Insight Report: Healthcare access barriers among people experiencing homelessness in Merton

Engagement with YMCA and Faith in Action winter night shelter

Executive Summary

This report presents findings from engagement activities with people experiencing homelessness or living in temporary accommodation in Merton, carried out between January and August 2025 with the YMCA and Faith in Action Winter Night Shelter. 15 in-depth conversations took place across two visits to the Faith in Action Winter Night Shelter at Martin Way Methodist Church and a focus group with 10 men was held at the YMCA.

Key insights:

People are unsure of how to register with their GP which can limit their access to basic and specialist healthcare.
Having translated information available in multiple languages is so valuable. Polish and Tamil speakers shared that it can be hard to communicate their needs and navigate the health and care system.
Digital exclusion through lack of phones or data, low digital literacy, and device limitations can block people from using NHS apps and booking appointments online.
People aren’t sure how to access mental health services and whether these are free. Some people thought that you had to pay to access services such as IAPT and this along with long waits put them off seeking help.
NHS dentists are hard to find, leaving many unable to access routine or urgent dental care.
Confusion and fear over costs including uncertainty about eligibility for free care mean people avoid treatment, leading to untreated dental problems.
Delays of up to three months for physiotherapy and secondary care are stopping people from working and recovering, especially those in manual jobs. Some are forced to pay privately or turn to emergency services.
A&E can feel like the only option for some people, especially for work-related injuries. People face uncertainty around how to register with a GP, what documentation is required, or may have been turned away due to not having a fixed address.
Pharmacies are the first stop for quick advice, people suggested that they build closer links with community organisations to provide support for people who are homeless.
Primary care feels impersonal and hard to access, with people wanting better communication and home visits, particularly for neurodivergent patients and those with fluctuating health needs.

Next steps

The insights gathered will be shared with Merton’s local health and care providers and with Merton Council. We have shared our engagement from Faith in Action with our Merton Health and Care Together Place Committee and we expect to take this insight from the YMCA engagement to a future meeting.

The findings on access to dental care will be included in our overarching Merton and Wandsworth Oral Health report. They will also be shared with the South West London Local Dental Committee (LDC), the Merton and Wandsworth Primary and Community Care team and NHS England Public Health colleagues. We will also share them with our partners at King’s College Community Special Care Dentistry team to inform future service planning and support.

Introduction

3,398 people have applied for support with housing and homelessness in Merton since 2018. There is a significant divide between East and West Merton, with 73% of applications coming from East Merton. This reflects wider inequalities, including poorer housing conditions, higher deprivation, and worse health outcomes in East Merton. Housing insecurity is closely linked to increased risks of physical and mental health problems, making timely access to healthcare vital yet challenging for many people.

The purpose of this engagement was to better understand the barriers to accessing healthcare faced by people experiencing homelessness or living in temporary accommodation in Merton. We wanted to hear directly from those with lived experience about what helps or hinders their access to support, and how services might better meet their needs.

This work links to the Mayor of London’s plan to end rough sleeping, which says people who are homeless should be able to get help from a GP, dentist, mental health services, and support in the community. To make that happen, the NHS needs to make it easier for people without a fixed address to register with a GP and get care. Staff should be trained to understand the challenges people face and offer support that’s kind and respectful. Health services should also go to places where people already feel safe like day centres, food banks, and hostels. The Mayor’s Rough Sleeping Plan of Action 2025 | London City Hall

Methodology

This report draws on two connected strands of engagement carried out between January and August 2025. The following engagement activities focused on the lived experience of people facing housing insecurity in Merton, with a particular emphasis on barriers to accessing healthcare.

Faith in Action Winter Night Shelter – January & February 2025
NHS South West London Engagement Team held one-to-one interviews with men experiencing homelessness or living in temporary accommodation. 15 in-depth conversations took place across two visits to the Faith in Action Winter Night Shelter at Martin Way Methodist Church. Many participants were in manual employment and frequently relied on A&E for work-related injuries due to limited access to primary care. The aim of the one-to-one conversations was to better understand barriers to healthcare for people experiencing homelessness, including registration issues, language barriers, awareness of available services, and digital exclusion.

YMCA Engagement – August 2025
To build on reporting from Faith in Action and as part of a health day held with the YMCA, we ran a focus group with ten YMCA residents in Merton. We worked in partnership with the Merton Connected Social Prescribing team to make the most of this opportunity to share learning and strengthen connections. The YMCA provides supported accommodation and wrap-around services for people at risk of homelessness, helping residents access healthcare and wellbeing support. All participants gave informed consent before taking part. Participation was voluntary, and where appropriate, participants received remuneration to acknowledge their time and contributions.

Faith in Action Winter Night Shelter – in their own words

Faith in Action grew from collaboration between local faith groups across the London borough of Merton.

