NHS Long Term Plan must address shocking health inequalities for homeless people

Monday, 5 November 2018 - 9:08am

More than 20 organisations representing nurses, outreach workers and homeless health professionals have today (Monday 5 November) joined forces to urge NHS England CEO Simon Stevens to spend more on specialist health interventions for homeless people.

People who are homeless experience some of the worst health outcomes in England, and die 30 years earlier than the general population. 

Following the new £20 billion funding over the next five years announced in the 2018 Budget, the organisations, including St Mungo’s, Homeless Link and the Queen’s Nursing Institute are urging NHS England to use the upcoming Long Term Plan to commit some of this new spending to dedicated specialist interventions. They also want to see a clear plan for how to address the shocking health inequalities that exist at present. 

Rough sleeping has risen by 169% since 2010.  Of the people seen sleeping rough in London in 2017-18, 50% had mental health problems, 43% had alcohol problems and 40% had drug problems. Estimates also put the proportion with physical health conditions at 46%.

Rick Henderson, CEO of Homeless Link, said:

“Health problems can be both a cause and consequence of homelessness, in particular rough sleeping. The average age of death for a man that is homeless is 47, and for a woman just 43, which is around a shocking 30 years younger than the average person. Homelessness as a health inequality, which often goes unrecognised, is at the root of this problem and we must urgently address this. Along with our members, we urge the NHS and the government to seize this opportunity to improve the health outcomes for those most desperately in need.”

Howard Sinclair, CEO of St Mungo’s, said:

“A week ago, the Chancellor delivered a budget statement that cemented his pledge for £20 billion for the NHS. We are writing to ensure that this windfall reaches the most vulnerable people in society. 
“We welcome steps in the government’s new rough sleeping strategy to provide more services to quickly help people to come off the streets. But it’s not enough. The NHS plays a key role in supporting people’s recovery from homelessness and we are urging that the Long Term Plan addresses the striking health inequalities that homeless people face every day.”

Dr Crystal Oldman CBE, Chief Executive of the Queen’s Nursing Institute, said:

“The QNI supports a network of hundreds of nurses who are working with people who are homeless, witnessing every day the impact of rough sleeping on their health. Nurses know that investment into preventative measures and access to services will not only improve, enhance and extend lives but will save the NHS significant sums of money. 

“We recognise the need for a significant shift in approach and for planned investment in addressing the health inequalities of these most disadvantaged members of our communities. It is essential that this intention is reflected in the Long Term Plan for the NHS.”

In addition to calling for £30 million of funding for specialist services, the organisations are urging more flexibility with appointments, ensuring NHS staff have training to improve attitudes to patients who are homeless, and ending the scandal of people being turned away due to a lack of address or a substance use problems.

LETTER TEXT IN FULL

Dear Simon Stevens,

We are writing as a collection of national and local organisations working in the fields of homelessness and health. Many of us provide accommodation and support to people sleeping rough. We represent nurses, outreach workers, and other homeless health professionals who are passionate about rebuilding the lives of some of the most vulnerable in society.

People who are homeless experience some of the worst health outcomes in England, and die 30 years earlier than the general population. Following the new funding announced in the 2018 Budget, we are urging NHS England to use the upcoming Long Term Plan to commit some of this new spending to dedicated specialist interventions for this group, with a clear plan for how to address the shocking health inequalities that exist at present.

Rough sleeping has risen by 169% since 2010. Of the people seen sleeping rough in London in 2017-18, 50% had mental health problems, 43% had alcohol problems and 40% had drug problems. Estimates also put the proportion with physical health conditions at 46%. These factors are mutually reinforcing, and without targeted interventions and support, many end up stuck in a cycle of homelessness, poor health, and sadly too often – premature death.

The NHS could be doing much more for this particularly vulnerable group. We warmly welcome the objective in the Long Term Plan to reduce health inequalities and, in particular, your comments to the Health Service Journal in July 2018 where you identified outcomes for rough sleepers as a particular area of concern. The Government’s Rough Sleeping Strategy 2018 built on this, and as part of the Long Term Plan called on the NHS ‘to spend up to £30 million on health services for people who sleep rough, over the next five years’. The Budget 2018 committed new funds to the tune of £20 billion for the health service over the next five years, providing the necessary funding to deliver on this expectation.

The £30 million earmarked in the Rough Sleeping Strategy is a tiny fraction of the wider costs associated with homelessness. Estimates suggest £85 million is spent on acute services alone for people who are homeless, meaning costs per person of more than £2,100 compared to £525 per person among the general population.

We want to see at least the stated £30 million spent year-on-year, as new money to develop specialist services for people who sleep rough. Specialist interventions – such as dedicated mental health provision for people on the street and tailored services to increase access to general practice – can prevent admissions to acute services further down the line. Schemes to address housing needs when people are in hospital can have a significant impact in preventing people being discharged to the streets, for example by using a Critical Time Intervention model. When delivered in partnership with local authorities and homelessness services, these kinds of initiatives can be essential in reducing rough sleeping.

Finally, there must be a change in approach. We want to see a commitment in the Plan to make core services more accessible to marginalised groups, and a route map for how to get there produced in consultation with service users. This means greater flexibility in appointments, ensuring NHS staff have training to improve attitudes to patients who are homeless, and ending the scandal of people being turned away due to a lack of address or a substance use problem. It also means a plan to work more closely with people experiencing homelessness and the other services they rely upon – local authorities, supported housing, day centres, and drug and alcohol services.

The Long Term Plan presents a vital opportunity to make improvements to the appalling health inequalities that exist for this group. We hope the positive messages you have made so far will transfer into clear commitments in the Long Term Plan. We look forward to supporting the delivery of these ambitions in practice in the months ahead.

Yours sincerely,

Mark Grant, Chief Executive, Action Homeless
Seyi Obakin, Chief Executive, Centrepoint
Mark Moody, Chief Executive, Change, Grow, Live
Stephen Bell, Chief Executive, Changing Lives
Jon Sparkes, Chief Executive, Crisis
Mike Thiedke, Chief Executive, Depaul UK
Andrew Redfern, Chief Executive, Framework Housing Association
Steven Platts, Chief Executive, Groundswell
Rick Henderson, Chief Executive, Homeless Link
Kathy Mohan, Chief Executive, Housing Justice
Corinne Clarkson, Chair of the London Network of Nursing and Midwives, Health Inclusion Network
Mark Simms, Chief Executive, P3
Mick Clarke, Chief Executive, The Passage
Alex Bax, Chief Executive, Pathway
Mike Barrett, Chief Executive, Porchlight
Crystal Oldman, Chief Executive, The Queen’s Nursing Institute
Polly Neate, Chief Executive, Shelter
Jean Templeton, Chief Executive, St Basils
Chris Fields, Chief Executive, St George’s Crypt
Howard Sinclair, Chief Executive, St Mungo’s
Bill Tidnam, Chief Executive, Thames Reach
Jon Kuhrt, Chief Executive, West London Mission

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Helen Harrison

Communications manager

Helen is the communications manager at Homeless Link. Helen is currently covering Louise Weaver's maternity leave.

Telephone: 0207 840 4427
Email: Helen.harrison@homelesslink.org.uk