For immediate release
- Homeless and inclusion health charity Pathway highlights the harsh reality faced each year by over 4,000 patients discharged from hospital to no fixed abode, due to a postcode lottery in safe alternatives.
- New analysis commissioned by Pathway from Alma Economics shows the return on investment of an expansion of specialist intermediate care – safe places people can stay after discharge from hospital – for people experiencing homelessness, with an estimated financial benefit of £1.20 and societal benefit of £4.30 for every £1 spent.
- Pathway is calling on Government to commit to ending discharges to the street in the cross-Government Homelessness Strategy and upcoming 10-year NHS plan, along with ensuring the scaling up of the specialist intermediate care and hospital care services necessary to achieve this. These services would save Government money, and support its ambition to shift care out of hospital into the community.
People facing homelessness experience some of the worst health of anyone in our country, and are admitted to hospital up to six times more often than those who do have homes.
The combination of unprecedented levels of pressure on our health services and the housing crisis means that people facing homelessness are being discharged to the street whilst still recovering from treatment1.
This has devastating consequences for their health, as they are forced to manage challenges like wound care, new medications, and mobility issues whilst lacking the most basic facilities. This can result in repeat admissions to hospital and is a missed opportunity to end their homelessness.
The solution, endorsed by the National Institute for Health and Care Excellence2, is ‘step-down’ accommodation. Also known as intermediate care, it offers safe, short-term housing and support for people recovering from a hospital admission. It links them to essential services like GPs, provides additional time to secure long-term housing, and helps their long-term recovery.
Combined with specialist multi-disciplinary teams in hospitals, to better identify and support patients facing homelessness, these services help free up crucial hospital beds by reducing preventable readmissions.
However, gaps in policy and funding mean that a postcode lottery exists for these vital services; they are commissioned in some places in England but not others. An audit of 11,000 patients experiencing homelessness revealed that 79% were discharged to locations that failed to address their needs3, such as the streets or unsuitable temporary accommodation. A recent survey4 of inclusion health professionals found that only 4% believed there was enough specialised homeless intermediate care available in their area for those in need.
Released today, new research commissioned by Pathway from Alma Economics shows that: an estimated 32,600 patients experiencing homelessness in England every year will require specialist intermediate care to ensure safe discharges from hospital. A programme to provide over 300 specialist intermediate care services to meet this need would deliver financial savings of approximately £5,200 per patient.
With a new 10-year NHS plan on the horizon and the Government wanting to see care move out of hospitals and into the community, it has an opportunity to listen to the evidence and seize this chance to create lasting, sustainable change. Pathway is calling on Government to commit to the scaling up of specialist intermediate care and hospital teams nationwide, to ensure that in future no-one will be discharged from hospital to the street, but to a safe place to recover.
The full report can be downloaded here.
Alex Bax, Chief Executive of Pathway said:
Everyone needs a safe place to recover after an illness, yet the awful reality is that many people have no option but to return to the streets after leaving the hospital – the very environment that often contributed to their illness in the first place. This leads to a vicious cycle of hospital readmissions, placing avoidable strain on NHS systems already pushed to breaking point.
It doesn’t have to be like this. An increasing body of evidence shows that a national programme of specialist intermediate care would not only improve lives, but also makes compelling financial sense. An investment of £1.1 billion will generate cumulative financial benefits of £1.3 billion and societal benefits of £4.7 billion over the course of a new 10-year plan for the NHS. Government must seize this vital opportunity to tackle the issue by expanding access to intermediate care and hospital-based health teams dedicated to supporting people experiencing homelessness.
Matt Downie, Chief Executive of Crisis said:
Every year, thousands of people are forced from hospital to the streets or to unsafe and insecure accommodation. By acting earlier and investing in services to end street discharge, we can prevent homelessness from happening in the first place and stop more people experiencing the indignity and trauma of having nowhere safe to recover.
The links between poor health outcomes and homelessness are clear. The Westminster government must be bold in its ambitions through its homelessness strategy and 10 year NHS plan to put in place solutions that provide safe and affordable accommodation to everyone who needs it. This means ensuring that housing benefit keeps pace with rising rents and building 90,000 social homes every year in order to tackle homelessness in the long term.
NOTES TO EDITORS To arrange an interview with a spokesperson, academic, economist, or any further enquiries, please contact the Pathway media team at dee.oconnell@pathway.org.uk or on 07989 396 320
Discharges to the street
An FOI exercise of all hospital trusts in England revealed at least 4,200 people were discharged to No Fixed Abode from 2022-23. This figure represents half of all trusts (those who responded to the FOI). More information about the problem and Pathway’s ongoing work to address it here.
Intermediate care for people experiencing homelessness
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.
Research Methodology
The cost-benefit analysis conducted by Alma Economics on behalf of Pathway, modelled the potential costs of delivering a national specialist intermediate care programme and its benefits using a three-step approach: assessment of the nationwide need for intermediate care, estimation of the average cost of provision, and estimation of the benefits derived from the programme.
Specific data and assumptions were obtained through various sources including academic literature which has examined previous programmes, data from existing facilities that provide specialist homelessness intermediate care across England, as well as input from experts and stakeholders. The financial and societal benefit-to-cost ratio was estimated over a ten-year period to assess the value of the programme’s benefits over a longer period of time. Full details of the methodology can be found included in the report here.
Key findings include:
- An estimated 32,600 patients experiencing homelessness in England are expected to require specialist intermediate care annually.
- Approximately 322 facilities are required to meet this need across the country.
- The proposed programme is estimated to deliver financial savings of approximately £5,200 per patient, including savings of £790 directly through the end of street discharge, and £4,400 through the reduction of delayed discharges.
- The social benefits of the programme were assessed are estimated to be worth £11,900 per person. The full report can be read here.
Previous Government action
The Conservative Government funded the Out of Hospital Care Model Programme. An evaluation showed that where the programme delivered intermediate care, street discharge was reduced to 5%, but that services were not sustained5. Dr Michelle Cornes, lead author of this study, is available for interview.
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.
[1] Cancer and stroke NHS patients among thousands discharged with nowhere to live | The Independent
[2] Overview | Integrated health and social care for people experiencing homelessness | Guidance | NICE
[3] Out-of-Hospital Care Models programme for people experiencing homelessness
[4] Always at the Bottom of the Pile: The Homeless and Inclusion Health Barometer 2024 – Pathway