EMBARGO: 00:01 hrs on Wednesday 13th March 2024

  • First of its kind report from Pathway and Crisis reveals the national crisis facing both our health and housing systems – with the average age of death for people experiencing homelessness just 46 for men and only 42 for women.
  • Although across the country there are many specialist NHS teams and services working to support patients’ needs, they are often isolated, underfunded and vulnerable to cuts.
  • With three quarters of healthcare professionals saying that people facing homelessness were often or always discharged from hospital to the street with unmet health needs, Pathway and Crisis are warning that improving the health of the most excluded in our society cannot happen without fundamental policy and system change.

New research launched today by the UK’s leading homelessness and health inclusion charity, Pathway, and national homelessness charity Crisis, lays bare the extent of the crisis faced by our health and housing systems – leading to worsening health for people in inclusion health groups. This includes people experiencing homelessness, those engaged in sex work, people from Gypsy, Roma and Traveller communities, and those in contact with the criminal justice system.

The report, launched today at Pathway’s annual conference, is the first of its kind to independently document the state of homeless and inclusion healthcare in England. Drawing on a survey of frontline medical and healthcare professionals*, the findings reveal how those who are most excluded in our society struggle to access health services due to discrimination and stigma.

People who are homeless or in other inclusion health groups face some of the most severe inequalities in their mental and physical health, as well as significant barriers when accessing healthcare. Two thirds of medical and healthcare professionals reported that people without proof of address or ID were refused access to GP services – excluding people in already vulnerable situations from essential health services, means health issues are often left until they get to a critical point. 

Such exclusion and the stigma that lies behind it often leads to preventable diseases being left untreated, resulting in health deteriorating – and in the worst instances, premature death. For the NHS, it leads people to rely on the most costly and pressured services, such as A&E and urgent care, as people have to wait until their condition worsens to get any support. Three quarters of survey respondents said that people facing homelessness were often or always discharged from hospital to the streets with unmet health needs.

Despite significant evidence of what is needed to address these issues[1], essential healthcare services are not getting the resources that they need. Two thirds of health and other professionals surveyed cited lack of resource as a barrier to providing effective care, with 59% describing uncertainty of funding as a challenge.

The lack of affordable, good quality homes also contributes to the immense strain on the health service, with poor quality housing, including damp and mould, often being detrimental to people’s health. Across England, homelessness is rising and more than one million households are on waiting lists for a social home. This is leaving many councils increasingly reliant on the use of temporary accommodation to house people – with over 100,000 households in England now living in such accommodation, including over 140,000 children.

Often in poor condition and without basic necessities like cooking and washing facilities, temporary accommodation is unsuitable for many people with existing health conditions and can actively lead to a deterioration in people’s health. Many people spend months or even years in such accommodation, including B&Bs and hostels, often located far away from their families and support networks – as well as far away from their previous health services.

Pathway and Crisis are calling on the Westminster Government, along with NHS England, to increase the availability of specialist care to meet the needs of people most excluded from services – as well as committing to deliver the social housing needed to ensure that everyone has access to a safe home.

The charities recommend that a National Safe Discharge programme is established to end the unsafe practice of discharging patients from hospital to the street.

You can download the full report here.

[1] This is set out in the guideline on homelessness from the National Institute of Clinical Excellence

Alex Bax, CEO of Pathway, said:

“People facing homelessness and other forms of social exclusion have both the worst health of anyone in our country, and the worst experiences of healthcare.

“This report makes clear what people working in specialist health services have known for a long time – that mainstream services often exclude the people who need them the most. It paints a bleak picture of overstretched, inflexible services leaving people to wait until they are at crisis point before they get any care. This is obviously bad for individuals and bad for the NHS – prevention and earlier intervention would be cheaper and better all round.

“This is made worse by lack of Government action on the social determinants of health, the building blocks of healthy and safe lives.

“We can and must do better, and the evidence of what to do is already there. The system failure described in this report requires urgent and fundamental reform, led by Government. It must make clear its expectations that NHS services should be more accessible to people who are socially excluded and end dangerous practices such as discharge from hospital to the streets.”

Matt Downie, Crisis Chief Executive, said:

“Homelessness is a public health emergency, and far too many lives are being endangered because people do not have a safe, secure place to call home.

“This report lays bare just how dire the situation has become. The availability of affordable, good quality housing is fundamental to our health – yet thousands are being pushed away from healthcare services due to something as simple as lack of address or ID, meaning health issues are often left untreated until they get to a critical point.  

“This cannot continue. Westminster must work with NHS England to increase the availability of specialist care for people most excluded in our communities, to ensure no one is shut out from our healthcare system.  But we also desperately need a long-term plan to increase housing supply, starting by building the 90,000 social homes a year we need to end homelessness for good.”



To arrange a spokesperson or case study interview, please contact the Crisis media team on 020 7426 3880, media@crisis.org.uk, or 07973 372587 (out of hours)

*The survey included a total of 156 completed responses from across England, by members of the Faculty of Homeless and Inclusion Health (more information below). Respondents came from a range of roles and backgrounds across healthcare, the third sector, Local Authorities and government, with some respondents reporting multiple roles. Of all respondents, 42.3% were healthcare practitioners working in specialist inclusion health services, 16% mainstream healthcare staff, 8.3% specialist inclusion healthcare service managers and 8.3% voluntary service managers.

Three quarters of respondents (118, 76%) had a professional healthcare qualification. Of the qualifications reported, nurse (38.3%) and medical doctor (31.3%) were the most common, with a range of other backgrounds being reported, including occupational therapists (6.3%), mental health practitioners (3.1%) and dentists (2.3%).

About Crisis 

Crisis is the national charity for people facing homelessness across Wales, Scotland and England. We know that homelessness is not inevitable, and we know that together, we can end it.

We provide services directly to people experiencing homelessness, carry out research into the causes and consequences of homelessness, and campaign for the changes needed to end it.

About Pathway

Pathway is the UK’s leading homeless and inclusion health charity. We exist to improve the health of people experiencing homelessness and other forms of severe social exclusion. Pathway’s Partnership Programme supports NHS organisations to scope, commission and create local Pathway teams to improve outcomes for in-patients facing homelessness.

About the Faculty for Homeless and Inclusion Health

The Faculty for Homeless and Inclusion Health is a multi-disciplinary network focused on health care for people experiencing homelessness and other excluded groups. Our aim is to improve the quality of healthcare for people experiencing homelessness and others in inclusion health groups.

Hosted by Pathway, the network brings together a wide range of people working in the sector, who care and reaffirm the fundamental right for all patients to be treated with dignity, compassion and respect.

Members include paramedics, podiatrists, dentists, professors of epidemiology, psychiatry and infectious diseases, general practitioners, hospital consultants, specialist and district nurses, physiotherapists, psychotherapists, psychologists, counsellors, students from health related disciplines, and drug and alcohol specialists.

You can contact the Crisis media team on 020 7426 3880, media@crisis.org.uk, or 07973 372587 (out of hours).

You can contact Pathway through Communications Officer Jonathan Lucas on jonathan.lucas@pathway.org.uk