Being discharged from hospital onto the streets while recovering from a serious illness, or even surgery, is dangerous for patients, requiring them to attempt to manage issues such as wound care, new medication, and mobility problems in unsafe conditions. Inevitably, this leads to frequent readmissions to hospital, contributing to the ongoing severe pressures on the NHS. People facing homelessness are four times more likely to visit A&E as the general population, staying six times as long in hospital as in-patients.
A Freedom of Information Request to hospital trusts in England in early 2024 showed that at least 4,100 people were discharged from hospital to into homelessness from 2022-23.
To address this unnacceptable situation, Pathway advocates for the scaling up of step-down services – a form of intermediate care. This solution, which has the backing of the National Institute of Clinical Excellence, provides safe, short-term accommodation and support to someone recovering from a hospital admission, whilst helping them to access services such as GPs, find long-term accommodation, all while supporting their healing and recovery, and helping to free up much-needed hospital beds by preventing avoidable readmissions.
The effectiveness of this kind of care is well-evidenced. A recent evaluation of intermediate care for people facing homelessness in one county in England found a 56% reduction in A&E visits and a 67% reduction in emergency admissions. This saved £47,000 of NHS funding per patient. However, there are too few of these services to meet growing demand, with an audit of 11,000 patients facing homelessness showed that an overwhelming 79% were discharged to somewhere that didn’t meet their needs, such as the street or unsuitable temporary accommodation.
In 2021, the Government launched the £16m Out of Hospital Care Model Programme, designed to provide more intermediate care for people facing homelessness on discharge from hospital. However, a new evaluation showed that while the funding helped to provide some new services, many closed down again as soon as central funding ended.
We know step-down intermediate care improves people’s quality of life and can end homelessness. However, not enough is being provided. My study of over 11,000 patients facing homelessness suggests 79% of them were discharged to somewhere unlikely help them to recover. This could be back to the street or to a hotel or other temporary accommodation with no support.
Professor Michelle Cornes, University of Salford and lead researcher of the recent evaluation
If you are interested in our ongoing work to end street discharge, please let us know through the form below, along with any other areas of Pathway’s work that are of interest to you.