Homelessness is a significant challenge for health services, and the numbers of homeless people are increasing nationally. Recent published research estimates that at least 320,000 people are homeless in Britain1. This is a year-on-year increase of 13,000, or a 4% rise, suggesting that nationally one in 200 people are homeless.
Homelessness is associated with poor health outcomes, with dire consequences for individual patients. Homeless and excluded people are 10 times more likely to face an early death than those of us with a home2. The average age of death for a homeless woman is 43, and for a man 473. Recent investigations have found high numbers of people literally dying on the streets4.
Patients experiencing homelessness and social exclusion can be challenging to treat due to their multiple and complex needs. A person who is homeless is:
Because of the severity of these health issues in the homeless population, there is a significant cost to the NHS.
Ten years ago the Department of Health’s own research estimated that the increased use of health services by homeless people cost at least £85 million per year7.
Pathway hospital teams improve health care for homeless patients in hospital. Without a Pathway team, busy hospital staff often find they have little alternative than to discharge patients back into homelessness. The streets are not an easy place to recover, and many patients end up back in hospital very rapidly, with the same problem all over again.
The UCLH Pathway Team involves in-hospital GPs, dedicated Pathway nurses and Pathway Care Navigators, working with others to address the housing, financial and social issues of patients. Following its introduction, A&E attendances by supported individuals fell by 38% with a 78% reduction in bed days. Pathway was set up as a charity to build on this first team. It helps the NHS to create hospital teams to support homeless patients, and ten hospitals in London, Leeds, Bradford, Manchester, Bristol and Brighton have since adopted the model.
Aldridge, Robert W et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet, Volume 391, Issue 10117, 241 – 250
Thomas, B. (2012) Homelessness kills: An analysis of the mortality of homeless people in early twenty-first century England. London: Crisis.
The Bureau of Investigative Journalism: Dying Homeless: Counting the deaths of homeless people across the UK
Beijer, Ulla et al. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. The Lancet Infectious Diseases, Volume 12, Issue 11, 859 – 870.
Story, A. (2013) Slopes and cliffs: comparative morbidity of housed and homeless people. The Lancet. Nov 29. Volume 382. Special issue. S1-S105
Department of Health (2010) Healthcare for single homeless people. London.