Homelessness, and especially rough sleeping, has significant negative impact on people’s physical and mental health. It also places substantial costs on the NHS. When homeless people access health services, they tend to do so in an unplanned way (often through A&E) and to be in a state of chronic ill health. In 2010 the Department of Health estimated that people who are sleeping rough or living in a hostel, a squat or sleeping on friends’ floors consume around four times more acute hospital services than the general population, costing at least £85m in total per year.
Local authorities have a statutory duty to find suitable accommodation for people who are homeless or threatened with homelessness and who are in priority need. The definition of ‘priority need’ includes: families and pregnant women, people aged 16 and 17 years old, people aged up to 21 if they were previously in care and other people who are vulnerable for a variety of reasons. These people are usually referred to as ‘statutory homeless’.
Specialist homeless organisations (represented by Homeless Link ) mostly work with ‘non-priority’ or non-statutory homeless people who receive a much lower level of assistance from local authorities. These people are typically single. They run a wide range of services including outreach, day centres and hostels and they have specialist mental health workers.
Housing associations work with local authorities to make homes available for statutory homeless people. Some also specialise in providing accommodation and various types of support to help both statutory and non-statutory homeless people to settle into temporary or permanent accommodation.
All three of these types of organisations run direct access hostels and temporary accommodation for people who are homeless.
Being homeless makes people vulnerable and being vulnerable can lead to homelessness. In this negative cycle of reinforcement, homelessness can sometimes be associated with domestic violence, drug and alcohol use and poor mental health. There are also high levels of homelessness among ex-offenders.
Evidence suggests there is considerable potential for those commissioning health and wellbeing services across the NHS and public health to incorporate homeless prevention activities within the services they already commission, and target those population groups known to be more at risk of homelessness. Further information is provided in this Public Health England and Homeless Link document on Preventing Homelessness to Improve Health and Wellbeing [Coming soon].
Areas that have high numbers of homeless people tend to have specialist primary care services like Inclusion Healthcare that are set up to work with homeless patients. In other areas, homeless people’s access to primary remains patchy. Primary care can enhance the way it meets the health needs of homeless people, and reduce ‘Did Not Attends’, by holding surgeries in day centres, hostels and other temporary accommodation.
36% of homeless patients leave hospital with nowhere to go. If they don’t get the right support, they risk being discharged back onto the streets which has consequences for their health and increases the chance of readmission. Discharge into unsuitable B&B accommodation is also common.
Housing Advice Teams can make provision for a homeless person to be housed following discharge, but too many people present on the day of discharge or even several days afterwards. The most successful projects in a DH-funded Hospital Discharge Programme were those which combined health and housing professionals in the homeless person’s package of care, during and after the stay in hospital: www.homeless.org.uk/connect/news/2015/feb/09/investment-needed-to-continue-homeless-hospital-discharge-improvement#sthash.R3IHXPYo.dpuf
Housing organisations can provide dedicated officers to work directly with local hospitals to facilitate planned patient into safe, suitable accommodation with appropriate care and support.