King's Fund - Sharp increase in hospital admissions related to homelessness

4 Mar 2020 02:33 PM

New analysis from The King’s Fund shows a steep year-on-year rise in the number of hospital admissions related to homelessness in England.

In 2018/19, 27,883 people were admitted to hospital in England with a primary or secondary diagnosis of homelessness, up from 24,500 in 2017/18. Since 2013/14 there has been a 130 per cent 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.

The report’s authors found that people who sleep rough experience a ‘toxic combination’ of struggles over personal safety, food, shelter and ill health. The average age of death for those who died while homeless in England and Wales in 2018 was 45 years old for males and 43 years old for females – more than 30 years below that of the general population.1 Around a third of these deaths are the result of treatable medical conditions like respiratory disease and HIV.2

Despite their poor health, people sleeping rough often find it hard to access services. As well as practical barriers such as not owning a phone, the attitudes of some staff and a misbelief that patients need a home address to register for GP services can make it hard to book NHS appointments. Challenges accessing care often lead to health issues not being picked up until they are more serious and require hospital treatment.

Researchers from The King’s Fund examined efforts to better support people sleeping rough and have produced a series of practical recommendations for health and care services. They 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. The authors recommend that staff be given greater flexibility to look beyond tight eligibility criteria for services and do the right thing for the individual.

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 co-ordinate their efforts with other agencies and avoid people who sleep rough being bounced from service to service. The authors also 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.

Dena Pursell slept rough on the street from the age of 16 to 19 and experienced several health issues as a result. Commenting on her experience, Dena said:

‘I used to have really bad breathing problems – I got bronchitis when I was first out on the street. I did try to register with a doctor, but they weren't having it because I had no address. Most of the services I went to I found that people would give me clothes and food, but they wouldn’t help with any other problems I had like anxiety or depression. 

‘People do need help. You can't just put someone in a house who hasn't had one for years and put a roof over their head and expect everything to be hunky dory, it's not going to be. There's a lot of other issues that have probably caused that person to be in that situation.’

Julia Cream, Fellow at The King’s Fund, and lead author of the new 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.’
          
During the 2019 general election campaign, the government made a manifesto commitment to end rough sleeping by the end of 2024. Last week the Prime Minister confirmed an extra £236 million to help ‘get rough sleepers off the street’.

This new research into health and care for people sleeping rough follows the launch of The King’s Fund’s new strategy which includes a focus on improving the health of those with the worst outcomes. 

1.Office for National Statistics, ‘Deaths of homeless people in England and Wales: 2018’. Office for National Statistics website. Available at: www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsofhomelesspeopleinenglandandwales/2018 (accessed on 2 March 2020).

2.Aldridge RW et al (2019). ‘Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England’. Wellcome Open Research, vol 4, pp 49–66. Available at: https://wellcomeopenresearch.org/articles/4-49 (accessed on 2 March 2020).

Notes to editors

Hospital admissions data

  • The data on hospital activity in England is taken from the Hospital Episode Statistics collection, the most complete compilation of data on hospital activity in England available. We have used the publicly available summary statistics for each year which are available on the NHS Digital website.
  • Hospital activity was reported where the ICD-10 code ‘Z59.0 – Homelessness’ was present as a diagnosis. 
  • Each hospital episode relates to a period of care for a patient under a single consultant within one hospital provider. A stay in hospital from admission to discharge can be made up of one or more episodes of care. 

Dena Pursell

Dena Pursell is not available for interview, but a short video of her talking about her own experience of sleeping rough is available for re-use on request. Dena now works as a homeless health care navigator with the charity Groundswell and helps people to access health and care services. Groundswell exists to enable people experiencing homelessness to take more control of their lives, have a greater influence on services and have a full role in our community.

Further information

For further information, contact Andrew McCracken, Head of Press and Public Affairs, The King's Fund: a.mccracken@kingsfund.org.uk | Tel: +44 (0)20 7307 2594 | Mob: +44 (0)7774 907 960

The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.