Becky Evans from homelessness charity Groundswell explains they hope to roll out their #HealthFirst strategy across the UK, working towards an inclusive health system where everyone has access to the care they need, ultimately moving people out of homelessness. 

 Homelessness and Health Inequalities

 The level of recent media attention on homelessness and early preventable deaths will have not escaped many people. The reality is that deaths of homeless people have increased by 24% over the past five years. On average the age at death is 44 years old. It is well known in our sector that poor health and the experience of homelessness are inextricably linked, yet in much of the media discourse about the premature death of rough sleepers, the narrative has focused on a lack of housing.

Over half of all deaths of homeless people in 2017 were due to three factors: accidents (including drug poisoning) accounted for 40%, suicides accounted for 13% and diseases of the liver accounted for 9%” (ONS 2018).

If we are to reverse the inequalities experienced by homeless people and solve this crisis, more focus on poor health outcomes, which are both a cause and consequence of homelessness, is needed. Moreover, it is essential to understand the reasons behind health inequalities in order to remove the barriers to access: people need more support to overcome these barriers to health care and treatment.


 At Groundswell we believe that the responses to the issues will not be effective without the involvement of people who have experienced homelessness themselves. We know that by asking people with experience of homelessness to help us lead new ways of tackling homeless health inequalities, the issues can be more effectively addressed. The system needs to learn from their shared experience and make the changes needed to tackle health inequality.

Homeless Health Peer Advocacy (HHPA), set up by Groundswell in 2010, supports people who are experiencing homelessness to access health care appointments and navigate care pathways that aren’t adequately adapted to need. We have delivered multiple peer-led research projects that detail the experiences of homeless people in relation to oral health or pain, for example.

HHPA gives Groundswell a unique insight into the barriers that people face in trying to access care and treatment. There are some fantastic specialist services for people experiencing homelessness to access care and treatment, or have a supported discharge from in-patient stays.

However, people also experience inconsistency in information amongst services and staff about the rights of people with no fixed address accessing healthcare. When someone is homeless, they are often living chaotic lives, trying to navigate systems to find a safe place to sleep, secure work, claim benefits and overcome debt. Their health is often not a priority.

What is Groundswell doing about it?

Groundswell has reflected on what we have been able to achieve so far.  We are determined to make homeless health everyone’s business.  Therefore, with health and participation at the forefront of our vision, we have developed the #HealthFirst approach to facilitate system change. This puts the people who have experience of homelessness in the driving seat to tackle homeless health inequalities. #HealthFirst is a recognition that health is the foundation to move out of homelessness.

Building on our experience we are aiming to widen the network of peers nationwide, to gather and use grassroots insight to deliver actions to improve access to health. In real terms this means we are:

  1. Building a network of organisations who are developing Homeless Health Peer Advocacy services in their own area;
  2. Expanding our understanding of the experiences of people who are homeless in accessing services;
  3. Developing partnership with a wide range of stakeholders to develop national and local action plans to improve homeless health;
  4. Expanding the reach of our information campaigns such as ‘access to health care’.

This movement will change the landscape of homeless health and the participation of people with experience of homelessness in developing and delivering the solutions to end homelessness.  We are at the early stages and already many individuals and organisations have expressed an interest in joining us.

If you’d like to learn more about developing a Homeless Health Peer Advocacy service in your area, or are interested in patient experience-led system change, Groundswell would love to hear from you.  Please contact Groundswell to arrange a call; we’d be very happy to have a chat.

Becky Evans

Development Manager at Groundswell


Photo by Simone van der Koelen on Unsplash.

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