#HealthNow Literature review update: how has patient experience changed for people who are homeless?

Research on health and homelessness conducted over the past two years all took place under the shadow cast by the COVID pandemic. This update summarises a significant body of evidence which has been gathered during an unprecedented time for the health and homelessness sector. Most of the literature discussed in this review focuses on changes to healthcare and patient experience that were directly influenced by the effects of national lockdown periods, required distancing measures and consequent changes to service delivery.

This report examines literature published since our first #HealthNow literature review in 2020, tracking any new trends and changes. It also outlines the findings from the five #HealthNow  research reports, contextualising them within the greater body of homeless health literature in order to summarise the learnings from this work and to identify where further knowledge and evidence is needed.

The report presents evidence that:

• Proof of address requirements still present a barrier to registering with GP services.
• Access to dentistry is severely limited for people experiencing homelessness.
• Digital exclusion continues to affect people who are homeless.
• The pandemic also led to positive changes. In drug and alcohol services especially, changes in how professionals and patients interacted resulted in improvements in trust.
• Continuity of care is extremely important for people experiencing homelessness.
• Dedicated ‘inclusion health’ and outreach services can promote engagement and reduce feelings of stigma.
• Powerful new evidence links homelessness to premature death.

We shared findings from this report with members of our #HealthNow peer network and they reflected on the importance of:

• Further steps being taken to ensure that no one is refused registration to primary care services due to lack of ID or proof of address, such as redesigning registration forms and improving education.
• Training and education for staff in all healthcare settings to ensure they feel better equipped to work in a holistic way and trauma-informed way.
• Accurate coding of people experiencing homelessness’ specific vulnerabilities on their healthcare records so that their needs can be prioritised.
• The need for proactive support to help people to engage and prioritise their healthcare, especially in relation to mental health and drug and alcohol services.
• Increasing opportunities for services to learn from what is working well and share good practice.

We will continue to work with our #HealthNow peers and use this report to coproduce clear recommendations for policy and practice to ensure that homeless health inequalities are tackled at a national level.

Read the full report