Health for people who are homeless

At any one time, hundreds of people sleep rough in the capital.  Numbers in London have doubled since 2009/10.  About a quarter of all people sleeping rough in the UK are in London. 

Although the term ‘homeless’ is often applied in everyday language to people who sleep rough, there are much broader definitions covering anyone who does not have a home. This includes people whose accommodation is insecure; those facing eviction, living in temporary accommodation, squatting, people at risk of violence, those housed in property potentially damaging to their health, and those who cannot afford their current accommodation.

Our vision

Every homeless person should receive care that is consistent in quality and experience with that of the general population and bespoke to meet their specific needs, and the systems which support homeless people will be linked up to reflect the transitory nature of the population and support improved communication and outcomes across the system.

Key London challenges

Over the course of a year some 8,000 people sleep rough in the capital.  Although numbers have levelled off in the last year, the numbers are double what they were in 2009/10.  The term ‘homeless’ is often applied in everyday language to people who sleep rough, however there are also broader definitions covering anyone who does not have a home.  The number of people experiencing these other types of homelessness has also grown in London.  

Homelessness may be a consequence of health problems, and is very commonly a cause of worsening health. The wellbeing of people who are homeless is at significant risk, especially those who live and sleep on the street. Many people who sleep rough will have significant needs in relation to physical health, mental health and substance misuse.  The average age of death for a person who is sleeping rough is just 47, half that of the general population.  Current systems of healthcare struggle to meet their needs and it is common for them to have a number of complex health problems.

Homelessness is a growing and significantly greater problem in London than elsewhere in England and recent studies have identified the impact this population can have on the system:

  • Homeless individuals use eight times more hospital inpatient services than other people of similar  age, and are more likely than members of the general public not to be registered with a GP. 
  • Of a sample of the homeless population, half of total acute care costs were incurred by 10% of people.

This demonstrates that quality of life could be improved for this population group by earlier intervention and pro-active services as well as financial savings by changing the model of care. Vulnerability is a key issue in homeless services: both for service users themselves, such as being victims of violence and/or the lack of engagement with, and understanding from, mainstream services; and the often short-term funding for service providers. Furthermore, homeless people and rough sleepers are transitory, and so the issue is necessarily London-wide and more needs to be done with our partners, such as local government, to link programmes across London and mainstream services.

Despite affecting a relatively small population, homelessness is growing and reaches right across health, public health, social care and into related areas such as housing and the justice system.

The London Homeless Health Programme was established to address recommendation 31 of the Better Health for London report (2014):

Commissioning guidance to support London CCGs to improve health services for people who are homeless

We have worked with Pathway to create a training package for GP receptionists and practice managers

The 'right to access healthcare' cards aim to help people who are homeless to register and receive treatment in GP practices in London

This report tells the stories and experiences of healthcare from the perspective of people who are currently homeless across London.

Why health services need to be improved for people who are experiencing homelessness.

This resource pack is designed to signpost NHS staff and commissioners to range of resources that can support their work with people who are homeless.