A report from a conference held by the King’s Fund looking ahead to how the health service will develop over the next five years concluded that “the £20bn of unmet cost pressures on the NHS is seen by many to trump all other issues”. and that following the election, all the cards have been thrown into the air and no-one is sure where they will fall”. We have already noticed how pressures on healthcare service have meant that it is harder to guarantee how often the centre has nurses on-site. It seems worthwhile to remind ourselves of why we want to preserve health services that are specifically tailored to work among the homeless population.

Homelessness creates such multiple risk factors to health that it is difficult for homeless people to achieve even basic health and well being. Risks include lack of nutrition, hygiene facilities, personal safety, privacy, warmth, space, access to warm clothing, money, mobility, stable, supportive relationships, and more. Health almost inevitably deteriorates as a result of being homeless – as immediate needs such as shelter, food and warmth are placed ahead of health needs. Already, homeless people suffer from significant health inequalities in comparison with people in more secure accommodation both in terms of their health status and their ability to access health services.

Mental Health Needs
• Mental health problems are a leading cause of homelessness – in one third of cases, losing a home is associated with mental health problems • Homelessness can create mental health problems for the first time and exacerbate those which already exist.
• Mental health problems were eight times as high among hostel and B&B residents and 11 times as high among people sleeping rough compared to the general population.
• People who sleep rough are 35 times more likely to commit suicide.

Physical Health needs
• People sleeping rough have a rate of physical health problems that is two or three times greater than in the general population.
• The average life expectancy for rough sleepers is 42.
• Homeless people experience significantly higher rates of health problems including respiratory disorders, skin and dental problems, musculoskeletal problems, and sexually transmitted diseases.
• The rate of tuberculosis among rough sleepers and hostel residents is 200 times that of the known rate among the general population.
• Rates of chronic chest/breathing problems and frequent headaches were twice as high among people in hostels and B&Bs and three times higher among people sleeping rough.

Access to healthcare
• In spite of the severity of their health problems, homeless people frequently experience great difficulties in accessing health care.
• They are 40 times more likely to not be registered with a G.P.
• Yet they are four times more likely to use Accident and Emergency than the general population.
• Difficulties with access include: significant administrative barriers to GP registration, need for flexibility and accessible opening hours such as drop in or same day appointment and need for outreach to ensure that homeless people access services. That’s why we feel lucky to have primary health and mental health services on –site as this promotes ease of access and immediate assistance for clients.

We hope that in the current economic climate and the political drive for savings, such services continue to be offered to some of the most vulnerable and excluded populations

Margaret Shapland – Advice and Welfare