A Hounslow Homeless Health Needs Audit (HHNA) was commissioned by Hounslow Borough Based Partnership (BBP) as part of the CORE20PLUS5 health inequalities work to survey and assess the health needs of people experiencing homelessness. The audit aims to shape how services can be best delivered to support their health and wellbeing.
Health Background
The average age of death of someone experiencing homelessness is around 30 years lower than that of the general population. It is well known that people experiencing homelessness face significant health inequalities, and poorer health outcomes than the rest of the population.
Often people experience poor health because of homelessness, with the associated trauma of homelessness leading to worsening mental health, poor availability of good quality food, gruelling physical conditions for those who sleep rough and an increased risk of self-medicating.
It is then vitally important that local authorities and health systems understand the health needs of people experiencing homelessness in their area and commission the services needed to provide the support for people to move on to sustained accommodation and fulfilling, healthy lives.
Audit Delivery approach
The survey was administered by local homelessness service staff and providers between July 2024 and August 2024. All respondents were currently experiencing homelessness.
- In total 115 responses to the HHNA in Hounslow went on to analysis.
The estimated population for the HHNA was 320 individuals. This means with 115 responses; the resulting data has a margin of error of 7.5 and a confidence level of 95%.
Captured Data
Table 1: Gender of respondents
|
Count |
% |
|
|
Male |
91 |
79% |
|
Female |
22 |
19% |
|
Non-binary |
1 |
1% |
|
Other |
1 |
|
Across those surveyed:
- 72% (83) of respondents identified themselves as currently having at least one of the listed mental health conditions.
- 51% (59) of respondents reported more than one current mental health diagnosis.
- 71% (82) reported that they smoke cigarettes, e-cigarettes, cigars, or a pipe.
Table 2: Highlights the Top 10 physical health problems with a higher percentage of diagnoses occurring after experience of homelessness vs before experience of homelessness.
|
Count of diagnoses that occurred post- homelessness |
% of diagnoses that occurred post-homelessness |
|
|
Hepatitis C |
4 |
100% |
|
Cancer |
1 |
100% |
|
Liver problems |
12 |
86% |
|
Stomach problems, including ulcers |
13 |
76% |
|
Problems with feet that affect your day to day life |
14 |
74% |
|
Heart problems |
8 |
73% |
|
Chronic breathing problems |
9 |
64% |
|
Circulation problems / blood clots |
7 |
64% |
|
Diabetes |
5 |
56% |
|
Skin / wound infection or problems |
8 |
53% |
Table 3: Where respondents were currently sleeping.
|
|
Count |
% |
|
In a hostel or supported accommodation |
67 |
58% |
|
Rough Sleeping |
22 |
19% |
|
In B&B or other temporary accommodation |
9 |
8% |
|
Sleeping on somebody's sofa/floor |
7 |
6% |
|
Vehicle or caravan on the side of the road or in a car park |
4 |
3% |
|
Hospital |
2 |
2% |
|
In emergency accommodation |
1 |
1% |
|
Squatting |
1 |
1% |
|
In asylum housing |
0 |
- |
|
Other |
2 |
|
Table 4: Prevalence of physical health conditions
|
|
Hounslow HHNA Current |
Hounslow HHNA Ever |
USOH |
||||
|
|
Count |
% |
Count |
% |
Count |
% |
|
|
Joint aches / problems with bones and muscles |
32 |
28% |
45 |
39% |
194 |
37% |
|
|
Dental / teeth problems |
27 |
23% |
37 |
32% |
187 |
36% |
|
|
Difficulty seeing / eye problems |
16 |
14% |
18 |
16% |
114 |
22% |
|
|
Problems with feet |
15 |
13% |
19 |
17% |
95 |
18% |
|
|
Fainting / blackouts |
12 |
10% |
20 |
17% |
93 |
18% |
|
|
Stomach problems, including ulcers |
12 |
10% |
17 |
15% |
104 |
20% |
|
|
Heart problems |
10 |
9% |
11 |
10% |
68 |
13% |
|
|
Chronic breathing problems |
10 |
9% |
14 |
12% |
70 |
13% |
|
|
Asthma |
9 |
8% |
10 |
9% |
125 |
24% |
|
|
Skin / wound infection or problems |
9 |
8% |
15 |
13% |
92 |
18% |
|
|
Circulation problems / blood clots |
7 |
6% |
11 |
10% |
67 |
13% |
|
|
Liver problems |
7 |
6% |
14 |
12% |
57 |
11% |
|
|
Diabetes |
7 |
6% |
9 |
8% |
29 |
6% |
|
|
Urinary problems / infections / incontinence |
6 |
5% |
11 |
10% |
61 |
12% |
|
|
Hearing loss |
5 |
4% |
7 |
6% |
** |
||
|
Traumatic brain injury |
5 |
4% |
5 |
4% |
** |
||
|
Epilepsy |
3 |
3% |
6 |
5% |
25 |
5% |
|
|
HIV |
1 |
1% |
1 |
1% |
4 |
1% |
|
|
Tuberculosis (TB) |
1 |
1% |
2 |
2% |
4 |
1% |
|
|
Hepatitis C |
1 |
1% |
4 |
3% |
44 |
8% |
|
|
Cancer |
0 |
0% |
1 |
1% |
20 |
4% |
|
|
Acquired brain injury |
0 |
0% |
1 |
1% |
** |
||
|
Dementia |
0 |
0% |
0 |
0% |
** |
||
|
Other |
3 |
3% |
6 |
5% |
** |
||
|
|
|
|
|
|
|
||
Table 5: Registration at primary healthcare services
|
|
Count |
% |
|
GP |
99 |
88% |
|
Specialist homeless healthcare centre |
23 |
21% |
Suggested areas to increase awareness
- 53% (59) of respondents stated they use drugs (This figure is far higher than the general population figure of 9.5% using illegal drugs in the last year reported in the Crime Survey for England and Wales).
- Results show that knowledge of where to access sexual health services could be improved, with 62% (66) of respondents stating that they know where to go to access sexual health advice and 38% (41) stating that they did not.
- Survey data also revealed that people experiencing homelessness in Hounslow are relatively high users of emergency services, with between 23-36% using each emergency service in the past 12 months. Across A&E, ambulance and hospital admissions, respondents in Hounslow were more likely than USOH respondents to be accessing care for their mental health and for an alcohol problem. This suggests these as key areas to further understand what is driving emergency service use, and whether changes could be made in primary or secondary care to help people to manage their health outside of emergency healthcare settings.
- A smaller number of respondents were repeat users of emergency services, with 7-11% having used emergency services more than three times in the past 12 months.
Next Steps
This Homeless Health Needs Audit was undertaken to inform London borough of Hounslow’s public health team as part of their CORE20PLUS5 health inequalities work. It provided vital insight into the health needs of people experiencing homelessness across Hounslow, the services they are accessing, and associated health outcomes.
The team has now been running workshops for all BBP Colleagues to plan next steps on how to improve service delivery.