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  • An immersive exhibit at NHS Confed Expo 2024 (12th and 13th June), created with people who have experienced homelessness, reveals the harsh reality faced each year by over 4,000 patients discharged from hospital to no fixed abode.
  • Pathway, the homeless and inclusion health charity, is calling on all political parties to ensure no-one is discharged from hospital to the street, through an expansion of NICE recommended step-down accommodation provision.
  • Providing people facing homelessness with short-term wraparound support and accommodation after discharge from hospital could save the NHS £16.8m over the same period, as well as reducing their rough sleeping by 89%.

After an FOI to hospital trusts in England earlier this year showed that at least 4,100 people were discharged from hospital to into homelessness in 2022/23, Pathway is showing an immersive exhibit to an audience of senior NHS leaders on 12 and 13 of June to draw attention to the issue.

Being forced onto the streets while recovering from a serious illness is dangerous for patients, requiring them to attempt to manage difficulties such as wound care, new medication, mobility problems and even recovery from surgery without proper facilities. Failing to resolve people’s homelessness during their recovery also contributes to pressures on the NHS, with people facing homelessness four times more likely to visit A&E as the general population, and staying six times as long in hospital as in-patients.

Pathway, the UK’s homeless and inclusion health charity, attributes the rise in discharges from hospital into homelessness to the twin crises facing our country – historic NHS pressures and the ongoing housing and homelessness crisis. All forms of homelessness across England are rising with more than 112,000 households trapped in temporary accommodation (12 % increase since last year) and 3,898 people rough sleeping on any given night (27% increase on the previous year). At the same time, pressures to free up hospital beds mean that people facing homelessness are discharged to the streets while recovering from serious hospital treatment.  

There is a solution, which has the backing of the National Institute of Clinical Excellence. ‘Step down’ accommodation, is an intermediate care service that provides safe, short-term accommodation and support to someone recovering from a hospital admission. It connects them to services such as GPs, allows more time to find long-term accommodation, while supporting their healing and recovery, and helping to free up much-needed hospital beds through preventing avoidable readmissions.

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. 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 to the street or unsuitable temporary accommodation. A recent survey of healthcare professionals working with people facing homelessness showed that just 3.9% of them thought there was enough specialist homelessness intermediate care in their local area for the people who needed it.

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.

Professor Michelle Cornes, University of Salford and lead researcher of the recent evaluation said, “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.”

Pathway, the specialist homeless and inclusion health charity, is calling on the next Government to make a commitment that no one will be discharged from hospital to the street, backed by the necessary scaling up of intermediate care and specialist hospital teams to make this a reality.

To highlight the issue, they are hosting an installation at NHS Confed Expo in Manchester to draw attention to the experience of being discharged from hospital to the street. Designed in collaboration with people with lived experience, this  immersive scene illustrates the appalling conditions of a rough sleeping site and asks, is this ‘a safe place for discharge?’

Alex Bax, Chief Executive of Pathway said “We all want somewhere safe and warm to recover when we’ve been ill, and the streets are a completely unsafe and inappropriate place for this. Sadly, this is the reality for far too many people facing homelessness who leave hospital. The next Government has an opportunity to end the shame of people being discharged from hospital to the street, by providing more specialist intermediate care, along with specialist hospital teams. We call on all political parties to make this a reality.”

Matt Downie, Chief Executive of Crisis said, “Homelessness is a public health
emergency, and far too many lives are being endangered because people do not have a safe, secure place to call home. The availability of affordable, good quality housing is fundamental to our health – yet thousands of people each year are discharged onto our streets because there is nowhere else to go. Alongside more specialist healthcare and support services for people facing homelessness, the next government must deliver the 90,000 social homes we desperately need.”

Notes to editors

  • An FOI exercise of all hospital trusts in England revealed 4,200 people were discharged to No Fixed Abode. This figure represents half of all trusts (those who responded to the FOI).
  • Intermediate Care is a multidisciplinary service designed to help maximise people’s independence, providing support and rehabilitation to people at risk of hospital admission or who have been in hospital. In the case of people recently discharged, this is known as “step-down care”, and aims to ensure that people rejoin the community in a timely, sustainable way and prevent avoidable readmissions.
  • Professor Michelle Cornes is Professor of Health and Social Policy Inequalities at the University of Salford. She is a Visiting Professor at the Policy Institute at King’s College London and a leading researcher in the Homelessness Research Programme in the NIHR Policy Research Unit in Health and Social Care Workforce within the Institute, leading the evaluation of the 2021 Government-funded Out of Hospital Care Model programme.
  • Ending discharges to the street will be a major focus of Pathway’s work over the next year.

Installation at NHS Confed Expo

  • Pathway will host an immersive installation at NHS Confed Expo in Manchester on 12 and 13 June 2024, depicting the reality of rough sleeping upon discharge from hospital.
  • This has been co-created with members of Pathway’s Lived Experience Group, made up of people who have experience of homelessness, including rough sleeping, and health inequalities. The Lived Experience Ambassadors who led the design of this project will be in attendance on both days and available for interview.
  • Attendees will have the opportunity to experience the sights, sounds and smells of rough sleeping; a soundscape of street environments will be available to listen to, with rucksacks containing personal belongings and real-life stories, as curated by members of Pathway’s Lived Experience Programme, available to view and read.
  • The experience will also provide attendees with an understanding of the complex medical needs and conditions that an individual might be managing in such an unsafe environment.

About Pathway

Pathway is the UK’s leading homeless and inclusion health charity. We exist to improve the health of people experiencing homelessness and other forms of severe social exclusion. Pathway’s Partnership Programme supports NHS organisations to scope, commission and create local Pathway teams to improve outcomes for in-patients facing homelessness.