Some 27,883 people were admitted to hospital in England due to homelessness in 2018/19, according to the King’s Fund, a rise of 3,000 on the previous year. Overall, the number of homeless-related hospital admissions increased by 130 per cent in five years, analysis by the think tank found. These figures were released at the same time as a report by the King’s Fund looking at how healthcare could be better provided to rough sleepers.
Life expectancy for the homeless is thirty years lower than the average, with people suffering a “toxic combination’ of struggles over personal safety, food, shelter and ill health”, according to the report’s authors. Over the past two years, work by the Bureau of Investigative Journalism, the Museum of Homelessness and the Office of National Statistics has highlighted the number of deaths among the homeless. At least 726 homeless people died in 2018.
The King’s Fund estimates that a third of homeless deaths are from treatable medical conditions such as respiratory disease and HIV. The combined impact of physical health conditions, poor mental health, substance misuse, the traumatic experiences that lead people to becoming homeless, and the trauma that can result from sleeping rough all add to the burden homeless people carry. Despite these higher levels of medical need, however, homeless people struggle to access healthcare. The system is fraught with barriers, inflexible services, and discrimination. A study by the British Journal of General Practice found three quarters of GPs in London required documentation and proof of address for people to register, despite guidelines from the NHS stating these are not necessary.
Dena Pursell slept rough from the ages of 16 to 19. Speaking to the King’s Fund, she said, “I used to have really bad breathing problems – I got bronchitis when I was first out on the street. I did try to register with a doctor, but they weren’t having it because I had no address. Most of the services I went to I found that people would give me clothes and food, but they wouldn’t help with any other problems I had like anxiety or depression.”
The report calls for “multifaceted approaches to outreach”, including street outreach, in-reach across services, embedded healthcare workers in councils and voluntary sector organisations, and a system of peer advocates to help people navigate the system.
It also says these approaches need to be tailored to local situations, with different organisations and people involved in ensuring access to healthcare. The Conservative manifesto in December’s election pledged to end rough sleeping by the end of 2024 and the Prime Minister recently announced £236m in funding to address rough sleeping. He has recruited former Tony Blair advisor Dame Louise Casey to conduct a review of the causes of rough sleeping.