Key statistics

• people experiencing homelessness are three times more likely to use emergency health services than the general population
• 45% of respondents reported self-medicating with drugs or alcohol to cope with mental health difficulties
• average age at death for people experiencing homelessness is between 43 and 46 years.

Key messages

• people experiencing homelessness often rely on informal networks, such as friends, family or peers, to learn about available services
• mistrust of formal institutions, lack of information and fragmented systems limit engagement with health and social care
• effective outreach depends on culturally sensitive approaches delivered through trusted community resources
• collaboration with community-based organisations is central to improving access
• many participants reported confidence in using the internet to access information and support.

Policy implications

• service information may need to be shared through informal and community-based channels as well as formal routes
• outreach models should be designed around trust, cultural sensitivity and existing community relationships
• digital access should be considered as part of service engagement strategies
• stronger integration between health, social care and community organisations may improve access.

Gaps

• limited evidence on how informal information pathways affect longer-term outcomes
• lack of evaluation of different outreach models and their effectiveness
• limited insight into how digital access varies across subgroups within the homeless population.

Commentary
This study highlights how homelessness intersects with inequities in access to health and social care. People experiencing homelessness face multiple barriers, including mistrust of institutions, fragmented services and limited access to information that is relevant to their circumstances.

Reliance on informal networks plays a dual role. These networks provide vital routes to information and support, but they can also limit access to preventative or coordinated care when connections to formal systems are weak.

The findings underline the importance of outreach approaches that are culturally sensitive and rooted in trusted local organisations. Delivering support through community-based providers can help overcome barriers linked to trust and engagement.

From a care equity perspective, the study points to the need for more integrated systems that recognise how people experiencing homelessness access information and support. Aligning health and social care services with trusted community organisations may reduce exclusion and improve access for people living in vulnerable situations.

Key statistics 

• 260 individuals experiencing homelessness made 567 emergency care visits between February 2019 and March 2022 in Northumberland and North Tyneside. 

• 55% of visits were repeat attendances within 12 months, indicating frequent reliance on emergency services. 

• 83% of attendees were male, with a mean age of 39 years. 

• 32% of emergency visits involved multiple diagnoses, showing high levels of comorbidity. 

• The most common diagnoses included poisoning related to drugs or alcohol, psychiatric conditions and social problems. 

Key messages 

• People experiencing homelessness in rural and coastal areas often present to emergency services with complex combinations of health, mental health and social care needs. 

• Substance use, mental health issues and social problems are common drivers of emergency care attendance. 

• Repeat emergency department use suggests gaps in accessible community-based support. 

• Rural and coastal contexts create additional barriers to care, including limited services and geographic isolation. 

• Integrated health and social care responses are needed to address the complex needs of people experiencing homelessness outside emergency settings. 

Policy implications 

• strengthen integrated health and social care support for people experiencing homelessness 

• develop community-based interventions that reduce reliance on emergency departments 

• improve coordination between hospitals, housing services and community organisations 

• address rural service gaps and barriers to accessing support 

• improve recording of homelessness status in healthcare data to support better planning 

Gaps 

• homelessness status was identified using the hospital code “no fixed abode”, which may underestimate the true number of homeless patients. 

• hidden homelessness (for example sofa surfing or temporary accommodation) may not be captured in routine hospital data. 

• the study covers two areas in North-East England, which may limit generalisability to other regions. 

Commentary 

This study examines the health and care needs of people experiencing homelessness who attend emergency care services in rural and coastal areas of North-East England. It uses routinely collected hospital data from Northumberland and North Tyneside to explore patterns of emergency department use and underlying health conditions. 

The findings show that people experiencing homelessness frequently present to emergency care services with complex and overlapping needs. Substance use, mental health conditions and social problems were among the most common reasons for attendance. Around one third of visits involved multiple diagnoses, highlighting the high levels of comorbidity within this population. 

Emergency departments often become a key point of access to care for people experiencing homelessness. Barriers to primary care, difficulties registering with a GP and limited availability of community services can all contribute to reliance on emergency services. 

Geography also plays an important role. Rural and coastal areas tend to have fewer specialised services, limited public transport and greater distances between service providers. These factors can make it more difficult for people experiencing homelessness to access continuous support, increasing the likelihood of emergency care use. 

From a social care equity perspective, the study highlights how homelessness intersects with geographic disadvantage. People experiencing homelessness in rural and coastal areas may face additional barriers compared with those in urban areas, including limited service availability and hidden forms of homelessness. 

The findings suggest that improving coordination between health services, housing support and community organisations could help address these challenges. Integrated approaches that address housing, health and social needs together may reduce emergency department reliance and improve outcomes for this population.