The government is currently reviewing proposals for reform of the Housing Benefit system, which they outlined in January 2006: A New Deal For Welfare. Reforms constitute a national roll out of the Local Housing Allowance pilot Scheme in the private rented sector (Welfare Reform Green paper, 2006). Whilst this proposal represents a change to the administration of the benefit, it does not contain any proposals to change any underlying rules or regulations of Housing Benefit policy.
Poor quality housing is closely associated with poor health (Haslam, 2003). Many people find themselves trapped in temporary accommodation whilst waiting for their local authority to find them more permanent accommodation. Bed and breakfast accommodation is the most likely type of temporary accommodation. Temporary accommodation tends to be ill-designed, ill equipped and ill maintained, many concerns have been raised over the use of such accommodation by both campaigners and local authorities, as it has been found that people living in temporary accommodation such as bed and breakfasts have an elevated prevalence of major health problems, with around forty five percent of the bed and breakfast population of adults experiencing psychological distress compared to just twenty percent of the general population.
Rates of self-reported depression and anxiety are three times higher amongst those in bed and breakfast accommodation and ten times higher in rough sleepers (Crisis, 2006). Living in such conditions as over crowding, sharing cooking and bathing areas, a lack of space, both inside and out, engenders stress and is more likely to put a strain on family relationships. Where there is children involved the stress in the parent can be passed onto the child both directly and indirectly, thus impairing normal child development, whether it is through the lack of a safe space for a small child to play and explore or an older child who might find it impossible to find a quiet place to do their homework or lacks privacy as they are growing up. The government claimed they recognised the concerns raised about the impact of this type of accommodation, particularly on children.
Therefore they have placed a six week restriction as the length of time families with children should spend in bed and breakfast accommodation. Although this is good news for those with young children, for those who do not have a time restriction on their stay in this type of accommodation more help is needed via government policies to ensure more is done for these people. Young, single adults are particular vulnerable and are often not safe in bed and breakfast accommodation.
Centrepoint has found that sixteen and seventeen year olds are offered drugs or alcohol within hours of arriving at bed and breakfast accommodation. Many described the violence and alcoholism they witnessed, and how intimidated it made them feel, some girls also reported how they were approached for sex. In a survey conducted by Centrepoint in 2002, it was found that out of one hundred local authorities fifty nine of them did not have a strategy as to how they house sixteen and seventeen year olds. Many young people are being refused housing when they should not be. Many are told to return home to situations that may not be safe or sustainable.
Access to appropriate primary health care is an inequality that many homeless people face in relation to welfare provision. Despite the increased and poor level of health amongst the homeless, homeless people are on average forty times more likely not to be registered with a General Practitioner (GP) than the general public. This is often due to the problems many homeless people face trying to register with a GP and gaining sympathetic treatment (Government Office, 2005). Currently GPs receive finance on the basis of the number of registered patient that they have. Funding is paid to the GP for every twelve months that the patient is registered. In theory the GP gets paid a year behind. If a permanently registered patient moves before the end of the financial year they take the money that is associated with them to their new area.
If the patient is only temporarily registered the GP can only guarantee income from that person for up to nine months. Because many homeless people lead transient lives, GPs are aware of this therefore this can be seen as a strong disincentive for a GP not to allow a homeless person to register with them because they are aware that they may treat a homeless person for ten months and then the homeless person moves to another area, therefore the GP will lose the funding for the past ten months treatment. It has also been suggested that the poor health status of some homeless people makes them relatively expensive to register and this may also act as a disincentive.
Also many GP registration systems may work against homeless people, because may GPs’ systems require that anyone who wishes to register and use their services should have a permanent address in order to register. A permanent address is something that homeless people do not have. Many GPs often view homeless people as difficult or challenging individuals who feel that if they allow homeless people to register with them this may cause problems with other patients.
The popular conception of homeless people as disruptive, drug or alcohol dependent still permeates society (Burrows, 1997). In addition to the administrative, budgetary and prejudicial barriers to registration, there are also other difficulties that homeless people have to overcome. Some homeless people can be individuals who are socially marginalised who lack the skills to deal with bureaucracy or to express themselves. Low educational levels may make it difficult for homeless people to advance their case, particulararly if faced with a hostile receptionist or hostile health professional.
Registration with a GP is the main means by which people in the UK receive medical services and access to other health services. As it is the GP that refers their patients to specialist and other support networks without a GP many homeless people are prevented accessing the services that are needed. It is particularly important that homeless families with young children have regular health checks. Babies and young children should receive follow up visits from community midwives and health visitors, however millions of babies and young children are slipping through the net and are not receiving the adequate care they are entitled to because of barriers preventing them being registered with a GP. Also services within the National Health Service are generally designed to deal with a single or limited range of issues (Department of Communities and local Government, 2004).
Many homeless people have multiple or complex needs, or a dual diagnosis may be required. These complex or interwoven issues often prevent homeless people from accessing health care. Many homeless people also have mental health problems, such as personality disorders which make it more difficult for them to fully engage with people and services. Because of their transient, chaotic lifestyles many homeless people miss appointments for health services or have moved on before they receive an appointment as waiting lists within the NHS can be very long.
There is also the issue that health is not a priority for many homeless people, because they are faced with so many other problems, they often forget or do not have the means to take care of themselves, therefore they only visit a GP or want to access health services once they are ill or have a health issue. Many try to use accident and emergency units for something that should be dealt with by a GP. Because accident and emergency units are over stretched they tend to tell a homeless person that they can not treat them and they should make an appointment with their own GP, but if a homeless person does not have a GP no treatment will be accessed by the homeless person.
It can be concluded that there are many inequalities and barriers that homeless people are faced with, when accessing welfare provisions. Increasing housing inequality is not inevitable. The government can and must choose to do something about it. The government can and should be doing more to help these vulnerable members within our society. Increased investment in good quality social housing is needed so more people can benefit from the security and affordability of social housing.
There also needs to be more opportunities for people at risk of homelessness and for those who do become homeless, more support, help and guidance is needed to help these families and individuals find settled homes, not just a roof. Tighter restrictions should be placed on private landlords’ to ensure that the housing that they provide is both safe and secure for the individuals and families that rent their properties. Local authorities play a key part in determing a persons’ housing status, more commitment is needed to ensure that these welfare systems are run more efficiently. Homelessness has no place in a sustainable community and it can and should be eradicated.
Burrows R, Pleace N Homelessness and Social Policy Routeledge; London. Quilgars D (1997) Centrepoint (2005) Temporary Accommodation www.centepoint.org.uk (Accessed on 12th Novermber 2006) Crisis (2006) About Homelessness www.crisis.org.uk (Accessed on 16th November 2006) Communities and Moving On www.communities.gov.uk Local Government (2004) (Accessed on 12th November 2006)