Background Emergency departments in rural and coastal regions in North-East England and the wider United Kingdom are often attended by people experiencing homelessness, who experience multiple unmet health, housing, and social care needs. Little is known about the underlying issues that these populations face, which lead to them accessing emergency care. This study explores the challenges that people experiencing homelessness face before presenting to emergency services in rural and coastal areas of North-East England.

Methods A qualitative study was undertaken in Northumberland and North Tyneside (rural and coastal regions in North-East England). One-to-one interviews were conducted with people experiencing homelessness in the area. In conjunction, a combination of one-to-one interviews and focus groups were undertaken with people from organisations that provide support to people experiencing homelessness in these regions, for example, frontline staff from housing associations, police, ambulance services, emergency care department, primary health care, mental health services, and alcohol and drug recovery services. Using a semi-structured interview guide, questions were asked around three main topics: experiences accessing emergency services; health issues; and social issues. Interviews and focus groups were audio recorded and held either in person or remotely using Microsoft Teams. The Framework approach was used for a thematic analysis of the data collected. Transcriptions were coded line-by-line by researchers who met as a group to refine codes iteratively.

Results Interviews were undertaken with twenty people experiencing homelessness (aged 18–56 years, 70% male). Interviews and focus groups were completed with eighteen people working in services that support people experiencing homelessness (aged 20–56 years, 56% female). Four key findings were developed: 1) health and social services are not easily accessible for people who are living in constant crises; 2) emergency departments provide temporary respite from daily struggles and substance use; 3) unexplored and undiagnosed disabilities, notably depression, anxiety, and learning disabilities were factors in access difficulties; and 4) negative and traumatic experiences with other health and social services leads to despair and distrust in support systems.

Conclusion Emergency care departments are often seen by people experiencing homelessness as easily accessible and safe places for help with health and other related issues. Services need to be more accessible and provide timely support that can address the underlying health and social care needs of people who are homeless. Further research is necessary to understand how services can work better to provide such accessible and sustainable support to people experiencing homelessness.