Steep rise in hospital admissions linked to homelessness

Author: Caroline White

There has been a steep year-on-year rise in the number of hospital admissions related to homelessness in England, new analysis of admissions data from health think tank, The King’s Fund, shows.

In 2018-19, 27,883 people were admitted to hospital in England with a primary or secondary diagnosis of homelessness, up from 24,500 the previous year.

Since 2013-14 there has been a 130% increase in hospital admissions related to homelessness.

The analysis coincides with a new report* from The King’s Fund, which finds that many people sleeping rough struggle to access health and care services until they are acutely unwell.

People who sleep rough experience a ‘toxic combination’ of struggles over personal safety, food, shelter and ill health, the report says.

As well as practical barriers to accessing healthcare, such as not owning a phone, the attitudes of some staff and a misconception that patients need a home address to register for GP services can make it hard to book NHS appointments, it says.

Difficulties accessing care often lead to health issues not being picked up until they have become more serious and require hospital treatment.

The average age of death for those who died while homeless in England and Wales in 2018 was 45 for men and 43 for women – more than 30 years below that of the general population. Around a third of these deaths are the result of treatable medical conditions like respiratory disease and HIV.

Researchers from The King’s Fund looked at efforts to better support people sleeping rough and found that people sleeping rough rarely fit neatly into service specifications, meaning health, housing, and care staff have to work around complicated rules and procedures.

Staff should be given greater flexibility to look beyond tight eligibility criteria for services and do the right thing for the individual, the report recommends.

As the government launches its new review of rough sleeping led by Dame Louise Casey, The King’s Fund is calling on her to highlight the critical importance of addressing physical and mental health issues to keep people off the streets and focus on removing barriers to joined-up work across agencies.

This includes the implementation of rules about proving a ‘local connection’, which the research found can limit the support provided to people sleeping rough.

The new report recommends that local health and care leaders coordinate their efforts with other agencies to avoid rough sleepers from being bounced from service to service.

The authors call on relevant government departments to work together to provide longer-term funding for local areas to allow them to plan and provide services effectively and sustainably.

Julia Cream, Fellow at The King’s Fund and lead author of the report, said: “People who sleep rough are living on the margins of society and all too often their health needs go unmet. They can face a toxic combination of drug and alcohol dependence, poor mental health, childhood trauma, abuse, and domestic violence. No one agency has all the solutions – health, housing, care and criminal justice all have to work hand in hand.

“Our research shows that the health and care of people who sleep rough can be improved when long-term funding is combined with local collaboration, listening to the needs of people who sleep rough and enabling staff to do the right thing.”   

Last week the prime minister pledged an extra £236 million to help “get rough sleepers off the street.”

*Delivering health and care for people who sleep rough: Going above and beyond. Prepared by The King’s Fund, February 2020.