Is homelessness an afterthought for some health planners?

Thursday, 9 October 2014 - 12:38am

The links between homelessness and ill-health are well documented, so why are leaders from the health and social care system not taking more notice of the issue?

Photograph: Phalinn Ooi (Flickr)

An audit we have published today - in partnership with our member St Mungo’s Broadway - of local health and wellbeing strategies found that two thirds made no mention of homelessness at all. This is despite the stark statistics on homelessness and ill health.

Unhealthy state

We recently published research which found that 41% of people experiencing homeless reported a long term physical health problem, compared to just 28% of the general population. While 45% had been diagnosed with a mental health problem, compared to 25% of the general population. 

Not only is homelessness associated with higher health needs but the people it affects often face greater barriers to accessing care.

Problems accessing care

Think about the process you had to go through the last time you changed your GP. Then imagine doing that when you have nowhere to live or are staying at a different address every night. A lot of GPs expect a proof of a permanent address when you register.

Then there is the lack of flexibility with appointment systems for some care services. It can be difficult to agree to appointments days or weeks in advance, when you don’t even know where you will be staying tonight.

This often means that people who are homeless make higher use of more costly options to get their health needs addressed. In fact they are four times more likely to seek help from acute NHS services, for example A&E, than the general population, a situation that costs tax payers a lot of money.

Given this it is surprising to find that their health and wellbeing needs are not on the radar of more Health and Wellbeing Boards who directly influence commissioners of health and social care services in their area.

Not a priority for many

We looked at the strategies produced by 50 local Health and Wellbeing Boards; strategies that will shape the local health services of tomorrow.

We found that even in areas where homelessness was a significant issue, few had made tackling the issue a priority.  

Local health services have an incredibly long list of issues that people want addressed but we believe that tackling the link between homelessness and health will benefit those who become homeless and reduce costs for the NHS.

Identifying demand

Today’s report highlights examples of where the needs of single people experiencing homelessness have been identified.  Luton council for example carried out their own Homeless Health Needs assessment.

The results of this prompted a review of health services and how they deal with the needs of homeless clients.  This in turn then led to the local CCG commissioning three GP practices to provide services to homeless and hard to reach groups.

None of this would have been possible if the health needs of those who face homelessness in Luton had not been identified.

Moving forward

This is where our members can play a vital role by working with Health and Wellbeing Boards and local commissioners to firstly identify that homelessness is an issue and then helping them plan how they can be addressed. 

To help we have produced new guidance. The tool will help Health and Wellbeing Boards and local commissioners: 

  • Identify the extent of statutory and non-statutory homelessness in your area 
  • Use of accurate data to measure the health needs of single people experiencing homelessness
  • Provide clear channels through which the voluntary sector can contribute their views and data as part of this process
  • Work with client involvement groups to ensure that tomorrows healthcare services are informed by the experience of people who are homeless today.

Guidance on including single homeless people in your JSNA 2014

This briefing aims to help Health and Wellbeing Boards understand the case for including the needs of single homeless people in local health assessments and how to best do this.


'Needs to know' Research 2013

Produced by St Mungo’s Broadway and Homeless Link this 2014 audit of Health and Wellbeing Boards looks at whether the health needs of homeless people are being included in the planning and commissioning of healthcare services.


Talk To Us

Francesca Albanese

Francesca was our Research Manager from April 2014 to December 2015.

What is your area doing to improve the health of your clients?

Our Health Needs Audit Toolkit helps you assess local health trends and turn that assessment into practical action.