The charity will invest £1.6m trialling a service model at three of its 16 hostels, including health checks for all residents on admission, on-site surgeries run by nurse practitioners and ready access to specialist mental health and substance misuse care.
However, it wants to use this as a launchpad for London-wide reforms, under which rough sleeping would be seen as a specific needs category by the NHS, with associated commissioning strategies and funding.
Mayor-led commissioning body
It also wants to see the creation of a London-wide health commissioning body for homeless people, led by the Mayor of London and strategic health authority NHS London.
The charity said this would tackle the problem of rough sleepers being overlooked by individual primary care trusts because they were relatively few in number.
In a report this week St Mungo’s pointed to the poor health outcomes faced by users of its hostels. Of residents surveyed last year, 32% had an alcohol dependency, 63% had a drugs problem, 49% had a mental health problem, 43% had a physical illness and 83% had at least one of these.
However, it said current access to healthcare was poor due to personal barriers – including low self-esteem and a lack of motivation – and institutional obstacles such as a reluctance by services to take on rough sleepers because of fears they will be disruptive, patchy GP availability and inflexible appointment systems.
Variable prioritisation by PCTs
It said the prioritisation of homelessness by PCTs was variable and “further diluted by changes in key personnel, by the conflicting pressures of other priorities, and by uneven levels of knowledge and capacity”.
The report said a survey of hostel residents had found that one in three had a long-term condition for which they were not being treated.
It said the lack of access to primary care meant hostel users often ended up using emergency services, typically for pre-existing conditions.
An NHS London spokesperson said it welcomed the report “as an important contribution to the debate on how best to provide health services to homeless people”.
He added: “As a strategic health authority, we need to review how the health needs of the homeless are addressed in PCT commissioning plans. This also needs to involve our Clinical Advisory Group so we can understand any frustrations felt by health professionals.”