There has always been a need for local systems to strategically assess the health and care needs of people experiencing homelessness, and develop the appropriate service provision in response.

A number of policy changes have recently aligned to make this an ever more pressing requirement. As we begin supporting West Northamptonshire with a homelessness health and social care needs assessment, we argue this is the perfect time for others to follow suit.

Why now

Local Authorities (usually public health teams) must do a Joint Strategic Needs Assessment of the health and wellbeing of their local population, which includes assessing the health needs of people who are, or have been homeless. But there is variation in the extent to which the health and social care needs of people experiencing homelessness are considered, and service users and experts by experience are involved. The same can be said for other inclusion health groups.

Alongside the limitations of JSNAs, recent policy changes have further built the case for a dedicated needs assessment for this cohort:

  • NICE guideline NG214 was published in March 2022, issuing national guidance on providing joined-up health and social care services for people experiencing homelessness. A key recommendation for commissioners is to “conduct and maintain an up-to-date local homelessness health and social care needs assessment and use this to design, plan and deliver services according to need”
  • Following the Health and Care Act 2022, Integrated Care Systems (ICS) across the country have developed their initial interim strategies for the December 2022 deadline. Statutory guidance includes a section on “Groups who can be under-represented in assessments of need”, referencing people experiencing homelessness in this category. Local systems are encouraged to “identify opportunities for research where there are gaps in evidence, either of health and care need or gaps in how those needs might be effectively met”
  • The cross-government “Ending rough sleeping for good” strategy was published in September 2022. There are commitments to “support partners within the new Integrated Care Systems to develop joined-up local strategies that bring together housing, homelessness and healthcare”, a “£300m investment in the Adult Social Care Reform White Paper to boost the supply of supported housing”; and a £300m Housing Transformation Fund to “assess local need for long-term supported housing, and to develop supported housing strategies to boost supply and meet those needs”
  • Updated guidance for Health and Wellbeing Boards, published in November 2022, also references the needs of people experiencing homelessness and rough sleeping

In short, if your area does not have an up-to-date picture of local need for people experiencing homelessness; we recommend you address this as soon as possible.

The benefits

A needs assessment will not only place you in the best position to respond to the changes, funding rounds and wider trajectory outlined above; it will facilitate a significant improvement for people we know face significant health inequalities, and poorer health outcomes than the rest of the population.

The NICE guidance highlights that more effort and targeted approaches are often needed to ensure that health and social care for people experiencing homelessness is available, accessible, and provided to the same standards and quality as for the general population. It is very difficult to do this without the evidence base highlighting the need for multi-disciplinary services, tailored to the local context and current provision.

The ICS strategy guidance also cites housing and homelessness services as examples of “health-related services” that could be better integrated with the health and care sector. Likewise, the guidance champions co-production and specifically highlights people experiencing homelessness as a group of people that should input into the strategy’s production. If done correctly, the needs assessment should include thorough engagement with service providers (including voluntary and charity sector) and experts by experience. An additional benefit of the needs assessment is that the process itself can, and should, signal the start of a more collaborative and integrated response to homelessness locally.

The practicalities

Organisations like Pathway, an inclusion health charity, have long been advocating for and supporting local areas with homeless health needs assessments; often to inform the commissioning of specialist services like a Pathway Team in local hospitals. Transformation Partners in Health and Care (TPHC) have designed an interactive toolkit to support integrated care systems across London to conduct homeless health needs assessments. Likewise, Homeless Link have been supporting organisations for over a decade with their Homeless Health Needs Audits (HHNA).

We have just started supporting West Northamptonshire with a homelessness needs assessment that will cover health, social care, accommodation and support needs. From this we’ll develop key conclusions and recommendations to identify gaps and inform longer term, integrated provision and service delivery.

Please get in touch if you want to learn more about this work or how we could support you with a local homelessness needs assessment. We hope to share more insights and learning as the work progresses.

Cover image: Centre for Homelessness Impact/ Liam McBurney/PA