Rough sleeping: a health and care approach

Tackling rough sleeping requires both health and care solutions to help those most in need and reverse the long-term trend of a rising number of people living on the streets.

In a new publication for councils, the LGA says this is the best way to support the Government’s Rough Sleeping Strategy and achieve its target of halving rough sleeping over the course of this Parliament – and eliminating it by 2027.

Prevention, intervention and recovery are the focus of the strategy, with official statistics showing a 165 per cent increase in reports of rough sleeping over the past 10 years.

While the current number of 4,677 rough sleepers is down 2 per cent in a year, the overall long-term trend is of a vast increase in rough sleeping across the country. Almost half of all councils have reported a rise in rough sleepers in their area. Heart disease, diabetes and addiction problems are among the long-term physical health problems experienced by an estimated 41 per cent of people who sleep rough, compared with only 28 per cent of the general population. In addition, 45 per cent of rough sleepers have been diagnosed with mental health issues, compared with a quarter of the population as a whole. One in three has complex needs, which is defined as having at least two chronic health problems.

In particular, drug taking and alcohol can make it difficult for those who are experiencing rough sleeping to be helped off the streets, as continued abuse can result in them being excluded from accommodation. A ‘housing first’ approach, for those people with the most complex needs, is helping to solve this through offering stable accommodation without the need to be free of substance misuse problems.

However, long-term progress for the most vulnerable individuals can only happen through effective and integrated health and care solutions tailored around their needs.

The Homelessness Reduction Act 2017 places a legal duty on councils to prevent homelessness and support all those requesting help who may be at risk of homelessness, irrespective of whether they are in certain groups that, previously, allowed them to be prioritised.

Rising demand and the need to make efficiencies mean that areas are finding new and innovative ways to provide support through health and care services. For example, Tower Hamlets provides psychological support to those sleeping rough on the streets; Newcastle ensures rough sleepers who end up in hospital are supported so they are not released back onto the streets; and in Bradford, a mobile health unit goes out touring the streets to help those in need of their services.

What these examples demonstrate is that services work best when they are proactive and able to reach out to those who are most vulnerable. It cannot be left to those who are experiencing rough sleeping to book themselves in for appointments as those who are not homeless would do.

Good practices, where introduced, make a difference. Vital treatment and care is being given to people who are sleeping rough, which is helping them transform their lives and get off the streets. Meeting basic health needs is an essential part of meeting the Government’s and councils’ shared aim of eradicating rough sleeping.

‘Supporting the health needs of those who are experiencing rough sleeping’ is available at


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