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% increase in hospital admissions related to homelessness.

The number of older people falling into homelessness has surged in recent years with a 39% rise in people over 60 approaching the authorities because they are in need of housing by local councils over the last five years, with the figure increasing from 1,800 in 2012-13 to 2,500 in 2017-18.

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.

A third of homelessness deaths are treatable medical conditions 

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. Around a third of these deaths are the result of treatable medical conditions like respiratory disease and HIV.

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.

Misbelief that patients need a home address to register for GP services

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.

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."