says: “We are still able to intervene and help people. We take a committed, long-term approach and don’t limit how long we work with people.

“But no matter how hard you try there are some cases where you can’t help – some people die prematurely.

“The frustration is we could double our team and still not really feel we are reaching all the people who need support.”

The effectiveness of teams such as Pathway Plus and the work they do should not be measured by the basic statistics.

The only thing as striking as the scale, complexity and tragedy of homelessness in Brighton is the commitment, care and compassion shown to the homeless. So often society forgets these patients but not if these staff can help it.

At the fortnightly multi-agency meeting, hosted by the Arch GP surgery, where all the organisations trying to tackle this desperate issue trace the journeys of their patients and discuss their needs and next steps, that commitment, care and compassion could not be any more obvious.

It is driven home most powerfully when the solemn faces around the table begin to realise they have done all they can for one patient who has no recourse to public funds and will not be helped by the existing structures of society in this country.

Consoling the charity workers and healthcare staff who have spent weeks trying to give the man a second opportunity, Arch GP Tim Worthley says: ‘Thank you for everything you are doing for him.

“You are not missing anything, you are not failing. All we can do is try.’