One way to understand the impact of inequalities is to look at how social exclusion impacts on a specific group.


Who are they?

 “Homelessness is the problem faced by people who lack a place to live that is supportive, affordable, decent and secure” (Crisis 2005, p.1). Therefore homelessness covers a number of homeless states. “Rooflessness” includes rough sleepers, newly arrived immigrants and people left homeless due to violence or disasters. These are the most visible group but the majority of homeless people are families or single people who are living in insecure or temporary accommodation. “Some may have no choice but to squat, or to stay on the sofas of relatives and friends. Others live in supported accommodation, such as hostels, or in temporary accommodation, such as bed and breakfast” (Homeless Link  et al 2010a, p.1).

A permanent address is more than a physical space. It represents security and well-being in a very real sense as it is a “practical pre-requisite to living and working in modern society and a basic requirement for employers and other essential services” (Crisis 2005, p.1).

While legal definitions of homelessness appear to agree that homelessness is more than “rooflessness”, local authorities determination of the statutory homeless, and therefore those who are eligible for their support, are a much narrower group. This tends to exclude the “hidden homeless”, single people (people without dependents) who exist “out of sight" in hostels, bed and breakfasts, and squats or with friends and family (Crisis 2005).

Precise figures for the homeless population are difficult to ascertain due to the nature of homelessness. Figures on households accepted as homeless by local authorities are available for the different countries (Scottish Government 2010; St Mungo's 2011; Department for Communities and Local Government 2013a; Northern Ireland Housing Executive 2013; Welsh Assembly Government 2013). Rough sleeping figures for England have also been published (Department for Communities and Local Government 2013b). A new methodology for carrying out counts of rough sleepers in England is now being implemented (Department for Communities and Local Government 2010).

How are they affected by social exclusion?

People become, and stay, homeless for a number of different reasons. The main cause of homelessness is relationship breakdown with family and partners. But many other factors can increase the risk of homelessness including physical or sexual abuse, unemployment, alcohol and drug abuse, mental health problems, contact with the criminal justice system and lack of a social support network (Wright and Tompkins 2006).

Homeless people are among the most vulnerable and socially excluded in our society and often find it difficult to access the help they need (Crisis 2002). Premature mortality is higher among homeless populations (Wright and Tompkins 2006). Many homeless people present to health services with multiple morbidity including drug or alcohol dependence, mental health and physical problems such as tuberculosis and breathing difficulties (Wright and Tompkins 2006; Queen's Nursing Institute 2010a). An audit carried out by Homeless Link using a new audit tool, and involving over 700 homeless people in England, found that eight out of ten participants have one or more physical health needs and seven out of ten have one or more mental health needs (Homeless Link 2010b). The report provides statistics on the physical and mental health conditions and also on visits made to general practices and accident and emergency departments by the participants in the audit. Families living in temporary accommodation also experience more health problems than the general population (Vostanis 1998).

What is being done?

The cumulative evidence shows that only a multi-sectoral response which includes housing organisations, social services and health services can find long-term solutions to the needs of these client groups (Fitzpatrick et al 2000; Quilgars et al 2008). An annual survey undertaken by Homeless Link (2010c) charts the progress made in tackling homelessness and provides key evidence on the characteristics of homeless people and their service needs. 

A pilot project which began on April 2011, No Second Night Out (NSNO) (2011), is focussing on a rapid response to those who find themselves sleeping rough in London for the first time. Each week about 50 people are seen sleeping rough for the first time in London. The aim expressed by the Mayor of London is that “by the end of 2012 no one will be living on the streets of London and no one arriving new to the street will sleep out for a second night”. Six commitments to tackling homelessness have been made by a Ministerial Working Group on Homelessness and the intention also is to extend the principles that underline the way of working in the NSNO project nationwide (HM Government 2011).

In terms of health care for homeless people, flexibility in the provision of health services and different models of working help to overcome the barriers to accessing appropriate health care that many homeless people experience (Scottish Government 2005; Wright and Tompkins 2006).

Key to the provision of appropriate services is an effective commissioning process – “nurses have key leadership roles to play in the commissioning of health care for homeless people as they know their client group, know the health needs of their client group (both physical and mental and from a public health perspective), know the gaps in service provision, know the partner organisations from both the voluntary and statutory sectors and know models of good practice” (Queen’s Nursing Institute 2010b, p3).


All of the items in this reference list are available online. They were last checked on 2 April 2013. Some of them are in PDF format – see how to access PDF files.

Crisis (2002) Media brief: Critical condition: Homeless people's access to GPs (PDF 388.63KB). London: Crisis.

Crisis (2005) What is homelessness (PDF 110.94KB). London: Crisis.

Department for Communities and Local Government (2010) Evaluating the extent of rough sleeping: a new approach. London: CLG.

Department for Communities and Local Government (2013a) Statutory homelessness statistical releases. England. London: CLG.

Department for Communities and Local Government (2013b) Rough sleeping in England: autumn 2012. London: CLG.

Fitzpatrick S, Kemp P and Klinker S (2000) Single homelessness – an overview of research in Britain. York: Joseph Rowntree Foundation.

HM Government (2011) Vision to end rough sleeping: No Second Night Out nationwide. London: Department for Communities and Local Government.

Homeless Link (2010a) Homelessness - trends and projections. London: Homeless Link.

Homeless Link (2010b) The health and wellbeing of people who are homeless: evidence from a national audit - interim report. London: Homeless Link.

Homeless Link (2010c) Survey of needs and provision: services for homeless single people and couples in England (SNAP report) . London: Homeless Link.

No Second Night Out (2011) No Second Night Out (NSNO) project website.

Northern Ireland Housing Executive (2013) Homelessness. NIHE website.

Queen’s Nursing Institute (2010a) Improving healthcare for homeless people resource pack. Section B Module 1: Overview of health and homelessness. London: QNI.

Queen’s Nursing Institute (2010b) Improving healthcare for homeless people resource pack. Section B Module 5: Planning, commissioning and delivering services. London: QNI.

Quilgars D, Johnsen S and Please N (2008) Youth homelessness in the UK. York: Joseph Rowntree Foundation.

Scottish Government (2005) Health and homelessness standards. Edinburgh: Scottish Government.

Scottish Government (2010) Operation of homeless persons legislation in Scotland 2009-10. Edinburgh: Scottish Government.

St Mungo's (2011) Homelessness statistics. St Mungo's website.

Vostanis P, Grattan E and Cumella S (1998) Mental health problems of homeless children and families: a longitudinal study. BMJ 316(7135) 21 March pp.899–902.

Welsh Government (2013) Homelessness (includes most recent statistics). Welsh Government website.

Wright N, Tompkins C (2006) How can health services effectively meet the health needs of homeless people? British Journal of General Practice 56(525) 1 April pp.286–293.

This page was last reviewed 15 April 2015.