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The experience of Croydon’s street homeless makes the case for more dedicated support

Press release: 30 July 2020

Street homeless found it easy to access services in Croydon and most found dedicated homeless services positively impacted their health and wellbeing.

Nearly a quarter had a physical and/or mental disability, unemployment, health issues, or relationship breakdown had led to many becoming street homeless. Some were homeless due to awaiting immigration status.

Healthwatch Croydon recommends further dedicated support and access to other key health services; encourage training and support to enable employment; local support for awaiting benefits and those awaiting immigration status decisions, and dedicated therapies and rehabilitation.

An insight report of experiences of Croydon’s street homeless is published today, by Healthwatch Croydon, the local champion for health and social care, about their experiences of accessing to health services and to understand more about the journey that made them street homeless. We spoke to 50 homeless people between April and December 2019 to hear their experiences and inform decision-making on improving services.

These are our findings:

Street homeless found it easy to access services in Croydon: Most had utilised the hospital for one treatment or more, the dentists, pharmacist, A&E and the GP except for a few who said it was slightly difficult for them to access services because of their disability, language barrier and had no registration with a GP. The positive comments we have collated has shown some degree of improvement from when Healthwatch Croydon embarked on a similar project two years ago.

Most found dedicated homeless services positively impacted their health and wellbeing: We asked our respondents which services in Croydon had made a positive impact on their health and wellbeing. 86% of respondents had said the Salvation Army in

Nearly a quarter had a physical and/or mental disability: We found out during this research that 22% respondents had one form of disability or health condition including psychological trauma, heart problems, depression, diabetics, mental health issues, epilepsy, psychosis, brain damage, osteoarthritis, fibromyalgia and mood swings.

Unemployment, health issues and relationship breakdown has pushed many people to become street homeless: A number of the respondents stated that they were on a very low income which could barely cover the daily cost of living and therefore rent payment was impossible. Others told us part of the reasons why they are street homeless is mainly because of a breakdown in their personal relationship.

Some were homeless due to awaiting immigration status: We heard from several respondents who were homeless due to their immigration status, which prevented them from obtaining a job and a home. As a result, their needs varied in comparison to other street homeless respondents.

Nearly one in three were homeless from two to five years: While most of the respondents we spoke to had been homeless for six months to a year, we found that 30% that has been homeless for many years.

These are our recommendations:

Dedicate further support and access to other key health services for street homeless: More focus on providing staff who are trained to work with street homeless or providing a more dedicated support service will help increase satisfaction and experience of these services. It may still be an issue that homeless cannot access services due to not being registered with a GP, which is the gatekeeper of access. This needs to be considered and services that can support homeless to engage with health and social care services.

Encourage training and support enable street homeless to gain employment: It is important that street homeless have access to assistance in getting them back into work to help build their self-esteem and confidence especially for those who have been on the street for years. Job provision will keep them off the street.

Maintain permanent accommodation options for street homeless: Permanent accommodation brings stability for rough sleepers and builds their confidence. All the respondents we spoke to said the support they need was to have permanent accommodation.

Providing support with those awaiting immigration status decisions: We found many asylum seekers are rough sleepers, but some stay in hotels or B&B for a period of time, dependent on their status. Again, this is not something that is needed for all homeless people but needs consideration when developing services.

Provide dedicated therapies and rehabilitation: There is a need for medical attention for those street homeless who have mental and physical health issues. Restoring them to health or normal life through training and therapy after imprisonment, addiction, or illness can assist them to more confidence and assurance.

This insight report has been shared with Croydon Health Service NHS Trust (hospital and community services), Croydon Council, South West London NHS (GPs), South London & Maudsley NHS Foundation Trust (mental health services) as well as the organisations we worked with on this project: Crisis Croydon, Salvation Army and Nightwatch.

Gordon Kay, Healthwatch Croydon Manager, said “It is good to see that access to health and support services has improved for street homeless, but there it is clear much more work needs to be done to ensure their needs are met. This report makes a public case for focus on a range of dedicated services reflecting local needs. A number of new initiatives have been undertaken while we have compiled our research which look to tackle some of the concerns, but we call upon all on all partners in both health and social care services to keep the issue of homeless high on their agenda. This most vulnerable of communities needs all the support it can get.”

Dr Agnelo Fernandes, GP Borough Lead for Croydon said:

“Many thanks to Healthwatch for writing this valuable follow up to their 2018 report. Supporting  those who find themselves homeless continues to be really important to us so we’re glad to see that there has been a demonstrable improvement in access to and experience of both physical and mental health services. It’s really helpful to have this level of feedback from our service users and we will feed this report into our ongoing service improvement. We are committed to learning long term lessons from the pandemic to enable us to better support these vulnerable communities.”

Julia Pitt, Director of Gateway Services, Croydon Council said

“The Council is pleased to see that the experience of rough sleepers has improved in relation to accessing health services since the last report. During this time, we have secured Rough Sleeping Initiative Grant funding, recruited a Rough Sleeping Coordinator and launched 23 new initiatives for rough sleepers including a clinical mental health outreach service, and direct access accommodation for rough sleepers. We welcome research that evidences the health and social care needs of this group providing valuable insights for commissioners. The report quite rightly highlights the needs of those homeless people subject to immigration controls. Regrettably there are limits to the level of support the Council can offer this group owing to restrictions on access to public funds.”

Jonna Laine, Progression Manager, Crisis Croydon said:

“At Crisis Croydon, we are pleased to have been able to support Healthwatch with this research project. We believe access to health services in Croydon has recently improved as a result of dedicated health services for homeless people and effective collaboration between different agencies in the borough. However, many people experiencing street homelessness still report to our staff that they have been denied access to health services due to their immigration status, lack of documents or lack of fixed address.

“Therefore, we support the conclusion that further resources need to be dedicated to improving access to these services for those experiencing street homelessness, and to improving the quality of services available to those with multiple and complex needs. We also recognise the importance of stable and permanent accommodation for people’s wellbeing and health, and strongly support housing-led approaches that help everyone access and maintain suitable, permanent accommodation.