On March 13 and 14 this year, the Faculty of Homeless and Inclusion Health gathered in London for its annual conference, where we addressed pressing health issues facing people experiencing homelessness and other marginalised groups. Our collective concern about the state of health and care services available to these communities, in the midst of a damaging housing crisis, is profound. Despite efforts to improve accessibility and quality of care, significant barriers persist, hindering people from accessing the essential services they need and deserve. The disparities in healthcare outcomes for those facing homelessness and other inclusion health groups are glaring, reflecting systemic failures that demand immediate attention and action.
With an impending General Election in mind, Faculty members have produced this statement to send a clear message to our politicians. Drawing on research in our Barometer of Homeless and Inclusion Health, and the wealth of evidence colleagues shared at our conference, the statement outlines the way the NHS and housing crises are harming people in inclusion health groups, and calls for urgent reform, as well as significant action on the social determinants of health.
We urge colleagues to share widely on social media and with politicians and decision makers.
As Sir Michael Marmot, who closed our conference, put it:
“Things can and must change.”
Statement from the Faculty of Homeless and Inclusion Health, London, 14 March 2024
We, members of the Faculty of Homeless and Inclusion Health, made up of health professionals, researchers, commissioners, students, and people with lived experience, are dedicated to improving the quality and outcomes of healthcare services for people experiencing homelessness and others in inclusion health groups. We do this by leading with generosity, kindness, and compassion. Twelve years ago, we held our first Symposium calling for action on the homeless health emergency.
Today this call is even more paramount. We held our annual gathering in London this week where we considered the latest evidence and research in homeless and inclusion health. This showed that people facing homelessness and other forms of social exclusion have the worst health outcomes in our country, and the poorest access to the healthcare they need.
We in the Faculty deplore this state of affairs. It is axiomatic that our health and care systems are under immense pressure. We acknowledge this context isn’t working for many of us, but people facing social exclusion feel its effects much more sharply.
Context
Pressures across housing, health and social care are driving barriers to access and poor experience for the people who need it most. The deep resource crisis facing local authorities, playing out in housing services and social care, along with the twin crises in housing and the NHS, form the backdrop to services for people who have already been so poorly served. This financial context is leading to short-term funding cycles, driving uncertainty and short-term solutions for people with multiple needs.
Poor access and experience
These pressures are driving inflexibility in services and higher thresholds – the antithesis of what the evidence shows people in inclusion health groups need. People don’t get the care they need until they reach crisis point, when their needs are compounded and opportunities for prevention have been missed.
We know that stigma and discrimination are central barriers to healthcare access for inclusion health groups across many different services. This is underpinned by a lack of understanding and negative attitudes across services, which have found shameful reinforcement in some recent political narratives. This leads to unsafe practices and ultimately can cost lives.
Failure to prevent
We are deeply concerned that today’s context is also driving a lack of a coherent and concerted action for upstream, both in terms of preventing today’s children from becoming tomorrow’s adults facing homelessness and other forms of severe adversity, and supporting those leaving public institutions today who are at risk of harm.
A promise of integration, not yet achieved
NHS reform and the establishment of Integrated Care Systems (ICSs) could provide the opportunity for services and systems to work together to meet the needs of their populations, including those most in need. But this promise is being undermined by constant changes, including workforce and funding restructures, impeding colleagues’ ability to develop the relationships and conditions needed for integration to thrive.
Intense workforce pressures
Staff are the most valuable resource the health service has. However, recent years have seen a reduction in workforce numbers, increased work pressure, uncertainty over sustainability of roles, and our colleagues reporting that they are feeling both physically and psychologically unsafe. Moral injury abounds.
NHS incentives and organisation undermine action on inclusion health
While the NHS has sought to address health inequalities through certain initiatives, wider NHS incentives and funding structures across key health services do not support action on inclusion health and can have the opposite effect. This is exacerbated by policy decisions across the landscape, deepening social disparities. Our health and care systems do not exist within a vacuum. Government policies are having a detrimental impact on the social determinants of health, across migration, welfare, housing and inequality and poverty.
System Failure
The problems we describe here and experience at the front line and in our lived experience are a sign of system failure. For people in inclusion health groups, there are no dark corners of the NHS – barriers to good health are ubiquitous and systemic across a wide range of services. From primary care to urgent and emergency care, from dentistry to sexual health services.
Recommendations
We recognise that the next Government has an enormous task ahead in reforming a health and social care system that is failing so many. In doing so, we urge them to prioritise the needs of people in inclusion health groups, those who face the poorest health outcomes and the worst access to care. As people at the sharp end of health inequalities, action to improve services for them will benefit society as a whole, and pave the way for much needed reforms for people living with all forms of complexity.
We support the recommendations in the Barometer of Homeless and Inclusion Health, and would particularly highlight the need for:
- Leadership: While we recognise that inclusion health populations should matter to everyone within the health and social care system, this needs to be underpinned by strong top-down leadership at both the national level and within ICBs to drive forward standards and hold failing systems to account. To inform leadership there also needs to be meaningful participation of people from inclusion health groups at national as well as ICB level.
- Funding: We have evidenced that inclusion health groups have the greatest health and social care needs, and funding should therefore be proportionate to this the level of need. We would like to see an increase in investment for inclusion health groups, greater flexibility within funding streams, and longer-term funding cycles.
- True Integration: Integration that was promised through the development of ICBs has not been delivered and the constant changes experienced within ICBs has prevented not aided integration. To effectively meet the needs of inclusion health populations services and systems cannot work in siloes. True integration requires systems to identify and remove barriers for integration, create the opportunity for services to collaborate effectively, and promote coherent integrated commissioning.
- Prevention: Unless we effectively consider how we are preventing inclusion health populations from increasing, then the situation is only going to get worse. This requires action on the social determinants of health that lead to poor health and poor health outcomes; addressing the childhood experiences that we know lead to poor outcomes in later life; and improving the transition of people leaving institutions.
- Prioritising Inclusion Health: Above all we are asking the next government to recognise the importance of prioritising inclusion health groups. While the current situation is having a negative effect on everyone, those from inclusion health groups are significantly adversely impacted. However, we know that if we can truly tackle health inequalities for inclusion health groups, then we can get this right for everyone.