Matter for discussion: Improved health care for the "unseen"

This resolution was passed by voting members at Congress 2024.

People who sleep rough often sleep outside in doorways, parks or bus shelters. They can experience trauma, mental health issues, brain injury, along with poor access to food, shelter, and hygiene facilities. The underlying causes of people sleeping rough include societal and economic factors, such as inequality, poverty and deprivation, unaffordable housing, unemployment, exclusion, and discrimination.

Individuals who sleep rough may face difficulties accessing health care – an address is usually a prerequisite for accessing support. Individuals might not have a phone or internet to complete online e-consult forms and connect with their GP, or access to a place to charge their phone or adequate credit. They may not be in the same area as their GP and not have access to transport. Moreover, mental health services are usually located in hubs, which could pose a challenge for individuals who need to travel to access these services.

People who are rough sleeping have some of the worst health outcomes and are more likely to experience and die from preventable and treatable medical conditions, and to have multiple and complex health needs. 84% of people who sleep rough in England are male, and 80% aged over 26. The average age at death is 44 years (men) and 42 years (women), compared to 76 and 81 years in the general population. 35% of deaths for people who sleep rough are caused by alcohol or drugs, compared to 2% in the general population. Although this study was undertaken in England, it is likely that these trends can be broadly applied across the UK. 

In England, the rough sleeping strategy set an ambition to end rough sleeping by 2027, supported by local authority implementation. With the evolution of integrated care systems – bodies with a clear mandate to improve health outcomes for the population, there is an opportunity to provide better support to people who are rough sleeping to access the right health care service at a time and place that meets their needs.

In Wales, the Government publishes monthly statistics on rough sleeping and provides additional funding to strengthen services for rough sleepers, including outreach and access to emergency accommodation. In Scotland, numbers of rough sleepers increased during 2022/23 (Scottish Government, 2023), although these are still below pre-pandemic levels. In Northen Ireland, the Belfast Inclusion Service brings health care out of clinical settings and into the community and on the streets, with the intention of wrapping care around the people who need it most, where they need it. The services include dental care, nursing care, podiatry and mental health counselling for those sleeping rough or in hostel accommodation.

The reading list for this debate is available here.

References

Department for Levelling Up, Housing and Communities (2022) Ending rough sleeping for good. Available at: https://assets.publishing.service.gov.uk/media/631229d7e90e075882ea2566/20220903_Ending_rough_sleeping_for_good.pdf

Public Health England (2020) Health matters: rough sleeping. Available at: www.gov.uk/government/publications/health-matters-rough-sleeping/health-matters-rough-sleeping

Scottish Government (2023) Homelessness in Scotland: 2022-23. Available at: www.gov.scot/publications/homelessness-in-scotland-2022-23/pages/reasons-for-homelessness-and-prior-circumstances/ 

Welsh Government (2024) Homelessness accommodation provision and rough sleeping. Available at: www.gov.wales/homelessness-accommodation-provision-and-rough-sleeping 

Welsh Government (2018) Inquiry into rough sleeping in Wales. Available at: https://business.senedd.wales/documents/s72682/RS20%20-%20Welsh%20Government.pdf

Further reading

Bullingham R (2023) Developing a nurse-led homeless health service at a general practice in Wales., Primary Health Care, 33(6), pp. 17–22.

Rae B E and Rees S (2015) The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care, Journal of Advanced Nursing, 71(9), pp. 2096–2107.