FOR IMMEDIATE RELEASE 11.03.25

  • Annual report from Pathway and Crisis lays bare the crisis facing our homelessness and health systems.  
  • Over 60% of health professionals surveyed say they regard the health system as unsafe for people facing homelessness and other forms of social exclusion, based on the NHS definition of safe care.  
  • New research highlighted in the report shows that four in ten people facing homelessness aged 18 – 59 are frail, 400% higher than the general population. This shows the devastating impact of homelessness on health. Even very young people facing homelessness are affected, with researchers finding that a quarter of people experiencing homelessness aged 18–29 years old are frail.  
  • The two charities call for the Government’s forthcoming NHS 10-year plan and the cross-Government homelessness strategy to make fundamental reforms – to improve the quality of care and prevent the multiple harms that homelessness causes. 

This second annual snapshot report from homelessness and inclusion health charity Pathway, and national homelessness charity Crisis, reveals that failures in housing and health systems continue to push people into vicious cycles of homelessness, poor health and destitution. The report focuses on the experiences of people most excluded from help. Termed “inclusion health groups”, this includes people experiencing homelessness, Gypsy, Roma Traveller communities, sex workers, vulnerable migrants and people in contact with the Criminal Justice System. The report presents new evidence, including a survey of frontline medical, housing and care sector staff, and the insights of people who have experienced homelessness. 

92% of staff surveyed said missed opportunities to provide safe, effective and high quality care are causing harm to patients, and 60% thought health services are unsafe for health inclusion groups, following the NHS definition of patient safety as “the avoidance of unintended or unexpected harm to people during the provision of healthcare”. Examples of unsafe practices include poor hospital care and discharges to the street (more than 4,200 last year), leaving people with desperate unmet needs. The reported number of deaths of people experiencing homelessness continues to rise annually. In 2023 one person was recorded as dying while homeless every six hours1. 

The report, which was sponsored by Specsavers, shows that getting access to many mainstream NHS services is a huge challenge for people in inclusion health groups. 69% of frontline staff surveyed said that general practice was difficult to access for their patients, rising to 92% for mental health services. Poor understanding of people’s needs, stigma, discrimination and digital exclusion are the key barriers people experiencing homelessness face in trying to access to health services. These barriers not only result in missed opportunities for preventative intervention, but also in increased use of expensive emergency hospital care as health deteriorates until people have to go to hospital.  

People facing homelessness have much poorer health than the rest of the population, with new research2 showing that they suffer from clinically assessed rates of frailty at four times the rate of people who have homes. And people who are frail are more likely to become unwell, take longer to recover from illness or need hospital care. Even minor illnesses can have a dangerous, often life threatening, impact on people who are frail because their resilience is so low. Most people think of frailty as a problem of old age, shockingly, in our country it is also a problem of homelessness.  

Missed opportunities in both primary and hospital care are one part of a wider, worrying picture of unsafe practice identified across health, housing and social care services.  

The 20% rise in rough sleeping revealed in new Government statistics last week, puts huge demand on specialist health services, and requires urgent action. The government’s proposed ‘shifts’ for the NHS (from analogue to digital, hospitals to community, sickness to prevention) could be the driver of the changes needed to address extreme health inequalities. However, this will only happen if the specific needs of health inclusion groups are addressed. 

Being launched at Pathway’s two-day international inclusion health conference starting tomorrow, the Barometer report calls on the Government to: 

  • Improve the quality of care during hospital admissions and ensure that every person experiencing homelessness has a safe place to recover following an admission, ending discharge to the streets 
  • Improve access to General Practice and primary care for people facing homelessness by reforming finance arrangements to allow longer and more flexible appointments and enforcing legal entitlements to register.  
  • Provide people with the safe and secure housing they need, particularly through building the 90,000 social homes per year we need.  
  • Ensure people’s housing status is routinely recorded by NHS services, to better inform the planning and provision of services for people facing homelessness.  

Lord Darzi’s 2024 review of the NHS said that ‘homelessness is a health catastrophe’3. Crisis and Pathway are calling on the Government to put healthcare for people facing homeless and other kinds of social exclusion at the heart of tackling the current health and housing crises. The recommendations in the Barometer report address the fundamental system failures that lie beneath unsafe practice and extreme health inequalities. They would also save money and reduce pressures on the NHS by focusing on prevention and long-term health.  By taking concerted and bold action, the Government can ensure that those who face the poorest outcomes get the help they need and that the NHS is better equipped for the future. 

Alex Bax, CEO of Pathway, said:  

Working together Pathway and Crisis have set out the enormous challenges people facing homelessness face in seeking help for their desperately poor physical and mental health. We see the effects of this every day across our network of hospital homeless teams. Patients with leg amputations without wheelchairs. A woman with advanced breast cancer facing discharge to live in a shipping container. It is sadly no surprise that four in ten of the professionals we surveyed expect things to get worse for the sickest and most vulnerable people in our society, which is bad for all of us. 

Government must make sure that the new NHS 10 Year Plan initiates a fundamental reset of the way health services support our most vulnerable fellow citizens while the cross-Government homelessness strategy helps to make sure that health, housing and social services are properly joined up around people’s needs.

Matt Downie, Crisis Chief Executive, said:  

The twin crises in housing and the NHS are having a profound impact on the people Crisis supports. Through our services we’ve encountered people who have been discharged to the streets after major surgery, with hospitals under significant pressure to free up beds and local authorities unable to cope with the growing demand for homelessness assistance. 

Homelessness is a health emergency. The average age of death for people experiencing homelessness is just 45 for men and 43 for women. With the Westminster Government currently working on a new homelessness strategy and a 10-year plan for the NHS we need to see a coordinated approach. Our public services must start working together to tackle persistent health inequalities and identify opportunities to prevent and end homelessness.

Jo Osborne, Specsavers Homelessness Programme Lead, said: 

People experiencing homelessness are much more likely to need glasses to help them look for accommodation, build their skills, apply for benefits or get a job, yet face unnecessary barriers to NHS-funded sight tests and glasses. 

We need to raise awareness of these issues and, with our charity partners and the wider sector, do all we can to influence policy and systems and develop new clinical delivery models to provide eye and hearing care.

NOTES FOR EDITORS  

  1. Read the full report here.
  2. Contact information 
  • To arrange to speak to a spokesperson or arrange a case study interview with a clinician contact Steph Sykes on stephanie.sykes@pathway.org.uk or call Dee O’Connell on 07989 396320 (out of hours).   
  • Dr Jo Dawes, author of the research on frailty among younger people facing homelessness, is available for interview.  
  • To contact Specsavers, email philippa.simkiss@specsavers.com 
  1. Barometer report survey 

The survey included a total of 180 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, 44% were working in specialist homeless/ inclusion health services, 17% in mainstream healthcare and 11% in Local Authority services.   

Responses came from across England, including London (29%), South East (17%) and Yorkshire & The Humber (11%).  

Three quarters of respondents (72%) had a professional health or social care qualification. Of the qualifications reported, nurse (29%) and medical doctor (27%) were the most common, with a range of other backgrounds being reported, including occupational psychologist (8%) occupational therapist (5%), mental health practitioners (5%) and social worker (4%). 

  1. 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. 

  1. 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.  

  1. 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.