For immediate release 26.02.25
- The national homelessness crisis is driving growing numbers of vulnerable people into hospital, with Pathway’s specialist homelessness hospital teams supporting 28% more patients facing homelessness than last year.
- Despite these growing pressures, Pathway’s network of multi-disciplinary homelessness teams working in hospitals improved outcomes for 3,377 patients facing homelessness last year, reducing returns to rough sleeping by 40% on average.
- The network of eight teams across England generated an estimated saving of £4.8 million to the NHS.
- Applying their expertise to reduce readmissions and drive joined up working with GP and housing services, Pathway’s hospital teams could be critical to Government plans to shift care from hospital to the community for this patient group.
The UK’s leading Homeless and Health Inclusion charity Pathway UK has published its second annual report on the achievements of NHS hospital teams working in its Partnership Programme (PPP). The clinically led, multi-disciplinary teams work with homeless patients in hospital to address the multiple health and housing issues they face.
People experiencing homelessness have far worse health than people who have homes. With homelessness figures rising steadily and expected to rise further when official rough sleeping figures are released next week, their demands on the health system are growing.
People experiencing homelessness have major difficulties accessing GP care1, which leads them to use emergency services, often when their health is very poor. They use hospitals six times as often as people who have homes. Pathway teams supported 3,377 people experiencing homelessness in 2023/24, a major 28% increase on 2022/23.
In addition to increased demand, the hospital teams have seen clinical needs becoming more complex. Sixty per cent of patients seen by Pathway teams had mental health needs, while two in five had dual diagnosis of mental health and addictions issues. The challenges of supporting patients with complex needs are exacerbated by wider system failures in primary care and housing. This means teams face major challenges both finding suitable housing options (particularly safe accommodation essential for recovery from illness) for patients, and registering them with vital GP services.
Despite the obstacles, with compassionate care and dedication to improve things for their patients, the teams have achieved GP registration for 42% of patients who needed it and reduced returns to rough sleeping by 43%.
Like other specialist homeless health services, many Pathway teams are short-term funded. This uncertainty creates additional, unhelpful pressures on staff, preventing long term planning and undermining morale amongst staff working hard every day to improve care to those most in need.
Government has the opportunity to put these vital services on a firmer footing, through clear endorsement in the forthcoming 10 Year NHS plan and cross-Government homelessness strategy. The intensive use of hospitals by people facing homelessness means that Pathway teams would have to be part of Government’s ambition to shift care from hospital to the community. High quality, specialist teams in hospital prevent future readmissions, save the system money and properly connect people into the community services to keep people well.
While celebrating the achievements of Pathway’s hospital teams who continue to deliver under acute pressure, Pathway is calling for the health and housing needs of the most excluded people in society to be at the heart of the Government’s NHS 10-year plan and new homelessness strategy.
Alex Bax, Pathway CEO, said:
Resolving the entrenched and linked housing and health problems faced by the most vulnerable people in society not only saves the NHS significant sums of money, it also literally saves lives, and it shows how we can make the NHS work for those who need it the most. Depressingly specialist homeless health services routinely struggle for funding in the NHS. As a charity working alongside the NHS we do what we can to help but we really need health service managers to finally recognise that doing nothing for homeless patients leaves them cycling around the most expensive parts of the system and puts lives at risk.
Chris Sargeant, Pathway Clinical Director, said:
Pathway is incredibly proud of the continuing success of the teams we support, and the significant changes they bring to the lives of people experiencing homelessness in hospital and beyond. I know from my own experience that this is hard but rewarding work, and they do it brilliantly. We believe forty more NHS hospital Trusts need Pathway teams and we would love to speak to them about working in partnership with us.
NOTES TO EDITORS:
- Hospital team staff available for interview.
- Filming with one of the hospital teams can be arranged.
- Full Pathway Partnership Programme Report can be found here.
- Pathway’s recent policy papers on improving Inclusion Health can be found here.
- For further information contact Steph Sykes, Pathway Communication Manager: stephanie.sykes@pathway.org.uk
- Case study:
This case study presents a snapshot of the care of a person who attends hospital frequently. Two months of interactions are outlined below, to highlight the level of specialist support which some people need to make progress.
During this period the patient attended A&E on seventeen separate occasions, and on a further six occasions was admitted to a ward from A&E. Two of these admissions ended in self-discharges. The team saw him thirty-seven times, twenty-seven times while he was in hospital, and ten times in the community (not including planned visits in the community for wound dressings and other treatment).
The patient has complex mental health and physical health problems including schizophrenia, heart failure and respiratory failure. He often was ‘not-concordant’ with his treatment and this raised questions around his capacity to take this decision.
He was initially accommodated in an ‘E-bed’ (an emergency bed in a homelessness shelter) but lost this due to the complexity of his medical issues and seemingly declining capacity. Following this he self-discharged from hospital and returned to the streets.
The Pathway team made safeguarding referrals and led on Vulnerable Adult Risk Management (VARM) meetings which involved multiple services agreeing actions and delivering a plan to help him complete the necessary treatment and to find a place for him to stay which would be appropriate to his multiple health and mental health needs.
The team also liaised with his primary care provider and with the Mental Health Liaison Team (MHLT) to take the opportunity of a hospital admission to re-instate his anti-psychotic treatment.
Other teams both within and outside the hospital involved in his care were:
- Rough Sleeper Team
- Frequent Attenders Team
- Safeguarding- hospital and community teams.
- Adult Social Care
- Renew
- Community Nursing Team
- Mental health teams MHLT and the Community Mental Health Team (CMHT)
- Hostel providers
- GP
- Pharmacy
- Liaison and Diversion
The team’s Community Nurse spent time working alongside the district nurses when the district nurses were unable or struggled to offer treatment. The patient’s final admission came when he was found sleeping rough on the street with no shelter, open to all the elements, partially clothed and very unwell. He was taken to the hospital, where he was admitted long enough for his capacity to be assessed, treatment to be completed, and ultimately transferred to a suitable residential placement, where he remains.
This case illustrates the importance of persistence in being able to make progress across multiple admissions, working with multiple teams, and drawing the right people together around the person involved for a positive outcome.