Merton Homeless drop-in sessions

Open every Wednesday and Friday, the Homeless Drop-in welcomes around 50 to 60 homeless and vulnerably housed local people. They offer hot drinks, breakfast, a two-course hot lunch, internet access, advice and support from a professional staff team, supported by a dedicated team of around 50 volunteers and access to third-party local agencies and services. Rough sleepers can also access showers and laundry, donated clothes and food parcels.

Merton Winter Night Shelter

Faith in Action are home to the Merton Winter Night Shelter. The shelter provides emergency accommodation people experiencing homelessness, between December and mid-March. Teams of faith group volunteers, around 360 in total, provide a vital service for people across a dozen hosting venues in the borough.

YMCA – in their own words
The YMCA in Merton is part of YMCA St Paul’s Group, one of the largest YMCA federations in the UK. It provides supported accommodation for people aged 16 and over who are homeless or at risk of homelessness, alongside wrap-around services that help residents move towards independent living. Residents have access to on-site support workers, health and wellbeing activities, skills training, and pathways into education and employment. The YMCA also works in partnership with local health and care providers to connect residents with GPs, dentists, and mental health support, aiming to reduce health inequalities for some of the borough’s most vulnerable people.

Key findings and cross cutting themes

People are unsure of how to register with their GP which can limit their access to care including preventative, mental health and support for long term conditions.
Having translated information available in multiple languages is so valuable. Polish and Tamil speakers shared that it can be hard to communicate their needs and navigate the health and care system.
Digital exclusion through lack of phones or data, low digital literacy, and device limitations can block people from using NHS apps and booking appointments online.
People aren’t sure how to access mental health services and whether these are free. Some people thought that you had to pay to access services such as IAPT and this along with long waits put them off seeking help.
NHS dentists can be hard to find, leaving many unable to access routine or urgent dental care.
Confusion and fear about dental treatment costs. People aren’t sure if they’re eligible for free or subsidised treatment which can stop them from seeking help. This often means dental problems go untreated, even when care is urgently needed
Delays of up to three months for physiotherapy and secondary care are stopping people from working and recovering, especially those in manual jobs. Some are forced to pay privately or turn to emergency services.
Pharmacies are the first stop for quick advice, people suggested that they build closer links with community organisations to provide support for people who are homeless.
Primary care feels impersonal and hard to access, with people wanting better communication and home visits, particularly for neurodivergent patients and those with fluctuating health needs.

This insight shows the real challenges people facing homelessness and who are living in temporary accommodation in Merton deal with every day when trying to access health and care services. This ranges from not being registered with a GP or dentist, to language and digital barriers and long waits for treatment.

Organisations like Faith in Action and the YMCA are doing important work to try and fill these gaps, but there is more that health and care services must do to improve access, communication and support. We will share this insight with decision makers to help bridge these gaps. By improving communication and support whether it be through signposting or better advocacy, we can influence change and make it easier for people to get the help they need.

Detailed feedback from Faith in Action

Accessing healthcare while experiencing homelessness can be incredibly difficult – people who were either homeless or living in temporary accommodation shared the everyday barriers they face when trying to get help. Many were not registered with a GP, which meant they couldn’t access referrals or specialist care. Others didn’t know where to go for help with ongoing health issues like sinus problems or eye conditions. One man needed to see an ophthalmologist but couldn’t get an appointment without GP registration.

Language barriers were an issue, people who did not speak English as a first language felt like they couldn’t communicatetheir health concerns, especially those who spoke Polish or Tamil. Translated materials, like a Polish leaflet about Pharmacy First, made a real difference, helping someone understand how to get the right support in the community. They said they would visit the pharmacy the next day to get support for sinusitis, using the leaflet as a tool to help with language barriers. Additionally, Polish-speaking participants shared their experiences of seeking care from a Polish GP in Croydon due to language barriers they faced in Merton. Relying on word of mouth to find a GP who spoke their language or visiting the GP with a friend who could help translate.

There is a widespread lack of awareness about how to access mental health services and the fact that they are free of charge. Some people mistakenly believe they must pay for these services, while others are discouraged from seeking help due to long waiting times.

Digital exclusion creates additional challenges, as some people either do not own mobile phones or frequently have devices that are out of battery or lack data, making it difficult to use the NHS App or book appointments online.

Access to dental care is limited, with many people struggling to secure appointments with NHS dentists, resulting in prolonged periods without necessary treatment.

Some people wait up to three months for an appointment for Musculoskeletal Services (MSK), causing prolonged pain and, in some cases, preventing them from working. It was noted that the appointment may just be a telephone call to start with, causing further delays for treatment. These delays significantly affect their quality of life and recovery.

Reliance on A&E was often due to no other means of accessing care – many of the men were in manual employment and frequently relied on hospital services such as A&E for work-related injuries due to limited access to primary care services, which left them with no other option for immediate medical attention.

Detailed feedback from YMCA

Pharmacy

People are unclear about prescription payment rules, even when on benefits.
Some do not know whether they need to pay, leading to mistakes when completing forms. One person described ticking a box in error, assuming it was correct, and not paying for their prescription. They later received letters demanding repayment and felt threatened by the tone. Suggested improvements included providing a clear leaflet when prescriptions are collected, explaining eligibility for free prescriptions and showing which boxes to tick.

