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Nursing care for people experiencing homelessness

A Survey of the QNI Homeless Health Network

This report presents the expert knowledge and experience of Homeless Health Nurses and contributes to the evidence for meeting the health care needs of people who are homeless, giving clear recommendations to support service planning.

In 2007, a small group of experienced Homeless Health Nurses (hereafter referred to as HHNs) approached the Queen’s Nursing Institute (QNI) with a proposal to improve the healthcare of people experiencing homelessness, by linking up Homeless Health Nurses across England, Wales and Northern Ireland in a co-ordinated network.

Motivated by the inspiration of these nurses, the QNI’s Homeless Health Network was established. Since then, hundreds of nurses have contributed to this work. The QNI has supported the development of a series of projects and programmes over the past ten years, including national conferences, learning events, unique learning resources, and a specialist health assessment tool for nurses working with people who are homeless. The network has grown and now has a membership of over 800 nationally.

The network continues to support HHNs and a wide range of other professionals with an interest in homeless healthcare to collaborate and create resources, share practice, learn from each other, and gather data and evidence to inform policy in the field of homeless healthcare.

People experiencing homelessness are some of the most vulnerable to poor health outcomes across the population. Homelessness and housing insecurity in the UK is increasing – the number of people sleeping on the streets has risen by 132% since 20101.There is mounting international evidence about the negative impact of homelessness on health.

When comparing people who are homeless with the rest of the population, they are

  • 50 times more likely to have Hepatitis C
  • 34 times more likely to have Tuberculosis
  • 20 times more likely to die from harmful drug use
  • 9 times more likely to commit suicide
  • 8 times more likely to have epilepsy
  • 4 times more likely to have a mental health problem7

People who experience homelessness are likely to die at a younger age. Women with a background of homelessness, substance use, sex work and being in prison have a mortality rate 12 times higher than the general population. For men, this is 8 times higher.

Longer term homelessness almost inevitably leads to poor health outcomes, and the accumulation of many concurrent physical and mental health conditions. In this context it is vital that effective, frontline nursing care is widely available for people who experience homelessness.

HHNs have excellent insights into the specific needs of the people they work with every day. The QNI wanted to determine from the perspective of HHNs, their views of effective homeless healthcare and what make the most significant improvements. The evidence the QNI collected was based around exploring the care interactions between HHNs and their patients, to learn what kind of support is needed to enable people to both exit homelessness and sustain and improve their health.

In 2018, The Queen’s Nursing Institute surveyed 206 HHNs to ask them how they currently organise care, the range of services they provide and the challenges they face. This report gives a thematic analysis of their responses.