In the report, Voiceless, unheard and socially excluded: Accessing health and care while homeless or vulnerably housed, Healthwatch Dorset identifies key barriers that prevent people from getting treatment and care and recommends how services could improve support.
Understanding the challenge
The report highlights the concerning disparities in health outcomes for people experiencing homelessness, who often encounter some of the poorest health outcomes in both mental and physical health. Social exclusion and stigma frequently exacerbate their deteriorating health and contribute to preventable deaths. Shockingly, recent findings indicate that the average age of death for people experiencing long-term rough sleeping is just 46 for men and 42 for women (Source: Pathway, March 2024).
Listening to local people to inform positive change
To better understand these challenges, Healthwatch Dorset conducted a ten-week project from January to March 2024. During this period, they visited health, community and homeless support services in Bournemouth, engaging directly with 26 people who are currently experiencing homelessness or living in vulnerable housing, as well as seven health professionals and support workers.
The report is rich with firsthand accounts of the daily struggles faced by those attempting to access health and care services. As one service user poignantly shared, “There is no accountability for people who are dying on the streets. Services are very limited to us and there is no governing body who can challenge a service on our behalf.”
Key findings
The report identifies several significant barriers preventing people from accessing the care they desperately need:
- Lack of fixed address or ID: Many people are refused GP services because they lack a fixed address or formal ID.
- Digital exclusion: The reliance on online forms such as eConsult presents a significant barrier for those without access to technology or the skills to use it.
- Cost of communication: The cost of phone calls, often while held in a long queue, can prevent access to GP services as people don’t have phone credit.
- Mobility and transport issues: Limited mobility due to poor health, and lack of cheap and available transport, make it difficult for people to reach healthcare facilities.
- Stigma in healthcare settings: Many feel judged and uncomfortable in healthcare environments due to their appearance or hygiene.
- Common health issues are poorly managed: Addiction withdrawal
symptoms and leg ulcers are poorly managed, leading to people not seeking treatment or discharging themselves from hospital. - Barriers to mental health support: Those struggling with active addiction are often unable to access vital community mental health services.
- Limited NHS dental access: Access to NHS dental care is severely limited, with some people resorting to extreme measures to relieve pain.
- Poor access to basic facilities: Living without access to basic facilities such as washing and cooking for long periods is detrimental to physical and mental health.
Recommendations for change
Healthwatch Dorset has outlined several recommendations to address these issues, emphasising the need for integrated services, improved training for healthcare staff, and the removal of systemic barriers to healthcare access. Key recommendations include:
- Integrated neighbourhood services: Co-design and co-deliver services with people who have lived experience of homelessness to improve local health and social care.
- Empathetic, person-centred care: Train hospital staff to provide inclusive, non-judgmental care that addresses health inequalities, including better understanding and management of addiction withdrawal.
- Removing systemic barriers: Ensure processes are in place to support people experiencing homelessness in registering with a GP or dentist.
- Improving accessibility: Enhance support for health and care providers to meet individuals’ communication and information needs, and circumstances.
- Innovative service provision: NHS Dorset should collaborate with the GP Alliance and local homeless support services to provide more flexible healthcare options, particularly for wound and skin care.
The findings and recommendations from the report have been shared with the Dorset NHS Integrated Care Board (ICB) to aid in the development of improved community services. The report will also be shared with the Care Quality Commission (CQC) and Healthwatch England to amplify the voices of those who are often unheard in discussions about healthcare.
Kate Hibbitt, Operations Director of the HealthBus Trust, one of the organisations that supported Heathwatch Dorset to carry out this project, commented: “The HealthBus team are passionate about improving the health and wellbeing of the most vulnerable by providing specialist homeless healthcare. We are incredibly grateful to Healthwatch Dorset for carrying out this research to understand the daily challenges for people experiencing homelessness, exclusion and health inequalities. Our hope is that this report will amplify the homeless voices who have shared their unique insights into the struggles, barriers and systemic issues they face. We anticipate that these findings will provide valuable context to address change in the system, improving access, patient experience and their hopes for the future.”
David Freeman, NHS Dorset Deputy Chief Executive and Chief Commissioning Officer, said: “This report is very much welcomed by NHS Dorset. It provides real insights and reflections on the experiences of people who are often disadvantaged due to their insecure housing situation or homelessness. It brings to life the challenges people face in accessing health care and support. The findings very much align with work we have started with our partners across the Integrated Care System to review and plan improvements. Health and care services need to be responsive to anyone experiencing housing challenges and we need to make accessing health and care services easier for those vulnerably housed. This report will help us further develop our health and care offer, so it is equitable for all sectors of our community.”
Read the full report