• Caroline Shulman, J J Nadicksbernd, Theresa Nguyen, Erin Raquel Fantoni, James Lally, Matthew Bawden, and Briony Hudson.
• Homeless Health Programme, Transformation Partners in Health and Care, London, UK; honorary senior lecturer, UCL, London, UK; and pathway senior clinical fellow-homelessness and palliative care, London, UK.
• Clin Med (Lond). 2023 Jul 1; 23 (4): 387394387-394.

AbstractPeople experiencing homelessness have extremely poor health outcomes and frequently die young. Many single homeless people live in hostels, the remit of which is to provide support to facilitate recovery out of homelessness. They are not usually designed to support people with high health or care needs. A cross-sectional survey was developed with, and completed by, hostel managers to explore and quantify the level of health and care needs of people living in their hostels. In total, 58 managers completed the survey, with information on 2,355 clients: 64% had substance use disorder, 56% had mental health issues, and 37.5% were in poor physical health. In addition, 5% had had more than three unplanned hospital visits in the previous month, and 11% had had safeguarding referrals submitted over the past year. Barriers to getting support and referrals accepted were highlighted, particularly for people with substance use disorder. Hostel managers identified 9% of clients as having needs too high for their service, while move-on options were scarce. Our study highlights significant unmet needs. Health and care services are not providing adequate support for many people living in hostels, who often have very poor health outcomes. This inequity needs to be considered and addressed as a matter of urgency.© Royal College of Physicians 2023. All rights reserved.

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