The new research shows that in areas with high levels of rough sleepers less than a third of health authorities and Trusts have contracts in place to provide TB services. This is despite more than half believing TB represents a significant local health issue for this vulnerable group.
Crisis research in 1995 showed that one in 50 rough sleepers had TB - 200 times the rate in the general population. It was coupled with new, clear guidelines by Crisis and, shortly afterwards, the department of health on how best to tackle TB among homeless people. Yet 18 months on TB remains a danger to public health.
Results from the Crisis national survey of health authorities and NHS trusts, published on Thursday, also show that in areas with high levels of street homelessness:
-- only 20 per cent of providers monitor the housing status of hospital patients - making it virtually impossible to give the right follow-up treatment
-- only 36 per cent of providers had a member of staff following-up homeless TB patients
-- only minimal extra money is needed to implement provision and service. The focus should be on re-targeting existing funds to be more cost-effective.
In addition, a recent American study of TB transmission among urban homeless people showed the majority of cases to be new infections, not the result of reactivating old disease which is generally assumed.
Dr Ken Citron, who conducted the Crisis research, commented: 'Although we have previously recorded a TB rate of one in 50 amongst vulnerable homeless people, the problem is not yet at epidemic levels. And we have enough time and knowledge to make sure it doesn't become so - there are some excellent examples of effective TB services around the country.
'However, if health care purchasers and providers don't act many people will suffer unnecessarily. And the financial costs will be far greater than the cost of re-targeting existing TB services to the most vulnerable.'
-- health authorities have contracts in place with providers for the delivery of service strategies recommended in the guidelines
-- screening of day centre users and direct access hostel residents, focused on older men and alcohol users, is implemented
-- training is provided for staff working with homeless people in case finding, medical referral and directly observed therapy
The national survey of health authorities and trusts was conducted in autumn 1996. There was an 89 per cent response rate in those areas identified by Crisis as those where street homelessness is most prevalent. Overall there was a 51 per cent response rate.
Out of the shadow - Detecting and treating tuberculosis amongst single homeless people (Crisis 1995) - available on request from Crisis