Health and care services for people sleeping rough

People sleeping rough often experience barriers in accessing quality health and care. Our project, commissioned by the Department of Health and Social Care, seeks to understand emerging local approaches to tackling these barriers, as well as how integrated strategies can prevent and reduce rough sleeping on a sustained basis.

Why we did this project

People sleeping rough often experience barriers in accessing quality health and care and experience poor health outcomes. In 2018 the average age of death for people who died while experiencing homelessness was more than 30 years below that of the general population, with women on average dying at the age of 43 years old – 38 years earlier than women in the general population.

Those who experience rough sleeping can have high and complex support and treatment needs. Effective health and care services should address these needs but could also play an essential role in providing a solution to entrenched homelessness.

The government’s 2018 rough sleeping strategy sets out a plan to halve rough sleeping by 2022 and end it by 2027. As part of this, the Department of Health and Social Care, the Ministry of Housing, Communities and Local Government, Public Health England, and NHS England committed to gaining a better understanding of gaps in health provision for people who are sleeping rough, to inform future commissioning and ensure the health and care system meets people’s needs. They began by assessing the effectiveness of existing initiatives in achieving the following outcomes:

• that people sleeping rough can access health services of equal quality to others, and the impact of rough sleeping on health is minimised

• that ill health does not prevent people moving off the streets or sustaining a settled lifestyle.

What we did

Our project, commissioned by the Department of Health and Social Care, highlights successful local approaches to achieving these outcomes, describing the challenges experienced and identifying where action at a wider level is likely to achieve the best value.

The work considers:

• the perspectives of those with experience of sleeping rough on local health and care services

• the views of selected stakeholders on what needs to be in place to deliver effective health and care services for people sleeping rough

• the ways in which need and effectiveness are understood and measured across a set of local systems

• how local areas develop integrated strategies to prevent and reduce rough sleeping on a sustained basis, including through effective co-ordination of services

• the capacity and sustainability of the system to deal with both current and future demand, and where the challenges and opportunities might lie for government departments

We have reviewed published literature and work with local system leaders in a small number of case study areas to understand their emerging approaches.

Our partners at the University of York have also gathered the views of people with lived experience of sleeping rough on accessing health services in each of the local areas.

Video: lived experience of rough sleeping

Partner organisation

Centre for Housing Policy, University of York