An opportunity to effect change
We know that homelessness is catastrophic for health, and that ill-health is also a key cause of homelessness. Together with our members, Homeless Link is working to ensure that the relevant national and local health authorities take more responsibility for preventing and ending homelessness.
There are plenty of examples of good practice, but people experiencing homelessness and the organisations supporting them often describe that NHS services don’t meet their needs and that there has not been enough focus on preventing health issues that can contribute to someone becoming homeless. For people experiencing homelessness, services can be hard to access, stigmatising, and poorly joined up. Homelessness organisations are not always seen as the equal partner to health and other agencies that they should be, and certain health practices can undermine efforts to tackle homelessness.
The Government’s consultation to develop a new 10-year plan for the NHS is therefore an important opportunity to influence the changes in health policy that we want to see.
Our response
To address the consultation we held a series of dedicated sessions for members to focus in on the specifics of the questions being asked by the Department for Health and Social Care. Thank you to everyone who attended and shared valuable reflections from their services and the people they support.
We used those discussions, plus existing member feedback and research by Homeless Link, other organisations and academics, to put together our consultation response. The full submission is linked below.
Built around the questions asked in the consultation, the below sets out some of the key points that we made.
What does your organisation want to see included in the 10-Year Health Plan and why?
The failure of the Government to deliver homelessness prevention was a key theme of our conversation with members. We urged the NHS to lay out a commitment in the 10-year plan to prevent the causes and drivers of homelessness, and to outline the NHS’ role as a key player in the upcoming cross-departmental homelessness strategy. Our response highlighted the need to improve the accessibility of all forms of healthcare at population level, particularly focused on deprived communities.
“There are issues that disproportionately affect people experiencing homelessness […] the easiest way to prevent that is to prevent homelessness. This needs a bigger picture consultation, integrated strategy across departments, this strategy should get linked with MHCLG.”
What does your organisation see as the biggest challenges and enablers to move more care from hospitals to communities?
In general members supported moving care from hospitals to communities, particularly the delivery of community-based care in homelessness settings. However, we highlighted the untenable financial situation currently faced by homelessness providers, and the risk of service closures, emphasising that the NHS should not take for granted that they will still be there to support delivery. We argued that the NHS should invest in homelessness providers, recognising the important role they play in enabling health and preventing disease for people experiencing health inequality.
“It makes the assumption that [homelessness] services are going to continue, but we are seeing a lot of decommissioning, or seeing services on the edge of viability. The NHS needs to understand it's got a stake in it, delivery of services to the most vulnerable people.”
We highlighted that integrated budgets across health and homelessness, and a move away from short-term pilots and toward long-term funding for the provision of what works, would enable more care to be delivered in communities. We were clear that the NHS would need to support and resource any additional roles and responsibilities for the homelessness voluntary sector, as well as infrastructure upgrades to ensure services can deliver care in appropriate settings, with confidentiality and patient safety in mind.
What does your organisation see as the biggest challenges and enablers to making better use of technology in health and care?
Our discussion about using more digital technology in care highlighted concerns about possible digital exclusion, inadequate infrastructure and the need for more staff support. The consultation response requested that digital healthcare should be part of a menu of options rather than the norm, and that any increased demand on support services to enable digitisation should be met with the necessary funding and resources.
“We [started using] digital appointments […] it only works when the client has the choice to do one or the other.”
“We would be really happy to help everybody access care digitally, but would need an additional worker full-time. To make sure people keep the appointment, technology to keep it, and would need to advocate for the client.”
What does your organisation see as the biggest challenges and enablers to spotting illnesses earlier and tackling the causes of ill health?
Members highlighted the significance of stigma as a barrier preventing people experiencing homelessness from accessing healthcare. The NICE guidance on integrated care for people experiencing homelessness (2022) outlines the basic principles of responding to people in a consistent, non-stigmatising and trauma informed manner. Our response argues that further measures should be rolled out to put the recommendations from this guidance into practice consistently across the country, and appropriate training to ensure that staff have the skills to implement them. There was also clear support from members to involve more people with lived experience in healthcare, both in terms of co-production and as part of the workforce.
“There are a wide range of issues which can be faced by people experiencing homelessness which make it harder to interact effectively with health care providers … health literacy, being intimidated, low levels of trust in providers, lower education levels, cognitive issues, mental health issues.”
Further policy recommendations
There were a number of other specific areas where we highlighted key policy changes that the NHS and wider Government needed to make. The need for improved access to dentistry and primary care for people experiencing homelessness came through clearly, as did the need to end the practice of street discharge and extend the Duty to Refer to GP practices and other settings.
Next steps
The consultation officially closed on 2nd December, Homeless Link’s response has been submitted, and the Government have said that they aim to publish the new plan ‘next spring’.
As the Government works through the responses, the Policy Team will keep you updated about next steps as and when we hear, and keep you informed of further opportunities to engage and influence the new strategy. If you want to share your thoughts about health and homelessness please use the contact below.
