ICS0027

Written evidence submitted by St Mungo’s

St Mungo’s is a leading homelessness charity with national influence. We work in partnership with local authorities, health colleagues and communities, to end homelessness and rebuild lives.

Last year, we supported more than 24,900 people who were homeless, or at risk of homelessness through 180 services. We support more than 2,800 people every night. Our ambition is to end rough sleeping in this country, and we believe that policies and interventions can be put in place to end all forms of homelessness for good.

Q: The Committee will question senior officials and executives at the Department for Health and Social Care (DHSC) and NHS England on progress in establishing Integrated Care Systems in England; examining whether this new system is being set up in a way that will allow them to achieve these objectives.

St Mungo’s response

ICSs will not achieve their core objective of tackling inequalities in outcomes, experience, and access unless they have a focus on inclusion health populations, including people experiencing homelessness and rough sleeping.

Inclusion health groups are explicitly covered within the Core20PLUS5 approach taken by NHS England (NHSE), and there is an ‘expectation’ from NHSE to see these populations identified at integrated care system level. The Health and Care Act also requires Integrated Care Boards to ‘have regard to the need to reduce inequalities’; we believe that addressing the needs of inclusion health groups is key to achieving this.

While we welcome the fact that the new guidance for the preparation of integrated care strategies suggests that the strategies “could include a focus on what can be done for those experiencing significant, and multiple disadvantage”, we are concerned that this is not a mandate which requires ICS strategies to have a specific focus on these groups.

People experiencing homelessness or rough sleeping face worse health problems and much higher barriers to access health and care services in comparison to the general population. For example, people experiencing homelessness have five times the level of heart disease as the mainstream population; experience 18 times the level of psychotic illness as the general population; and homeless men experience 7.9 times the standardised mortality ratio to the general population, whilst for women, it is 11.9[1].

Evidence strongly suggests that people who sleep rough often experience even worse health outcomes than the wider group of people who are homeless. Further, their experiences of sleeping on the streets often make it more difficult to access the healthcare they need. The longer that people sleep rough, the worse their health needs become as these needs are compounded by the physically and mentally traumatic experience of sleeping rough.

In our report looking at Housing and Health over Covid 19, we found that of St Mungo’s clients supported in emergency Covid-19 hotels, 18% were not registered with a GP when they moved in. GPs are a gateway to access to other health services, as well as a preventative measure to avert increased A&E visits. As a result, research shows that people experiencing homelessness attend A&E six times as often as the housed population, are admitted four times as often and stay three times as long[2].

Recommendations

• All integrated care systems should include in their forthcoming strategies (to be published in December 2022) a dedicated focus on tackling health inequalities for inclusion health populations, including people experiencing homelessness and rough sleeping.
• As part of the Care Quality Commission’s (CQC) system review framework, there should be a specific focus on whether integrated care systems explicitly reference inclusion health groups as part of their health inequality strategy. Reference of these groups should be used as a litmus test for the quality of integrated care systems’ population health plans.

October 2022