The National Institute for Health and Care Excellence (NICE) and the Centre for Homelessness Impact (CHI) have jointly published a guideline on ways to improve access to and engagement with health and social care services for people experiencing homelessness.

‘Inclusion health’ is a term developed to address the health and care needs of groups that are traditionally excluded, including people experiencing homelessness. People experiencing homelessness have far worse health and social care outcomes than the general population, with an average life expectancy of over 30 years lower. But many of these premature deaths are from preventable and treatable conditions. Services that provide long-term commitment to care to promote recovery, stability and lasting positive outcomes are needed, especially for those with experience of rough sleeping. 

The guideline, published on March 16, highlights that a more inclusive, welcoming, non-judgemental and culturally sensitive approach is needed to promote engagement with services. It aims to provide guidance on models of service provision for services specific to people experiencing homelessness, as well as improving access and engagement with mainstream services. Aimed at commissioners, providers, planners and practitioners across disciplines and agencies, the guideline offers advice on how they can work together to support and improve outcomes for people experiencing homelessness.

Commissioners should recognise that people experiencing homelessness often need additional resources and a more targeted service delivery to ensure that resources are allocated according to need and disadvantage, improving long-term outcomes and addressing health inequalities. This also includes recognising the value of co-designing and co-delivering services with people with lived experience of homelessness, to improve the quality of health and social care

Key recommendations include:

• Embrace a person-centred engagement approach
• Offer additional resources and a more targeted service delivery approach to improve outcomes
• Don’t penalise people for missing appointments (ie. by discharging them from services)
• Reduce caseloads and lengthen contact time between health/social care practitioners and people experiencing homelessness to enable them to build trust and improve  engagement
• Use communication methods based on the personal preferences of people experiencing homelessness
• Recognise that an individual’s behaviour and engagement with services may be influenced by traumatic experiences, socio-economic circumstances and previous engagement with services
• Provide open-door services for people to self-refer after initial support ends, to reduce the risk of becoming homeless again

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 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 guideline, developed in partnership with the CHI, and hope the recommendations will help improve outcomes for people experiencing homelessness in line with NHS Long Term Plan.'

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Ligia Teixeira, chief executive of the Centre for Homelessness Impact, said: 'The evidence is very clear that people affected by homelessness are one of the largest groups systematically excluded from health and care services. The impact is often shocking: dramatically lower life expectancy, worse health outcomes and in the longer term higher costs on health and social care services.

'Some of the reasons for this are complex but some are easily fixed, such as by ensuring that lack of a permanent address is not a barrier to registering with a GP. Others require better designed and more flexible systems and, crucially, regular and meaningful opportunities to listen to and act on the insights of patients impacted by homelessness.'

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.

Download the full guideline.