People experiencing homelessness face significant health
inequalities and poorer health outcomes than the rest of the
population. 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. 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 covers people aged over 16 experiencing
homelessness, including people sleeping rough, staying in
temporary accommodation or ‘sofa surfing’ with family and
friends.
The draft guideline 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.
It 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.
“We’re pleased to publish this draft guideline, developed in
partnership with the CHI and PHE, and hope the recommendations
will help improve outcomes for people experiencing homelessness
in line with NHS Long Term Plan.”
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 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.
They 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.
About the draft guideline
- Putting recommendations into practice can take time. How
long will vary from guideline to guideline, and will depend on
how much change in practice or services is needed. Implementing
change is most effective when aligned with local priorities.
When exercising their judgement, professionals and
practitioners are expected to take this guideline fully into
account, alongside the individual needs, preferences and values
of their patients or the people using their service. It is not
mandatory to apply the recommendations, and the guideline does
not override the responsibility to make decisions appropriate
to the circumstances of the individual, in consultation with
them and their families and carers or guardian.
