Dr. Fiona O'Reilly:

Senator Dolan referred to the housing issue. Housing and health are linked, but he asked what else was linked. The whole gamut of social determinants of poor health - education, employment and networks - are linked. As such, it is important that there be cross-sectoral collaboration to tackle health issues. It cannot be done through health policy alone.

The Senator also asked about how good co-ordinated responses were. They are improving. One of our main reasons for being is to co-ordinate responses among health organisations that are working with homeless people in order that there is a joint medical record and web-based database that those organisations can access to see whether, for example, Johnny in Merchants Quay can be seen today and whether Dr. O'Carroll can see him in the Granby Centre tomorrow. That is good co-ordination, but there is not enough overall and it could be improved, particularly in mainstream services.

Deputy O'Reilly rightly stated that services should be delivered at the point of contact with homeless people. Were that a major national policy, it would be helpful. There are good examples and Dr. O'Carroll might address shared care and trying to get the new hepatitis C treatments out to people who would not otherwise receive them because they are not a hospital-going population. Hepatitis C treatment has to be initiated by consultants. Our population will not be able to access those treatments unless we think creatively. To that end, we are working on a shared care model with Dr. Jack Lambert. Running outpatient departments, OPDs, for homeless people is a waste of money because so many do not attend. Maybe we should stop expecting them to attend and bring the outpatient services to where they are. That would be a mind shift for mainstream services, but it is required and we should highlight it in policy.