Ms Emma Dolan:

A great deal has been said. I echo what Ms Darcy and Dr. O'Carroll said about poverty being the main cause of homelessness. In rural areas outside the urban centres the big issue is access to services. Dr. O'Carroll spoke about people experiencing drug or alcohol addiction and it being a cause of homelessness. That is a great deal more manageable if someone has means. If he or she is outside an urban centre, he or she might not have access to services. There might be nothing in the local area and the person concerned might not be able to afford to use public transport. He or she probably does not have access to a car. How is he or she to get to a GP, a hospital, the emergency department or psychiatric services unless he or she calls an ambulance? It quickly turns into a revolving door.

The other piece that continues to arise is the idea of fundraising for services that should available in the mainstream. Homeless services are available because there are gaps in the mainstream. In an ideal society homeless services should not be available, yet we have seen them expand exponentially in recent years to meet demand.

They are viewed as a legitimate response to people's health and housing needs. We are seeing an increase in the provision of emergency accommodation as opposed to the building of social housing. I echo the point made by previous speakers that the State needs to build social housing.

The people who engage with homeless services have complex needs and are dealing with multiple issues at the same time. Not only are they physically or mentally unwell they also do not have a home or access to paperwork, do not know where their belongings are and do not feel safe. All of these factors compound the problem and make it more difficult for them to visit a general practitioner.

In terms of inter-agency working, there is no cohesive strategy between the health and housing areas. They are entirely separate, as is clear from the way in which services are commissioned and procured. Even if we wanted to offer a solution that integrated health, housing and homelessness responses, the problem is that one speaks to the Health Service Executive one day and the local authority the next. Clearer mechanisms are needed to get everyone into the same room to find a way to navigate the issue. While there is certainly a will to do this and everybody is trying very hard, mechanisms are required to achieve this outcome. This filters down to the delivery of front-line services. People with multiple needs engage with multiple services. For example, a person will have a general practitioner and may have one consultant for a physical health need and another for a mental health need. He or she will also work with someone in homelessness services. Trying to bring all of these people together to establish good and effective case management systems to identify a cohesive strategy that will work for the homeless person and get him or her out of homeless services quickly can be complicated and difficult.

If services apply certain criteria and allocate specific resources using these criteria, one finds, for example, that if Ms Darcy has different criteria, there is a gap between the services provided and Ms Darcy's needs. Everyone involved can leave the room believing he or she has done his or her job because he or she has found he or she could not do anything for Ms Darcy within his or her remit. As a result, Ms Darcy does not get a response when the response must always be built around the homeless person.

As Mr. O'Connell stated, there are many solutions available and a great deal of good work is being done. The issue is one of capturing this good work, pulling it together and commissioning services in a way that one can respond rapidly. Housing First is an example of how to get homeless and health services working together and directed at the individual. The services also stay with individuals, which means that they do not have one case worker one day and another the following day because they are moved between one service and another. Instead, they have one case worker who knows them, knows their plan, works for them and co-ordinates the work of the health professionals with whom they are also engaged. It would be fantastic if this approach were used more widely alongside social care.

The rural issue must also be acknowledged. There is a dearth of services in rural areas. People refer to the large amount of vacant housing in rural areas. These areas do not have services and public transport and are not, therefore, an appropriate solution for many people who have been in homeless services for a long time and need a significant input from mainstream and voluntary organisations.