Sarah Champion
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Sarah Champion (Rotherham) (Lab)
It is a pleasure, Mr Chope, to serve under your chairmanship. For clarity, I will refer to homelessness, but I mean homelessness and rough sleeping.
Since my election, I have had the privilege of shadowing one of St Mungo’s homelessness teams in Westminster, and have spent time with some Rotherham charities and social enterprises that support rough sleepers. I would like to discuss the link between homelessness and health care, because I have seen that it is at the root of many people’s homelessness. Poor health is not only a consequence of homelessness; it is often its cause.
A report by the Department of Health suggests that as many as two thirds of homeless people have a serious chronic health problem before they become homeless. Many of the people St Mungo’s works with have complex physical and mental health needs. Their latest client need survey showed that 64% have physical health conditions, 70% have mental health conditions and 64% have issues with drugs and alcohol.
Andrea Leadsom
Does the hon. Lady agree that physical and mental health needs often go hand in hand and cannot be separated? For example, back-ache is strongly correlated with depression, and it is often the combination of the two that results in homelessness.
Sarah Champion
I completely agree with the points that the hon. Lady raises, and will speak about them, a little, later.
We know that homeless people use four times as many acute health services and eight times as many in-patient health services as the general population, at a cost of around £85.6 million a year. However, despite that, homeless people often find it difficult to access health services that can provide suitable treatment, because their complex needs may make them ineligible for traditional health and social care support. Some report facing discrimination when they do seek support.
Common health conditions for homeless people include mental health issues, foot conditions, dental problems, infections, sexual health issues and tuberculosis. One in 10 people diagnosed with TB has a history of homelessness. Lack of suitable washing facilities can aggravate those problems and increase the spread of infection. Not surprisingly, people sleeping rough often find that the cold and damp exacerbate their health problems and cause the onset of respiratory illness. Some rough sleepers even wake up covered in frost.
The links between homelessness and health are cyclical. Although many homeless people are struggling to access health care, more must be done at an early stage to encourage people at risk of homelessness to access public services. Mental health issues particularly are one of the key triggers that lead to homelessness. Up to 70% of homeless people suffer mental health issues and 14% suffer a personality disorder. In London, almost one fifth of rough sleepers have mental health needs combined with substance abuse. Perhaps the most depressing news of all is that rough sleepers are 35 times more likely to commit suicide than the general population.
I am extremely fearful that in Rotherham, the problem will be dramatically compounded, because our excellent NHS mental health foundation trust—Rotherham Doncaster and South Humber NHS Foundation Trust, or RDaSH—is facing a £7 million budget cut next year. Unfortunately, I believe it is inevitable that this funding crisis will lead to people not receiving the support they need, and consequently to increasing rough sleeping on our streets. Is it not time for the Government to tackle these problems head on? Is it not time to acknowledge that we must make it easier for homeless people to access health care, not harder?
Under this Government, the sad fact is that in London alone, almost 6,500 people were seen sleeping rough between 2012 and 2013, and the number is increasing, year on year. Under this Government’s watch, rough sleeping has increased nationally by 31% in the last two years. Shockingly, the average age at which a homeless person dies is now 47.
Money directed at homelessness prevention is sent to local authorities, but is not always ring-fenced. Often, it is not used effectively to stop people becoming homeless, or to encourage preventive health interventions. Homeless people experience significant regional health inequalities, which should be recognised, measured and addressed in local needs assessments. If health and wellbeing boards are to meet their duty to reduce health inequalities effectively, they must recognise, measure and address the health needs of vulnerable and excluded members of society, and that must include homeless people.
Some local authorities are including homeless people in joint strategic needs assessments and joint health and well-being strategies, but this group of vulnerable people is often not accounted for. The needs of the local homeless population should be reflected in joint health and well-being strategies, and in the commissioning of appropriate services. The emphasis on setting a small number of priorities across the wider community may mean that the specific needs of small, marginalised groups are overlooked.
The mobility of homeless people, who may move from borough to borough, should also be considered, and a pan-borough approach should be taken to commissioning specialist services when appropriate. Local strategies should reflect the needs of the most excluded, as well as setting goals for wider public health improvement.
Commissioners and providers should be monitored to ensure that they are reducing health inequalities, including between the homeless and the general populations. When it comes to signing up with a GP, homeless people are turned away because they do not have an address. There is a shortage of specialist drug and alcohol services, particularly dual diagnosis services for people with substance addiction and mental health problems. Many homeless people with learning disabilities find it hard to live in the community and to access specialist support.
People in Rotherham tell me about the problems that homeless people have in finding accommodation when discharged from hospital. That is not just a problem in Rotherham; it is a national problem. Too many people are discharged from hospital with nowhere to go. We need integrated health and social care provision that includes homeless people. That approach could help to address health inequalities and ensure that some of the most excluded members of society have a better experience of the health and social care system. They deserve that.