Optimising health outcomes for people experiencing homelessness (HOPE)

People experiencing homelessness or who are vulnerably housed have significantly poorer health and shorter life expectancies than the general population. They are more likely to need emergency care and usually spend longer in hospital when admitted.

According to the Homeless Link Health Needs Audit 2022, 68% of people who are homeless also have a long-term illness or disability, compared to 22% of the general population. 82% have a mental health diagnosis (compared to 12% of the general population). A report by the British Medical Journal (BMJ) found that homeless people’s visits to A&E trebled in seven years from 2011-2018. Research from the Salvation Army published in 2023 found at least 57,500 cases where people without fixed addresses attended A&E.

It is important to understand what helps to improve health and healthcare services for people in these situations to avoid situations where emergency care is needed. Learning what works best is critical to help reduce the health inequity of people experiencing homelessness.

What is the project doing?

This research aims to better understand what is known about health and social care services in homelessness that impact on health and emergency care.

We are working with Groundswell, a charity which involves researchers with experience of homelessness, to carry out this research. It will be carried out in three parts.

• Part 1: We will collect all the studies that explore how health services, voluntary schemes or housing initiatives affect the physical or mental health of people experiencing homelessness. From this we will create an interactive online map to show how treatments and services affect different aspects of health.
• Part 2: We will bring together studies found in part 1 that look at emergency care in a ‘systematic review’. This will help us understand what treatments or services support people experiencing homelessness to receive appropriate emergency care when they need it.
• Part 3: Using evidence found in parts 1 and 2 we will talk to people with lived and professional experience of homelessness to create a ‘systems map’. This will help us to understand where the system works well, what the barriers are, and where improvements are needed.

What are the project aim to achieve?

We want this research to make a real difference for people experiencing homelessness and those who support them.

In the short term, by finding and organising research that tells us about homelessness and health, we will raise awareness about what type of services and support make a difference.

In the longer term, we aim to help shape how health and social care is planned and delivered, especially in emergency care, so that people experiencing homelessness get better support when they need it most.