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Health, housing and social care integration for people experiencing homelessness: needs identified in an inpatient audit

Aerial photograph of Camden, London

Report supports NICE guidance for integrated health and social care for people experiencing homelessness, and finds that more appropriate accommodation is needed to support health and care needs of people who are homeless.

unable to return to living situation

needed basic accommodation

1 in 3
people had trimorbidity

The Health, housing and social care integration for people experiencing homelessness: needs identified in an inpatient audit took place over one week in February 2022 in hospitals across London. It was a detailed investigation of the health, care, support and accommodation needs of people identified as being homeless who were in hospital. The report is published in ClinMed Journal by the Royal College of Physicians, available here

Given the reality that unfortunately, there is currently no process for routine capturing of homeless health data, this report was carried out to help support more informed commissioning decisions to reduce these significant inequalities. The findings demonstrate unmet needs across health, housing and social care.

An audit of this scale and detail of this population has not been carried out before in hospitals across London. It represents data from 19 hospital teams (15 acute, three mental health and one community hospital) and focuses on an in-depth analysis of 104 of these people. Click here to download the report.

Key findings

The audit found high levels of complexity of health and support needs, the following key findings emerged.

  • Two-thirds (63.9%) had three or more different clinical issues related to their admission (the most being eight) and one third had tri-morbidity.
  • Most people (92%) were unable to return to their pre-admission living environments as they were not appropriate, safe or secure for their needs.
  • Appropriate accommodation with a range of additional care and support services (including community inreach or floating support) is needed to meet their complex needs, less than 1% of inpatients needed ‘just’ accommodation.
  • More than four in 10 (45.2%) were projected to need short-term intermediate care/step-down.
  • 46.1% were projected to need long-term accommodation with a range of support services, including 14% who needed specialist long term care.
  • Nearly one in four people had uncertain or restricted immigration status, meaning they may not be entitled to support with accommodation. Most of this cohort had care needs (62.5%). They all would have likely benefited from short-term intermediate care to prevent delayed discharges and support ongoing care and specialist case working.
  • Homelessness is not just a housing issue. Only one individual (1%) required accommodation alone following their hospital stay.
  • Due to a lack of safe and appropriate step-down options, almost half (44.2%) of people remained in hospital longer than needed.

Further work is needed to ensure teams are equipped to capture routine data on vulnerable populations to improve their visibility across the system and help inform commissioning decisions.

Long-term investment and a continued commitment to improving the accessibility and quality of services for these groups is crucial to sustaining achievements made to date.


What can you do?

Share the report with your network to raise awareness of the unmet need facing people experiencing homelessness

Download the report summary above and advocate for more funding and resource to reduce ongoing inequalities

Act on the recommendations of the audit and advocate for changes to reduce health inequalities