Today, we launch the third report in our research series The Unhealthy State of Homelessness. This report introduces new insight drawn from Homeless Health Needs Audits (HHNAs) undertaken across 14 local authority areas between 2022-2025, representing 727 individuals experiencing homelessness in England. The findings show clearly that health inequalities are worsening; that many people are in poor health before they become homeless; that health is negatively impacted by homelessness; and that opportunities for prevention and support are being missed.
HHNAs are undertaken on a placed based approach by local areas invested in better understanding the health inequalities of people experiencing homelessness. Aggregating this local insight gives us the ability to provide this national overview, and we’re grateful to all the local areas and partners who supported with delivering HHNAs to inform this updated report.
Our findings demonstrate a continued decline in physical health amongst people experiencing homelessness, with 81% of people reporting a physical health condition, sharp increases in conditions which relate to homelessness, and a big rise in the number of people managing between 5-10 physical health conditions.
81% of people experiencing homelessness report a physical health condition
As well as demonstrating a clear impact of homelessness in driving respiratory health conditions and poor musculoskeletal health, our findings also show that people experiencing homelessness are deeply impacted by wider population health issues. Whilst access to dental care is challenging across the general population, dental problems have risen to become the most commonly reported physical health issue amongst people experiencing homelessness and dental registration has dropped, due mainly to surgeries not taking on NHS patients.
Whilst we see a clear impact of homelessness on health, we also see that many people are unwell at the point of becoming homeless, with 58% of physical health diagnoses and 67% of mental health diagnoses predating individuals' experience of homelessness. The current situation presents a direct contradiction; as the complexity of managing poor health increases, access to healthcare becomes harder. We see clear consequences of this in data which shows increased rates of self-medication as people try to manage their mental health by any available means; and in rates of emergency healthcare use four times higher than the general population.
as the complexity of managing poor health increases, access to healthcare becomes harder
Our findings make clear that the wider health system cannot currently meet the needs of people experiencing homelessness across many measures – in fact this report suggests this is getting worse; with fewer people experiencing homelessness accessing life-saving cancer screenings, and increases in the proportion of people discharged from hospital to the street.
Despite these challenges, there is clear opportunity here. The high proportion of people who have been in touch with health and care systems, and with other government institutions, prior to homelessness indicates greater scope and opportunity for targeted prevention support. The response to this must sit upstream, and outside, of traditional homelessness services. It requires the involvement and investment of multiple partners across health and social care to effectively prevent homelessness wherever possible. The Government’s upcoming Homelessness Strategy with a stated commitment to inter-ministerial working is a golden opportunity to action this, introducing accountability for homelessness prevention amongst health and social care. It must also ensure that when homelessness does occur the experience is short-lived and, instead of creating a spiral into increasing and deteriorating poor health, provide rapid access to person-centred support across all areas of health and care.
The Government’s upcoming Homelessness Strategy with a stated commitment to inter-ministerial working is a golden opportunity
We see many pockets of best practice across the country, as well as an improved understanding of the complex interaction between health and homelessness, and a firm acknowledgement from the government of the need to tackle this issue. The new Homelessness Strategy is also an opportunity to set out the structures that enable good practice to grow, and provide the framework and resource to tackle health and homelessness as the interlinked issues that they are.
As the national government reinforces its commitment to an NHS that works better for everyone, and a cross-departmental homelessness strategy, we must see more invested by local and national government to recognise and address homelessness as a health issue, and commit to the shared accountability needed to take seriously, and reduce, the stark and unacceptable health inequalities caused by homelessness.
