Statistics suggest that homeless people attend A&E up to six times more often than people with a home, and that approximately 70% of homeless people are discharged from hospital without their housing or care needs being fully addressed.
Following the release of funding from the Department of Health for projects designed to tackle these concerns, NHS Arden & GEM Commissioning Support Unit worked with NHS and voluntary sector partners to design and implement a programme that would support hospitals in improving patient outcomes.
We worked with our partners to develop a system that has improved skills and understanding within hospital discharge teams. We streamlined the service by building expertise among a smaller group, supported by clear protocols and training to ensure homeless patients are set on the best care pathway.
The challenge
The majority of homeless people are discharged from hospital without a discharge summary, care plan or risk assessment, creating delays in assessing housing and support needs. Front line medical staff spend time trying to arrange accommodation for homeless patients, which could have been spent on providing medical care.
These challenges were recognised in the ‘Improving Hospital Admission and Discharge Report’ published in May 2012. Following this report, the Department of Health launched a £10 million fund to tackle the issues surrounding homeless discharge.
A successful bid for funding in Warwickshire, coordinated by voluntary sector homeless service organisations: Midland Heart, Coventry Cyrenians and Valley House, enabled the region to develop a partnership approach to improving outcomes for patients and reducing hospital admissions. The partners included NHS Arden & GEM CSU, NHS South Warwickshire Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, Coventry City Council and the CCGs covering Warwickshire, Coventry and Rugby.
Our approach
Working closely with Midland Heart, our role was to support the design and implementation of the new programme of ‘navigators’ and ‘brokers’ on behalf of all CCGs and providers.
"By developing the skill sets of nominated navigators and brokers, not only are we building a better understanding of the help available but we’re reducing the amount of time spent by discharge teams trying to identify solutions from scratch. Instead of reinventing the wheel each time, we’re building strong links with a variety of voluntary organisations and providers who can mobilise quickly to provide the support required."
Sue Lear, Associate Integration, NHS Arden & GEM Commissioning Support Unit
The role of the navigator, as part of the hospital discharge team, is to proactively identify homeless patients and establish their ongoing care needs. The navigator works with the community-based ‘broker’ to find out what help is available and what barriers may need to be addressed. For example, if a patient has been excluded from hostels due to lack of cleanliness, a broker might be able to overcome the issue by agreeing a placement with associated domestic support. Brokers can also help patients find temporary funding, nursing and benefits support.
Linking with the third sector not only enabled us to source a full range of support, particularly for those with a lower level of need, but has also enabled us to tap into different funding streams.
The outcomes
Through the project, better communication with patients has resulted in earlier identification of homelessness, leading to more efficient, quicker and better-planned discharge.
Front line medical staff have received training which has assisted in understanding and identifying homelessness earlier, understanding underlying issues, and dispelling myths. This secures a safe discharge from hospital, reducing the likelihood of readmission.
The service has been able to demonstrate:
- A high demand within hospital settings
- Positive outcomes for patients, who would have otherwise been discharged back into homelessness and without appropriate support, increasing the likelihood of them re-presenting at hospital
- Positive feedback from hospital staff
- Potential financial savings of over a quarter of a million pounds for CCGs.
Following an initial trial period, the service has now been recommissioned across North Warwickshire.
"The project benefited greatly by the close working relationship that was forged with NHS Arden & GEM Commissioning Support. This proved particularly valuable around the collection and analysis of data. The CSU was able to indicate the data needed to be collected at an operational level and the project team were able to respond to any additional information that was needed to give a rolling overview of how the pilot was progressing."
Paul Webber, Inclusion Service Manager, Midland Heart
"It has been really great here. I mean Kath really went out of her way for me to begin with and now I’ve got my own key worker who is continuing the process. And I think, I have to like thank the hospital for that, for getting the right person for the job."
Fiona, Patient
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