How many people are homeless?
The Office of National Statistics revealed that the number of people sleeping rough in England rose by 134% between 2010 and 2017. Rough sleepers make up a small proportion of the number of people who are homeless in England. The charity Crisis estimates that 4,134 were sleeping rough in 2016 on a single night across England.
Research by the Joseph Rowntree Foundation found that 1,252,000 people, including 312,000 children, were destitute at some point in 2015.
What is the general profile of people who are homeless?
The majority are UK born, young, single men. However there are also a considerable number of families living in destitution.
What are the factors leading to destitution?
Destitution is defined as being when someone lacks two or more basic essentials in one month e.g. slept rough, had one or no meals a day for two or more days, been unable to heat or to light their home for five or more days.
There is generally no single cause, but most people had been living in poverty for a considerable length of time before tipping into destitution. The most common factors driving this were:
• the extra costs of ill health and disability
• the high costs of housing and other essential bills
• a financial shock like a benefit sanction or delay.
What is the role of local government?
Local government is not obliged to help house people unless they are judged to be of priority need (families with children, people in an emergency after a flood or fire, or who are ‘vulnerable’ for various other reasons).
The new Homelessness Reduction Act 2017
Set to be implemented in 2018, the act asks local government bodies to intervene earlier to help prevent people from becoming homeless in the first place. It also means that officials have to also consider those who are not counted as priority need.
Health inequalities and people who are homeless
The striking thing about inequalities in health is that the people whose needs are the most overlooked are often those who are least able to advocate for themselves and this is a major issue if you are homeless. As mentioned earlier, many of those who come to be homeless have mental health issues or a disability. Housing, health and relationships are all affected by poverty, and those without a home have to face all three with little if any support. They are less likely to have emotional resources and would have been drained of much of their resilient capacity.
Equality legislation and the National Health Service
The Care Quality Commission (CQC) is a health service monitoring body in England. In 2016 it published its review – ‘A different ending: addressing inequalities in end of life care’ – which found that people who are homeless have very poor outcomes in terms of health care and also end of life care. It recommended an equality-led approach and asked that people who commission health services should fulfill their duties under the NHS Constitution, the Health and Social Care Act 2012 and the Equality Act of 2010. A key feature of these duties is to plan future services which will elimiate discrimination and advance equality when developing, arranging or delivering care in the future.
End of life care for people who are homeless
It is often said that the needs of people who are homeless are not well understood, and that they are seldom taken into consideration by different health providers. A lot of this stems from the structure of healthcare provision and the need for joined-up planning and service delivery. Often, people who are homeless, slip through the very fragmented and isolated working arrangements of care providers. The result is that they experience little continuity of care so that signs of deterioration in their health or circumstances are often missed.
Here are some discussion points to think about
As it is difficult to identify a homeless person who is dying, would it be more useful to shift towards focusing care on all homeless people who have advanced or deteriorating health problems?
Are health commissioners and providers adequately knowledgeable about their local homeless population and their needs?
Homeless people often have complex care requirements, yet don’t have access to
the continuity or quality of care services that they need. This is the case in hospital, when
discharged into the community and in terms of options at the end of life. Can health commissioners provide an alternative care pathway for those in this situation to take into account the factor of being homeless and the need for a different form of multi-agency working?
It has been suggested that within the current environment a hostel-based hospice may provide a solution for end-of-life care for those who are homeless. But this would need to be a service providing 24-hour care with the additional support of health, housing and social services. Is this feasible under the current systems and procedures of health provision in England?