The hidden cost of going unseen and unheard

John Williams has been selling Big Issue on and off for more than a decade. These days you’ll find him in Swansea city centre, where he’s been working his pitch for the last two years. His work depends on something most people barely think about: a pair of glasses.

“Without them I’d get really bad headaches, near enough migraines,” John says. “I wouldn’t be able to read properly, work out the money, see the card reader, or use my phone. It would make things very hard.”

When his benefits stopped, John discovered how difficult it could be to get even basic eye care. “Sometimes I could get glasses free on benefits, but when that ended it became difficult. I needed new glasses and didn’t know how I was going to afford them,” he explains. “At that time I’d just come out of homelessness, everything was up in the air with my address, and it was difficult to organise anything.”

This is what hidden homelessness looks like. John wasn’t sleeping on the streets, but without a fixed address he found himself shut out of vital services. Like many people sofa surfing or in temporary accommodation, he didn’t always see himself as homeless — but instability made basic healthcare feel out of reach.

A Crisis study found that 95% of people experiencing homelessness are ‘hidden’; only 5% are rough-sleeping. Limited access to basic health care, like sight and hearing checks, are an element of homelessness that’s often overlooked. That loss is felt most sharply on the margins, where even small barriers make work impossible. Vision Care reports that one in three people experiencing homelessness needs glasses, yet nearly 65% say they would put off visiting an optician. Not because they don’t want to see clearly, but because the system makes it almost impossible.

John points out, “If you’re moving around, trying to get letters or register anywhere it’s very hard.” His experience mirrors that of thousands whose health needs go unmet because their homelessness is hidden.

The workplace impact can be devastating. The British Academy of Audiology estimates hearing loss costs the UK economy £25 billion annually in lost productivity. That loss is felt most sharply on the margins, where even small barriers make work impossible. For people in insecure roles – zero-hours contracts or cash-in-hand jobs – any performance concern related to untreated hearing or vision problems can mean instant dismissal. Without support or workplace adjustments, people with sensory impairments are effectively locked out of employment.

Poverty also makes sight and hearing problems worse. Vision Care found that 90% of the 216 people they supported in 2023 who were ineligible for NHS treatment required glasses, while 14.2% had a diagnosable eye condition – 10 times the rate in the general population. A Canadian study reported nearly 40% of homeless adults had speech-frequency hearing loss, double the wider population. Cold nights and damp conditions often trigger untreated infections that cause lasting damage. For those sofa surfing or in temporary rooms, even basic antibiotics may be out of reach.

Each of these statistics represents someone unable to read a form, hear an interview question, or see a hand extended in help. Poverty causes impairment, and impairment keeps people in poverty. Hidden homelessness means these problems remain invisible until they push people into deeper crisis. The good news is that solutions exist.

Specsavers’ homelessness programme supported 729 patients across 130 clinics in 2024/25 – a fourfold increase on the previous year. They dispensed 472 pairs of glasses and provided ear care to 147 people. Not through complicated schemes, but by removing barriers instead of erecting them.

Since November 2022, all Big Issue vendors have been entitled to vouchers for free eye tests, glasses and ear wax removal at Specsavers. Mobile units visit community centres and out-of-hours clinics run in more than 150 stores. In Yorkshire, a programme across 16 temporary accommodation sites delivered 271 eye tests and 231 pairs of glasses – 88% of recipients said they would otherwise have gone without.

With 131,140 households in temporary accommodation as of June this year, the crisis isn’t looming – it’s already here. Every person denied glasses is someone unable to read a job application. Every untreated infection is another barrier to employment. Every bureaucratic hurdle is another year lost to preventable poverty.

John knows exactly what that means. “Big Issue were a huge help,” he says. “If they hadn’t stepped in, I honestly don’t know what I would have done.” His story shows how easily invisible problems can spiral without support – and how removing a single barrier can make all the difference.

Every pair of glasses dispensed, every hearing test offered, is more than healthcare. It is a lifeline for those the system too often overlooks.