Deaths amongst people experiencing homelessness should not go unnoticed

Dr Ben Sanders, Senior Research Officer

13.03.2024

741 people died in England and Wales whilst homeless in 2021 - we can't ignore this reality by no longer publishing these shocking statistics 

The official statistics published on rough sleeping and homelessness recently showed the deepening homelessness crisis. Whilst we have some data that indicates broad trends on rough sleeping there is an absence of in-depth evidence routinely collected on the outcomes and impact of the realities of people who experience it.

The ONS statistics on the number of people dying whilst homeless represent one of the only sources of information that are vital in helping us understand more about the links between homelessness and health inequalities and ultimately how to prevent premature deaths. Yet a consultation that closed last week outlined proposals to cease publishing these statistics. We at Crisis and others are strongly urging the ONS not to go ahead with these plans.  

Homelessness is a healthcare issue  

At Crisis and Pathway, we know through our own services and research the upsetting and distressing reality of what it is like to sleep on the streets. At Christmas, Crisis published new research exploring the realities of rough sleeping after speaking to over 150 people across England. 

From the research, we learnt that shockingly nine out of ten people sleeping rough had experienced some form of violence or abuse. Half had been physically attacked and one in five had someone urinate on or next to them while sleeping rough.  

It was clear also the significant impact rough sleeping has on people’s health and well-being. The majority of people we spoke to (94%) reported at least one health issue with over three-quarters reporting three or more. Living with physical pain (69%) and issues with their legs and feet (66%) were the most common issues and linked to people’s extreme living conditions and having to sleep out in poor weather.  

Not having access to facilities others might often take for granted, such as a washing machine or shower, nor anywhere to store personal items, meant keeping clean and healthy is difficult. Managing health conditions while living on the street is hard and almost a quarter of those surveyed said they could only sometimes access the health services they needed. Fifteen per cent said they cannot access health services at all. 

Living on the streets and having to navigate the ever-present dangers also takes a toll mentally. Eighty-six per cent of those in the research reported having at least one mental health issue. Sadly, just over half explained that they had thought about taking their own lives. A third struggled with PTSD. 

A lack of access to appropriate healthcare means that health conditions worsen while living on the street and can drive a pattern of unpredictable and chaotic use of emergency services; people who sleep rough are six times more likely to visit A&E than the general population and stay in hospital three times longer. 

We also know that even when people experiencing homelessness do access health services and hospitals that the support and service they receive often does not meet their needs. It is also the case that significant numbers of people facing homelessness are discharged back into a homeless situation and that there can be high rates of emergency readmission not long after.

While this research focused on the experiences of homeless people in England, the connection between health and homelessness is also clear in other areas of Great Britain where people experiencing homelessness are faced with similar risks. The latest Welsh Government statistics estimate that there are 136 people sleeping on the streets (although the reality is likely higher) and there are thousands more living in temporary accommodation, often without access to key facilities or somewhere warm to stay during the day. 

Research conducted by Cymorth Cymru in its 2017 Health Matters report outlined the increased incidence of health difficulties people experienced after becoming homeless and suggested that of those participants who had been in hospital, a quarter were discharged onto the streets or into unsuitable accommodation.  More recently, Public Health Wales published a briefing stating the clear correlation between affordable housing and physical and mental health. And, last October, the Welsh Government outlined an ambition to look at the how health services can better support ending homelessness within its White Paper. 

The ONS' plan to stop publishing annual recorded deaths of homeless people is a backwards step 

Homelessness is very poorly recorded in health data. This means that people facing homelessness are too often ‘invisible’ to Integrated Care Systems and those planning and funding healthcare services. This only serves to perpetuate in services that do not meet the needs of people experiencing homelessness.

Sadly, the cumulative impact of living on the street, associated health issues and poor access to health services means that across England and Wales in 2021 there were 741 deaths of people experiencing homelessness. It is likely in reality that this number is higher because of the issues with recording deaths of people experiencing homelessness. What these statistics also show, which is equally saddening, is that the average age at which a man who is homeless dies is 45 and for a woman it is 43. 

Homelessness is as much a healthcare issue as it is to do with the housing crisis and welfare system in the UK. As such, the recent news that the ONS are considering stopping the publication of the annual recorded deaths of homeless people comes as a shock.  

In light of what our new research showed, it is vitally important we are able to monitor and track these statistics given everything we know about the severity of health inequalities faced by people who are homeless is paramount.  

The suggestion of stopping the reporting of these statistics is particularly troubling given the paucity of data on homelessness already, especially within the health and care space. This would only be made worse by this decision.  

These statistics are widely used, not just by the sector to hold governments to account on homeless health inequalities (one of the only official statistics we have to do so), but also because they are used by researchers and other professionals across the sector. 

In our society, we count and record the things that matter to us. Each of these lives lost is a tragedy, and each of them matters. What does it say about a society and a political system that proposes that deaths among some of the most vulnerable people in society go unnoticed?  

While these statistics are still on a journey to be recognised as national statistics status and they can be improved, to cast them aside now would only serve to increase and entrench the invisibility and exclusion of homeless people. Given the rise in homelessness, it is now more important than ever that there is increased scrutiny of data and more light needs to be cast on the lives of people experiencing homelessness and the circumstances shaping them.