Promoting compassionate health care for homeless people

Homeless people attend casualty six times more often than the housed population, and stay in hospital three times as long, resulting in secondary care costs eight times the average. Homeless patients receive variable quality of care in hospital and are repeatedly readmitted and discharged without proper planning.

This project sought to make care better and more compassionate for homeless people. By linking primary and secondary care and introducing ‘care navigators’ – workers with personal experience of homelessness – it hoped to change the relationship between professionals and the street-homeless community and thereby improve experience and outcomes.

Achievements

• The service led to a 30% reduction in bed days taken up by homeless patients, by reducing the average length of stay.
• For some individuals, the service had a very positive impact on their care experience, their willingness to stay in hospital and the quality of their lives once discharged.
• Regular multidisciplinary team meetings helped the service to achieve the best outcomes for the patient, change attitudes and establish a culture of collaboration.

Challenges:

• It was difficult to recruit suitable candidates for the challenging role of care navigator.
• Clinician and patient surveys produced only a small amount of data. Instead, the team had to rely on qualitative feedback from patients and clinicians.
• Repeat admissions data was weak, as accommodation status changed frequently for patients, or readmission could take place at a different hospital.
• Differences in how costs are calculated across UCH units made it difficult to obtain full cost data for patients.

Who was involved?

The project was led by University College London Hospital, partnered by the Health E1 Homeless Medical Centre, Barts and the London NHS Trust and Brighton and Sussex University Hospitals NHS Trust.

The Pathway project at UCLH led to the establishment of a new independent charity, called Pathway, which now supports hospital teams in acute trusts across the country.

Supporting dissemination

This project was given further support through a Spreading Improvement grant to help disseminate learning and maximise the impact of the approach across the health service at a local, regional or national level.

Funding was used to develop a range of activities that enabled Pathway to put in place a more structured approach to working with additional hospitals and NHS institutions, and to stimulate others across the NHS to change their practice and adopt the model developed in the original project. These activities included:

• updating the interactive toolkit and document store
• developing formal training packages for new staff recruited to the Pathway hospital teams
• promoting a new multi-disciplinary education programme about homeless health care.

The Pathway project continues to spread across the UK with areas such as Edinburgh and Lothian expressing their intent to form their own Pathway teams.

The 2015 Homeless and Inclusion Health conference promoted and shared Pathway’s learning via a strand of workshops. A group of 11 service users who are experts by experience came from across the country to share their experience and contribute to the service user involvement workshops.

Two CPD accredited seminars were held for people working in health and social care, and experts by experience; and a new multi-disciplinary education programme about homeless healthcare has been initiated.

The online resource centre for Pathway hospital teams was updated and maintained. A digital library of presentations from the faculty conferences will be created for teams to use as a training tool.

Two specialist homeless GP practices in Leeds and Bradford piloted a process to check effectiveness and adherence to the Pathway model and Faculty’s Homeless Health Standards. The Care Quality Commission has confirmed their recognition of this process as valuable evidence of quality in specialist primary care practice. The documentation for this process is now available on the new Pathway website.

The London team piloted a medical respite project – Pathway to Home, which seeks to ensure that discharged homeless patients still in need of professional nursing can receive regular visits from nurses. They are now looking to create a medical respite facility service south of the river.