New NICE draft guidance to address homelessness and health inequality

NICE and the Centre for Homelessness Impact (CHI) have jointly published a new draft guideline to increase the access people experiencing homelessness have to health and social care services and improve their health outcomes.

Mortality among people experiencing homelessness is around ten times higher than the rest of the population and life expectancy is around 30 years less.

Yet, many of these deaths are from preventable causes as the homeless population face barriers to accessing health and social care services including stigma and discrimination, a lack of trusted contacts, and rigid eligibility criteria for accessing services.

The draft guideline is for people aged over 16 experiencing homelessness, including people sleeping rough, staying in temporary accommodation or ‘sofa surfing’ with family and friends.

It highlights that more effort and targeted approaches are often needed to ensure that people experiencing homelessness have access to the same standard of health and social care as the general population.

NICE recommends that care should be delivered via specialist multidisciplinary teams which span all sectors of care and be tailored to meet local needs. This care should encompass the physical health needs, mental health and psychological needs, drug and recovery needs, and social care needs of people experiencing homelessness.

Dr Paul Chrisp, director of the NICE Centre for Guidelines, said: “People experiencing homelessness face significant barriers to accessing health and social care compared with the general population, which results in huge health inequalities.

“‘Homelessness’ is a broad term as outlined by our draft guideline and does not simply refer to a person sleeping rough on the streets. By better understanding which people are experiencing homelessness and what their specific needs are, health and social care professionals will be better able to help them access the services they require.”

New pilot programme for homeless people being discharged from hospital

It comes in the same week that the Government launched a £16 million package for pilot projects to support people experiencing homelessness after being discharged from hospital.

These pilots in 17 areas – from London to Liverpool – will offer improved services to help some of the most vulnerable members of society with basic needs such as housing, employment and drug cessation, that can help them get back on their feet in the long term.

Dr Lígia Teixeira, chief executive of the Centre for Homelessness Impact, said: “The quality of services offered to people who are most excluded from society is too often far behind that offered to the general population.

“People who experience homelessness often have poorer health, especially mental health, and this guideline is an important step towards making health and social care services more accessible to them. It is very important to ensure that their needs as individuals are met and the guideline shows how this can be done sensitively and flexibly.”

The NICE draft recommendations suggest offering mobile outreach services with flexible opening and appointment times, drop-in services, and  help with transport would reduce barriers homeless people experience accessing health and care services.

It adds that people should not be penalised for missing appointments, for example by being discharged from the service. Peer supporters and advocates can help the person attend appointments or re-engage with care after missing appointments.

The draft guideline recommends that long-term engagement should be planned to help people who struggle to engage with services. Practitioners should take time to build a relationship of trust with the person, particularly when they first engage with services.

NICE and CHI worked with Public Health England (PHE), which has been succeeded by the Office for Health Improvement and Disparities (OHID), to develop this draft guideline.

The draft guideline will be out for consultation until 3 November and can be read here.