Rory Weal, Senior Policy and Public Affairs Officer, explains why St Mungo’s, together with more than 20 homelessness and health organisations, have joined forces to urge NHS England to spend more on specialist health interventions for people experiencing homelessness.
Rough sleeping has more than doubled since 2010. Spiralling housing costs, increasing insecurity for private renters and cuts to services that prevent homelessness have all played their part. But rough sleeping is not just a housing problem, it’s a health problem too.
One person dies every day while sleeping rough
We face a situation where on average one person dies every day while sleeping rough or in emergency accommodation and many more have to cope every day with serious health conditions. Of the people seen sleeping rough in London in 2017-18, 50% had mental health problems, 43% were alcohol users and 40% were drug users. An estimated 46% had physical health conditions.
Complex needs like these are mutually reinforcing. Without targeted interventions and support, many people end up stuck in a cycle of homelessness, poor heath, and – sadly too often – premature death.
People can get stuck in a vicious cycle
The issue of homeless health has gained increased attention in recent months. Over the summer the Government’s Rough Sleeping Strategy contained expectations for the NHS to be spending £30 million on health services for people who sleep rough. The Chief Executive of the NHS, Simon Stevens, also made similar promises that the needs of people sleeping rough would be addressed in the upcoming Long Term Plan for the NHS.
This attention is welcome and long overdue. Health problems, particularly mental health problems, are often the reason why people are stuck sleeping rough. Poor mental health is an obstacle to engaging with services that can help move people off the street, while at the same time being homeless prevents people getting the mental health support they desperately need. This increases their exposure to the dangers of life on the street, and as a consequence, also increases their risk of early death.
Urgent and emergency care costs are high
The human costs of neglecting to address these issues are severe, but so are the financial costs. Estimates suggest the costs of treating homelessness for hospital inpatient and A&E admissions alone run to £2,100 per person per year, compared to £525 among the general population. In 2010 the total cost of urgent or emergency care for people sleeping rough was estimated to be £85 million per year, but this represents only a small fraction of the total costs to health services. The current figure is likely to be significantly higher.
Without a conscious, proactive effort by the NHS and wider social services these barriers, and the resulting poor and costly health outcomes, will continue to persist, in turn costing core and acute services more in the process.
The Long Term Plan is an opportunity for change
The Long Term Plan is being developed by the NHS to cover the next decade of service delivery, and will be published later this year. It presents a vital opportunity to reduce the appalling health inequalities which exist for some of the most vulnerable and unwell people in our society.
The £30 million promised by the Government’s Rough Sleeping Strategy is an insignificant amount in the context of the wider costs associated with homelessness. That’s why St Mungo’s, together with 20 other organisations across the homelessness and health sectors, want to see at least this amount pledged every year to develop specialist services for people who sleep rough, delivered in partnership with local authorities.
Specialist interventions – such as dedicated mental health teams working with people on the street, or tailored services to increase access to general practice – can prevent admissions to acute service like A&E further down the line. When delivered in partnership with local agencies and homelessness services, these initiatives can be an essential in helping people off the streets too.
We hope the contents of the Long Term Plan will build on the real momentum we have seen on the issue of homeless health in recent months.
St Mungo’s, together with more than 20 homelessness and health organisations – including Homeless Link and The Queen’s Nursing Institute – wrote earlier this week to the Chief Executive of NHS England, calling for more action to address the appalling health outcomes faced by people sleeping rough. You can read our joint policy briefing, developed with Homeless Link, here.
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