The NHS in Crisis

Amongst challenges that people experiencing homelessness in the UK face daily, health inequalities are of increasing concern. The NHS is in the “midst of the worst crisis in its history”, facing rising maintenance costs, and staffing shortages, despite an increased demand for services between 2022 and 2023. Those facing poverty and homelessness in the UK are disproportionately affected. They are more likely to have health conditions that require treatment but face difficulties in accessing care.

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Health Disparities Among the Homeless Population

People experiencing homelessness in the UK are far more likely to have asthma, heart disease, and epilepsy, and 82% have a mental health diagnosis. The average lifespan for a homeless man is 45 years old, and 43 years for women, compared to 78 and 82 years old respectively. These numbers do not only show the mental and physical health diagnoses that homeless people face, but also indicate an increased demand for NHS services, worsened by a growing homeless population. Between 2010 and 2023, the number of people in TA doubled from 90,0000 to 180,000 and the number of people sleeping rough also doubled from 1768 to 3898.  

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Of these people, A&E attendances are nearly 2x as high and emergency admissions are 68% higher than those in least deprived groups, according to a Joseph Rowntree investigation. Increased demand for costly emergency services is a reflection of difficulties in accessing care that homeless people face. Despite people who are homeless experiencing health conditions that make them more likely to need health services, these people often do not receive the same level of care as the general population.

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Barriers to Access

For example, in primary care, a lack of identifying documents or most concerningly, a proof of address presents obstacles to people trying to register with a GP. Despite proof of address not being a legal requirement, a study found that only 31% of people with no ID/address were able to access GP services. Due to this, people experiencing homelessness attend A&E four times as often as the general population and are eight times as likely to need inpatient care. As the numbers of people in temporary accommodation continue to grow, the relationship between societal health and an increase in homelessness becomes increasingly obvious. Limited access to community and primary care places a costly burden on emergency services and urgent care.

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Making care more easily accessible, and investing in community services outside of hospitals are key measures that will substantially improve community health, and in turn, prevent people from falling into homelessness. As poor health precipitates homelessness, addressing homelessness requires improving access to healthcare. Despite these figures, the NHS 10-year plan, as reported on by the Financial Times, is lacking one crucial element. Despite one of the guiding principles being shifting health care to prevention and community services to relieve pressure on hospitals, spending on hospital services has increased as a proportion of total NHS expenditure, whilst the proportion spent on primary care and community health services has decreased. It’s clear that access to community care and support is vital in keeping people in good health, off the streets, and out of hospitals.

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