A homelessness team in a hospital has the opportunity to change lives

Over the past 15 years, a growing body of research has shown us just how bad homelessness is for health. The average age of death for someone rough sleeping hovers around the mid-40s, and new work on frailty has recently shown that homelessness leads to dramatic premature ageing. One quarter of those aged 30 and under facing homelessness are clinically frail, a similar rate to people in their late 70s or early 80s in the general population.

Our hospital teams’ data bears this out: last year, as well as the emergency medical condition that had got them into hospital, 66% of patients also had a substance misuse problem, 56% had a mental health problem and over 44% had co-occurring mental health and substance misuse problems. These figures were all up on the previous year.

Case studies from the teams illustrate the kinds of challenges the patients face: an emergency, hypothermia-related double amputation below the knee on a patient who has been struggling in the community; patients with hidden histories of brain injury; patients where relationship breakdown has led to living on the streets and addiction spiralling out of control; patients who have been the victim of extreme violence.

“The average age of death for someone rough sleeping hovers around the mid-40s and new work on frailty has recently shown that homelessness leads to dramatic premature ageing”

Alongside these challenges, the Pathway Teams Annual Report also shows that specialist clinician-led teams, based on an evidence-based model of multidisciplinary care co-ordination, can change what happens for people experiencing homelessness in hospital. With each patient, the Pathway teams work to build a relationship of trust, support them to stay in hospital and pull together colleagues from housing, social care, mental health, addictions services and the voluntary sector.

They focus on the needs of the patient in hospital and plan together what’s going to happen next. Through shared values, dogged determination and the strengths they find in their patients, the teams show that care, compassion and expert advocacy can literally change people’s lives. 

The results speak for themselves: in the past 12 months the teams reduced returns to rough sleeping by 62%, ensured that 70% of patients were successfully connected to a new GP before leaving hospital and reduced delayed discharges from 17% to 12%. We have calculated that in the last year these teams saved the NHS over £9m in avoided future care costs, making 13,000 beds available for other patients.

Beyond that, our teams’ unique perspective has wider lessons for the housing and homelessness sector. Over the past two years teams have reported continuously rising levels of need and complexity. People experiencing homelessness are not only sick, they are getting sicker. Teams report a chronic lack of appropriate support in the community for people with more complex needs, and this lack of support leads to people ending up in hospital. 

“Over the past two years teams have reported continuously rising levels of need and complexity. People experiencing homelessness are not only sick, they are getting sicker”

What is also remarkable are the stories of recovery and hope, of patients supported into the right services, of lives stabilised and progress away from homelessness. As one of the patients puts it: “St George’s Hospital [in south London] saved my life and the Pathway team have helped me to build a new one.”

When people are forced into homelessness, declining health leads them ultimately to the NHS, so fixing the housing crisis will also help the NHS. But at the same time the NHS itself, as our largest (and best-funded) public service, can step forward, to make its own contribution to ending homelessness. 

However, despite their impact and their delivery of a NICE-recommended intervention, most of our teams are funded with short-term, one-off budgets and every year must re-justify their existence. Pathway has lobbied hard for commitment to consistent NHS investment in specialist homeless and inclusion health services in the government’s homelessness strategy.

Last week, we heard we had been successful – in part. The government made a bold commitment in the strategy to ending discharges from hospital to the street, a move that would be life changing for thousands of people if implemented well.

The strategy also contains a commitment to embed housing workers in hospital discharge teams, but this stops short of the NICE-recommended multi-disciplinary teams that we know work so well. Enlighted NHS trusts, integrated care boards and local authorities who have commissioned these teams see the results for themselves, as our report shows. 

We must hope that the government catches up, and sets out as bold an ambition as it has for street discharge.

Alex Bax, chief executive, Pathway