Topic summary on health and homelessness

The Health and Homelessness JSNA is a refresh of an earlier JSNA on working age adults experiencing chronic homelessness that was initially published in 2017. It provides a summary of what we know about the health issues that affect Manchester residents who are experiencing, or at risk of experiencing, homelessness and rough sleeping and describes what Manchester City Council and other organisations working in the city are doing to support this group of people as well as some of the opportunities for action that exist.

The work to refresh the JSNA has been sponsored and supported by members of the Manchester Health and Homelessness Task Group. The publication of the JSNA has been timed to coincide with the new Manchester Homelessness and Rough Sleeping Strategy 2024-2027

The JSNA covers two distinct categories of people: individuals or families experiencing (or at risk of experiencing) homelessness, including families with children, and people (predominantly single people) who are rough sleeping or at risk of rough sleeping. Historically, work to address homelessness has focused on people who are rough sleeping- This means that the data and evidence that exists in respect of the health of people experiencing homelessness is mainly focused on this small cohort of rough sleepers. It is acknowledged that there is a gap in the evidence-base in respect of the health of individuals, families and children experiencing other forms of homelessness which we will seek to address in future iterations of the JSNA.

• Nationally, nearly 80% of people experiencing homelessness having a physical health condition and around a third of this having between 5 and 1 0 diagnosed health conditions. A local audit of 76 homeless people registered with Urban Village Medical Practice between April and September 2021 shows high levels of substance misuse, mental health problems and blood borne viruses in this cohort of patients.
• Around 25% of people experiencing homelessness report having co-existing mental health and substance misuse needs (a 'dual diagnosis') and just under 50% of these report that they self-medicate with drugs and/or alcohol to help them cope with their mental health. Locally, around half of people sleeping rough in Manchester have been assessed as having dual mental health and substance misuse support needs.
• Just over 10% of people experiencing homelessness report that they had used A&E services more than 3 times in the past 12 months. Just over half (54%) of homeless women report being up to date with their cervical schedule screening compared to 70% of the general population.
• Nationally, there were 741 deaths of homeless people in England and Wales registered in 2021, of which 17 (23%) were in Manchester. The Manchester figure represents an increase of 6 deaths compared with the number registered in 2020 but is lower than the 28 deaths registered in the year immediately prior to the pandemic (2019).
• Currently, there are around 4,500 children living in temporary accommodation in Manchester Living in bed and breakfast hotels and other forms of temporary accommodation can be particularly detrimental to the health and development of children. A recent study undertaken by the Shared Health Foundation found that children living in temporary accommodation are at greater risk of suffering from poorer health, social and educational outcomes, with indirect consequences to their emotional well-being and mental health.
• People who are less able to control their environment, adapt their behaviours or respond to new risks are panicularly vulnerable to the health impacts of climate change. Rough sleepers are likely to be particularly affected by changes in weather patterns, particularly extreme temperatures, rainfall and wind speed, and may also be more exposed to a range of outdoor air pollutants which are known to reduce life expectancy and are associated with a range of negative health effects, including respiratory and cardiovascular disease.

There are a range of local sewices that exist to support the housing needs and health of people experiencing homelessness and rough sleeping in Manchester, including the Manchester City Council Homelessness Service and Rough Sleepers Social Work Team, Urban Village Medical Practice, the Greater Manchester Mental Health Trust Mental Health and Homeless Team, drug and alcohol treatment and support services provided by CGL, the Homeless Families Health Visiting Team, Mustard Tree and St Ann's Hospice Homeless Palliative Care Service.

The following 12 actions have been co-produced by members of the Health and Homelessness Task Group in support of the new Manchester Homelessness and Rough Sleeping Strategy 2024-2027.

1. Improve service over for prison leavers experiencing or at risk of homelessness.
2. Increase the reach of homelessness support in North Manchester.
3. Explore options for community-based wellbeing services in different parts of the City.
4. Develop an offer to meet needs of people with neurodiverse issues andacquired brain injury
5. Improve the number of smoking cessation interventions delivered for thehomeless populatiom
6. Support timely admissions to drug and alcohol in-patient detox for people who are sleeping rough
7. Strengthen co-production and develop peer support opportunities
8. Deliver the work on Inclusion Health Standards
9. Improve care coordination for people who are sleeping rough.
10. Scope the feasibility of expanding the Manchester pathway hospital in-reachm service (MPATH) to cover North Manchester and Wythenshawe Hospitals.
11. Improve hospital discharge experiences for the homeless population.
12. Make information on 'access' to services easy to follow and navigate.

This JSNA was completed in December 2023 and was presented to the Manchester Health and Wellbeing Board on 24 January. View a full copy of this JSNA.