Pharmacy customer service quality varies across Merton.
While there was praise for pharmacies in Wimbledon and Merton High Street, others shared negative experiences, particularly people who are homeless, who described being spoken down to or patronised. These interactions left them feeling embarrassed.

Pharmacies are often preferred over GP appointments.
Many people said they would go to a pharmacy before visiting their GP, as they were seen more quickly and received useful advice. For example, one mother took her child to a pharmacy after she bumped her head. The pharmacist advised visiting A&E but also provided paracetamol to help in the meantime.

People want pharmacists to offer more vaccinations beyond the flu jab.
Many said they would prefer to have a wider range of jabs at their local pharmacy instead of needing to book at their GP practice. They felt this would be more convenient and improve uptake.

Pharmacists could be better connected with community organisations. Some shared positive examples, such as a local pharmacist delivering medication to a person with mobility difficulties. While this was understood to be a bespoke service, people felt it should be available to more patients. Suggestions included pharmacists attending health days at venues like the YMCA and other community settings, so people could access advice on the spot. There were also calls for pharmacies to open 24/7 for urgent needs, and for pharmacists to be able to prescribe antibiotics for minor infections — not just under the Pharmacy First scheme, but for everyone.

Dentistry

Getting a dentist appointment is tricky when most practices are not taking on new NHS patients. People described ringing every dentist in the area with no luck. Only one person in the room was registered with dentist. Others said the process of having to fill out a form put them off trying to register.

More needs to be done to inform people if they are eligible for free treatment. Some people who can access free/subsidised treatment because they receive Universal Credit were not aware of what they were entitled to.

Not being able to afford regular dental check-ups is leading to people being removed from dentist lists. People are being taken off dentists list after not going for an appointment for two years. This is despite dentists being aware patients might have more complicated issues with their teeth.

People would rather suffer in silence or turn to their own methods of pain relief, including drinking, rather than trying to urgent dental services. Not everyone was aware that they could use NHS 111 to get urgent dental treatment.

“[If I had toothache] I would just go to the pub, it worked when I had the flu”.

Distrust in dentists because of a lack of consistency about advice and treatment. People shared experience of being told they needed expensive treatment by one dentist only to be told by another that they didn’t need anything. This puts people off getting help because of the worries of the cost of treatment.

Digital

Digital health tools are not one-size-fits-all.
People felt the NHS App should not be promoted as universally suitable. Concerns were raised about data sharing and its impact on those with low digital literacy. Some described receiving appointment notifications via the app without feeling ready to use it. They suggested a gradual rollout, with training for those who want it. One positive example was shared where a person uploaded a photo of an ulcerated leg and was able to get a quicker GP appointment as a result.

Optometry

The cost of eye care is a barrier to people seeking the support they need. The cost of glasses is especially expensive for many despite them being essential for people to go about their day to day life.

“My current pair of glasses cost me £900!”

Primary Care

Personalisation in primary care is essential.
People felt that having accurate notes on patient records makes a significant difference to the quality of care. For example, neurodivergent patients described only being contacted by preferring letters or texts despite preferring telephone calls. When calls go unanswered, GPs may try only three times before the matter is closed, leading to missed care. There was also a desire for a return to home visits for those whose health can change rapidly:

“I don’t always look at my phone and I might be in good health one day and the next day I’m not – what do I do then if the GP won’t ring me back?”

Quick feedback mechanisms could improve GP services.
Some people suggested a short survey after each appointment to capture immediate feedback, which they felt could resolve issues before they escalate into complaints.

Secondary Care

Long wait times for appointments have knock on effects on people’s wellbeing. Some who suffer with limited mobility because of MSK issues were having to wait a long time for an appointment. This had wider impacts on their ability to work and go about their lives as normal. One man who is now not able to work because of issues with his leg said he missed one appointment for at Guys and St Thomas’ and now he cannot get another, and another felt he had no choice other than to get treatment privately. Drug and alcohol services were also noted as hard to access.

“Where else can I go?”

Hospitals are not always accessible for those with limited mobility. Large hospitals with lots of corridors to navigate can be an extra challenge for people with mobility issues who attending appointments.

“It took me 25 minutes to walk from the bus stop to the dermatology ward for my appointment, but I’m too embarrassed to ask to use a wheelchair”.

More clarity around the triaging process when calling 999 and call handlers should provide more information about the actions they are suggesting. One man shared that he called 999 for chest pains and was told to get a taxi and they weren’t sending an ambulance. He was scared and ended up having to travel on the bus to get to A&E.

People want broader improvements to NHS services.
Suggestions included reducing waiting times at A&E (“I waited 11 ½ hours to be seen”), increasing GP appointments (“We need more”), improving follow-up and communication, and expanding patient transport for all (“I waited 18 hours at A&E for an MRI scan because I needed to be seen and I couldn’t get home as I was in too much pain”).

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