Hospitals are discharging homeless patients on to the streets, including those admitted with serious illnesses or addiction.
Homeless agencies say the practice puts vulnerable people back into the worst possible environment - and wastes public money.
District Health Board figures show scores of patients are discharged to "no fixed abode" in Wellington and Auckland every year.
Dozens more have been discharged to emergency shelters or the Auckland City Mission, which has no capacity to house them.
Homeless support agencies claim the Corrections Department and mental health services are also kicking people out on to the street. Corrections said this was "extremely rare" but has refused to release figures.
Mike Leon, who runs the Wellington Night Shelter, said the emergency accommodation provider had become a dumping spot for those who needed long-term care.
In the past month alone, two mentally ill men had been discharged from supported accommodation and dropped off at the shelter, he said.
On one occasion, a nurse had asked him to administer a man's medication but he refused.
"We are increasingly being used as an alternative to a mental health ward but we are not trained for that."
Others never turned up at the shelter, discharged instead on to the street before inevitably returning to hospital, he said.
"We are pouring money into tertiary care . . . to get them to a point where we can kick them out again. It's incredibly wasteful."
Capital and Coast District Health Board figures show there were 41 hospital discharges to the Wellington Night Shelter last year.
An additional 85 were released to "no fixed abode".
In Auckland, there were more than 300 discharges from hospitals to "no fixed abode" including 28 to the Auckland City Mission, which faces a shortage of beds. Another 15 were discharged to the Auckland emergency night shelter, which closed last year. Most were discharged from a hospital emergency department.
The figures are for discharges, rather than people, and in some instances the same person is being readmitted repeatedly.
Auckland DHB stressed that someone with "no fixed abode" was not necessarily homeless but Wellington Downtown Community Ministry director Stephanie McIntyre said the real number of discharges on to the street was probably even higher, as many homeless patients would give fake addresses.
Hospitals and other health providers were not uncaring, but often had nowhere to discharge homeless patients, she said.
"How can we possibly think that someone who has had significant mental health treatment will be OK back on the street? But what do you do?"
One solution would be funding dedicated long-term accommodation for the most severely ill or addicted, McIntyre said.
"Homes for 15 or 20 of these [vulnerable] people is a more cost-effective solution. Rather than having them in and out of hospital."
Auckland City Mission homeless outreach manager Garrick Martin said previously there was a significant problem with homeless people being discharged with no support.
"A couple of years ago people were being discharged to the street after having a triple bypass."
Auckland DHBs and support agencies had since reached an agreement to flag homeless patients and refer them on to support. This included a policy prohibiting the discharge of homeless people on to the streets or to emergency accommodation.
Since then there had been far fewer problems, but a lack of long-term accommodation meant the policy was not always followed, Martin said.
"It has improved, but we are not there yet. We hope we will get there."
Robert Ford, the planning and funding manager for Auckland DHB's mental health and addiction service, said there was a robust process of screening homeless patients and connecting them to support.
However, homeless people sometimes refused help. In other instances, there was simply nowhere to send them, he said.
Capital and Coast's mental health clinical director for addictions and intellectual disability, Nigel Fairley, said hospital patients were offered support and their accommodation needs were "assessed".
Mental health patients were only discharged when the right level of support was in place.
This included "appropriate" accommodation, he said.
The DHB does fund a pilot outreach service, called Te Roopu Aramuka Wharoaroa, which works intensively with about a dozen of Wellington's most desperate homeless.
VICTIM OF THE SYSTEM
It is only a matter of time before Rick Parry is back in hospital. An alcoholic, he has been admitted to Wellington Hospital's emergency department three times in the past month. The first two times he was admitted after collapsing in the street. The third time he was referred by his doctor, who bluntly told him he was drinking and starving himself to death.
"My doctor told me if I don't do something, I won't see the winter out." However, without intervention, there is little hope for change. Every time Parry is admitted to hospital he is kept long enough for a recovery and then discharged.
He returns to his small room at the Wellington Night Shelter, where he has already overstayed his welcome, and spends most of his day in Cuba Mall drinking and begging. Parry, 57, said although the food and medical care at the hospital were welcome, staff were not interested in his circumstances. "They didn't ask me where I was going or how I'm going to get there. They just kicked me out on the street."
He does not attend drug and alcohol counselling – he has refused, claiming it will not work – and attempts to get into a rehabilitation programme have so far also failed. He left his last rehabilitation stint in January last year, one of his many visits over the decades. Since then, he has been living in the shelter and spending most of his days on the streets.
He says he weighs 47kg and often does not eat for days, claiming he has "no appetite". His skinny forearms are covered in bruises and weeping sores from regularly passing out on the street. Parry is desperate to get back into residential rehabilitation but feels the system has probably given up on him.
"When you get to my age and you've been around the tracks they don't want to know." Night shelter manager Mike Leon said it was easy to blame Parry for his dire situation but the reality was that without help, he would die. "In a few days or weeks he will be back in hospital. If he doesn't get residential treatment he will die."
He and other support agencies have been attempting to find alternative accommodation for Parry for months without luck. Leon insists Parry will not be kicked out on to the street but his time at the shelter is running out. "There needs to be somewhere for people like Rick."
Capital and Coast District Health Board would not comment on Parry's case.
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