The unhealthy state of homelessness report explores the health and wellbeing of homeless people in England and the support that is available to them.
Homelessness and health campaign
Poor health is widespread amongst homeless people. Evidence gathered from Homeless Link’s 2014 Health Needs Audit provides a stark picture of the health outcomes experienced and self-reported by homeless people. It showed that 73% of people experiencing homelessness suffered from a physical health problem, and 80% a mental health problem. 39% said they took drugs or were recovering from a drug problem, whilst 27% had, or were recovering from, an alcohol problem.
People living in dangerous conditions, such as squats or on the streets, are more likely to have unhealthy lifestyles which can cause long-term health problems or exacerbate existing issues. Data indicates that 77% of homeless people smoke, 35% do not eat at least two meals a day and two-thirds consume more than the recommended amount of alcohol each time they drink.
Despite high levels of GP registration, a significant number of homeless people are not receiving the help they need with their health issues. More than a quarter of those who are receiving some treatment said they would like more help.
Homeless people are heavy users of acute NHS services; the latest data indicates that the number of A&E visits and hospital admissions per homeless person is four times higher than for the general public. This is estimated to cost a minimum of £85m per year.
If we are to truly break the link between ill-health and homelessness, we need action across the health system; this means better commissioning of services which prevent and treat poor health experienced by homeless people. This also means concerted effort by front-line NHS staff to help individuals manage and overcome their health problems.
The longer people remain without a stable and safe place to live, the more these problems multiply and the harder they are to overcome. The cycle of these factors, such as unemployment, debt, poverty and homelessness work to compound over time and make it difficult to improve health outcomes in isolation. Preventing the situations that lead to poor health is needed.
We are calling for action across the health system to tackle these issues, including:
- Investment in interventions at a much earlier stage to prevent homelessness and associated poor health outcomes.
- Greater investment in community mental health services and improved care for people with co-occurring mental health and substance misuse conditions.
- Primary care services to be more targeted to the specific needs of homeless patients, and housing and health are joined up as part of the same pathway.
- Greater investment in the homelessness sector for approaches known to improve the way homeless people engage with the health system.
- Homelessness services to support clients to register and engage with GP, dental and optician services.
- NHS England and Public Health England to publish a clearer set of actions about their plans to reduce the health inequalities of homeless people.
- The Department of Health to continue coordinating the Inclusion Health work-stream at a national level.
- Public reports to be published assessing the quality of services offered to homeless people and recommendations for improvement.
- Clinical Commissioning Groups to state how far they have improved access to services and health outcomes for homeless people as part of their annual reporting requirements.
Homeless Link first conducted research into the health of homeless people in 2010 and there are signs that improvements have been made since then. We are continuing to work closely with our members, the NHS and Healthwatch England to improve the way homelessness and healthcare services work together to provide support.
We worked closely with our members and Health and Wellbeing Alliance partners to influence the development of the NHS long term plan. The NHS long term plan was published 7 January 2019. The plan sets out its strategy for the next decade, as well as detailing how it will spend the Government’s pledged investment of an extra £20.5bn a year over the next five years.
Homeless Link welcomed the plan and were pleased to see a commitment to spend up to £30 million to ensure people sleeping rough have better access to specialist homelessness support integrated with existing outreach services. We were also pleased to see a wider focus in the plan on addressing health inequalities. We have long been calling for Government to improve the health and wellbeing outcomes for those at highest risk of, and experiencing, the poorest health.
We now look forward to seeing how the plan will be delivered. The proof will be in the experience and health outcomes of people experiencing homelessness. We will continue to work with NHS England, our members and partners to make sure that access to services is easier, and that services are shaped to help support people with complex lives.
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Head of policy and communications
Caroline currently job shares her role with Helen Mathie, jointly overseeing Homeless Link’s policy, research, information and communications team.
020 7840 4458
17 Dec 2018 - 4:28pm
6 Oct 2017 - 3:13pm
22 May 2017 - 4:17pm