Today, a coalition of organisations working directly with people experiencing homelessness or other forms of social exclusion are calling on the Westminster Government to accept amendments to the Health and Care Bill as it passes through the Lords. The amendments would ensure the NHS plays its full role in tackling health inequalities amongst these groups.

The full letter reads:

Ms. Gillian Keegan MP
Minister for Care and Mental Health
Department of Health and Social Care
39 Victoria St

11th January 2022

Dear Minister,

As organisations supporting or representing people from marginalised communities, we are writing to urge you to amend the Health and Care Bill so that it addresses the needs of people who experience severe health inequalities  as a result of social exclusion.

As you will know, there is a well-established link between disadvantage and poor health that demonstrates the devastating impact that social exclusion can have on someone’s physical and mental health. For example, the average age of death for people experiencing homelessness in England and Wales is 46 for a man and 42 for a woman. This is compared to life expectancy in the general population of 79 for men and 83 for women. We also know the life expectancy of Gypsy, Roma and Traveller communities is around 10-12 years less than the general population.

People who experience the most extreme of health inequalities, such as those who are homeless; sex workers; Gypsy, Roma and Travellers communities; vulnerable non-UK nationals; and people with substance misuse issues, also encounter significant barriers to accessing and receiving healthcare that meets their needs. These barriers can include stigma, discrimination, no fixed address or photo ID, fragmented services, a disruption to continuity of care because of unstable accommodation, immigration status, and a lack of awareness by healthcare professionals of their specific needs. Too often this results in people continually moving through support systems without getting the help they need.

We work directly with people in this situation on a daily basis and witness how they can fall through the gaps of basic health services. For example, one patient experiencing rough sleeping, supported by the HealthNow partnership, had run out of his medication but could not afford to travel to his GP or pharmacy. He also struggled to read and write so he couldn’t understand written information. With the support and help of a Health Advocate this individual was able to access the help of his GP and local Drug and Alcohol Service.

However, such services that connect these communities to mainstream healthcare and support their holistic needs, are not currently widely commissioned and remain a postcode lottery. This was highlighted in the Kerslake Commission on Homelessness and Rough Sleeping, which found that during the pandemic there was a significant degree of local variation in response to meeting the health needs of people experiencing homelessness. King’s College London found that 56.5% of homelessness projects in England do not have specialist primary healthcare services in their area.

We strongly welcome the Government’s commitment to tackle inequalities and to integrate health and care services. However, we are concerned that the current Health and Care Bill does not go far enough to address the needs of people who have historically faced severe health inequality and continue to do so. As the Bill passes through the House of Lords, we urge you to accept the amendments laid by Lord Young of Cookham which will be considered today, on the first day of Committee Stage (amendments 152, 156 and 157 to Clause 21). The amendments are also co-sponsored by Baroness Armstrong of Hill Top; Lord Shipley; and Baroness Neuberger. We have attached these cross-party amendments in full to the accompanying email for your ease.

The amendments will ensure that all newly created Integrated Care Partnerships have ‘due regard’ in their strategies to improving the health outcomes of people who experience the worst forms of health inequalities due to social exclusion. Although the Bill already places a duty on Integrated Care Boards to have regard to the need to reduce health inequalities, we do not consider this to be at the scale nor the level of integration required across the health and care system to tackle health inequalities faced by the people we support and represent.

These amendments would ensure specific and dedicated attention from Integrated Care Partnerships to people who experience severe health inequalities. It will help strengthen and complement the Government’s welcome ambition in this area to tackle the ‘disease of disparity,’ as the Secretary of State for Health and Social Care said recently. Building on the progress made in the pandemic, it will also make clear the importance of having a stable home on health outcomes, by ensuring Integrated Care Partnerships consider housing in addition to health and social care in their local strategies. It is clear from our expertise working with these groups that inadequate housing can have a devastating impact on an individual’s mental and physical health.

Beyond the damaging effect of health inequalities on individuals, these unmet health needs also come with a huge and avoidable cost to the healthcare service and wider society. These amendments will help alleviate pressure on emergency care and save money, at a time when NHS services are under unprecedented pressure – research by the Lankelly Chase Foundation estimated conservatively that the cost of severe and multiple disadvantage to society is £10.1 billion per year.

These amendments will help the most marginalised in our society to access and benefit from critical health services, and we call on the Government to use the opportunity of the Health and Care Bill to strengthen its commitment to tackling health  inequalities. We would welcome the opportunity to discuss these amendments with you as the  Bill passes through the House
of Lords.

Yours sincerely,

Matt Downie MBE, Chief Executive, Crisis
Alex Bax, Chief Executive, Pathway
Steven Platts, Chief Executive, Groundswell
Sarah Mann, Director, Friends, Families and Travellers
Steve Douglas CBE, Chief Executive St. Mungo’s
Sally Daghlian OBE, Chief Executive, Praxis
Anna Miller, Head of Policy & Advocacy, Doctors of the World UK
Enver Solomon, Chief Executive, Refugee Council
Stephen Bell OBE, Chief Executive, Changing Lives
Moya Woolven, Chief Executive, Basis Yorkshire