Supporting the health needs of those who are experiencing rough sleeping

Tackling rough sleeping has long been a priority for successive governments. According to the latest official statistics, rough sleeping in England has increased by 165 per cent since the autumn of 2010. Whilst the current number of 4,677 is down two per cent in a year, the overall long-term trend is of a vast increase in rough sleeping across the country. Almost half of all councils have reported an increase in people sleeping rough in their area. The Government has set the ambition of halving rough sleeping over the course of the parliament and eliminating it altogether by 2027. To do that, its 2018 Rough Sleeping Strategy focuses on prevention, intervention and recovery.

At the heart of all three is the need to address the health needs of those experiencing rough sleeping. Homeless men and women die young – by an average age of 47 for men and 43 for women. This compares to 79.5 for males and 83.1 for females in the general population.

An estimated 41 per cent of people experiencing rough sleeping have long-term physical health problems such as heart disease, diabetes and addiction problems, compared to 28 per cent of the general population. Another 45 per cent have been diagnosed with mental health issues, compared to 25 per cent. One in three have what are classed as complex needs – defined as having at least two problems.

Drug taking and alcohol in particular can make it difficult for those who are experiencing rough sleeping to be helped off the streets as continued abuse can end up with them being excluded from accommodation.

For those individuals with the most complex needs, a Housing First approach, which involves offering stable accommodation without the need to be free of substance misuse problems, is helping tackle this. But long-term progress for these vulnerable individuals still requires effective and integrated health and care solutions to be tailored around their needs.

The Homelessness Reduction Act 2017 places a statutory duty on councils to prevent homelessness and support all those requesting help who may be at risk of homelessness, irrespective of whether or not they are in the groups which previously allowed them to prioritise.

The rise in demand and need to make efficiencies means that areas are looking to innovate in how they support people, and to integrate health and care solutions. So what works? The examples in this report shows there is plenty of good practice out there. For example, Tower Hamlets has used it to pay for psychological support on the streets.

But there are other examples that pre-date this funding boost. Newcastle is ensuring those who are experiencing rough sleeping who end up in hospital are supported so they are not released back on to the streets, while in Bradford funding has been sourced to pay for a mobile health unit to tour the streets.

So much of what works is based on making the most of every opportunity to engage this vulnerable client group. Services need to be proactive – those who are experiencing rough sleeping cannot just be booked in for appointments as a member of the general public would be.

Where good practices are introduced though it makes a difference. People on the streets are being engaged and given vital treatment and care, which in turn is helping them transform their lives and get off the streets. If rough sleeping is going to be eradicated, addressing basic health needs will be an essential part of that.

Councillor Ian Hudspeth


LGA Community Wellbeing Board 


Case studies