Health and homelessness

This page looks at the relationship between homelessness and health and shows examples of where local authorities and health agencies are working closely together. It also demonstrates how health issues can be incorporated into reviews and strategies.

By Pat Illingworth, Health Visitor (Homelessness), Slough Primary Care Trust

Links between homelessness and ill health

People can become homeless due to poor health. Poor health in turn is likely to be exacerbated by homelessness. Addressing the health needs of homeless people in homelessness strategies can contribute towards breaking this cycle.

Street homeless

Research[1]into the health of the single homeless rough sleeper population shows that:

• 30-50 per cent of homeless people experience mental health problems
• about 70 per cent of homeless people misuse drugs
• rough sleepers have an average life expectancy of 42 years
• there are high rates of TB, respiratory problems and skin diseases.

In spite of this level of poor health street homeless people are 40 times more likely than the general population not to be registered with a GP. [2]

Temporary accommodation

Families living in temporary accommodation also experience significantly more health problems than the general population: [3]

• homeless children are twice as likely to be admitted to hospital for accidents and infectious diseases
• behavioural problems have been found to be higher among homeless children
• mental health problems are significantly higher among homeless mothers and children.

Partnership working

Primary Care Trusts

Primary Care Trusts (PCTs) provide primary and community health care. PCTs are also responsible for:

• improving the health of people living in their area
• the main local public health functions.

Each PCT has a Director of Public Health. The Public Health Directorate in your PCT is the first place to contact in relation to the health aspect of homelessness strategies.

Most PCTs have the same boundaries as local authories. Where they are not the same, joint working is more problematic and a local housing authority (LHA) may have more than one PCT to work with.

The main role of the PCT's Public Health Directorate is providing public health leadership for health improvement by:

• working in partnership with their Local Strategic Partnership (LSPs) and local community
• delivering a range of public health services and programmes for their community
• providing expert public health advice and support.

Joint working

It is important that services are effectively co-ordinated and the LHA makes links both:

• at a strategic level in the PCT, and
• with front line practitioners working with homeless people.

The preparation or revision of the homelessness strategy may be an incentive for the PCT to review what health services are available for homeless people in the area, to identify gaps and examine what services might be developed to fill those gaps.

Local Delivery Plans

PCTs are required to develop three year Local Delivery Plans in accordance with the priorities set out in the Department of Health Planning and Priorities Framework. Many of the identified priorities are areas where homeless people are particularly disadvantaged, namely:

• access to primary care
• waiting times in A&E
• mental health services
• reduction in teenage conceptions
• better services for drug users
• reductions in health inequalities.

If the issues identified in the homelessness review match with any of these areas this may provide a specific lever to promote partnership working with the PCT.

Health content of reviews and strategies

There is no template for what homelessness reviews and strategies should contain on health issues. However a basic structure might be:

• a demonstrable understanding of the links between homelessness and ill health
• an assessment of homeless people's health and health care needs
• an understanding of the network of health care services
• an evaluation of current provision
• a plan to address the gaps in services.

Examples of services for homeless people that can be developed include:

• improving access to health care through specialist and mainstream providers
• developing resource packs on:
  • homelessness services for use in health services
  • health services for people living in temporary accommodation
• ensuring input from health workers into vulnerability assessments and resettlement plans
• developing protocols between hospitals and homelessness services.

Existing good practice

Many LHA areas, particularly those with a high homeless population, already have specialist health services for homeless people.

These may be:

• health care teams going into hostels and other temporary accommodation
• a specialist health visitor post
• a GP surgery that has a specific responsibility for homeless people.

Where these exist they are a useful source of data on homelessness in the area and their activities and plans can be included in the strategy.

There are also many examples of partnership working between housing authorities and PCTs. These include:

Blackpool

Blackpool PCT have a Health Team for the Homeless. They work closely on a one-stop shop model with:

• housing advice
• hostel services
• child care
• adult services
• asylum team
• environmental health
• voluntary sector providers.

They provide a health service to all homeless people accommodated by Blackpool for their stay in temporary accommodation and for six weeks after being resettled. They also work with non-priority homeless people and run a homeless health clinic.

Richmond

Richmond LBC's homelessness forum has a health and social care subgroup. The group reviews its progress at the end of the year and publishes an annual plan. The local authority, the PCT and the voluntary sector jointly own the plan.

Housing Services run a 'What we do in Housing?' training course aimed at non-housing staff in the statutory and voluntary sectors. About half of attendees have been health visitors. Contact: C.Waters@richmond.gov.uk

Slough

Slough PCT has a specialist health visitor for homeless people. Aspects of her work include:

• working closely with Slough Borough Council's housing department, she has contributed towards the development of a non-housing needs panel to provide an objective health perspective on requests for rehousing
• developing good practice guidelines for community practitioners and GPs to facilitate appropriate referrals to the local authority housing
• developing good practice guidelines for health visitors supporting people accommodated in bed and breakfast accommodation and women's refuges
• submitting a successful bid to the Children's Fund for a link worker post to support families and children living in temporary accommodation, enabling other projects to recognise the needs of families in temporary accommodation
• working with other statutory and voluntary agencies and primary care to address the health care needs of asylum seekers and refugees.

Contact: Pat.Illingworth@berkshire.nhs.uk.

 

 

[1]Sian Griffiths, Addressing the health needs of rough sleepers, ODPM, 2002.

[2]Crisis, Critical Condition: Homeless people's access to GPs, 2002.

[3]P. Vostanis, The impact of homelessness on the mental health of children and families, 1996.