NHS hospitals across the capital are able to treat the illnesses and injuries of patients who are homeless, but do not have the resources to give them time to recuperate before safely discharging them back into the community
*Step -down care is a term used primarily in the UK for supportive and rehabilitative healthcare given to a patient recuperating from an illness or intervention, who is regaining the ability to function independently.
People experiencing homelessness are among the most vulnerable and isolated in our society, with the worst health outcomes
This will free up NHS beds and provide respite for these extremely vulnerable people, with a far better chance of a safe and full recovery.
Once discharged from Mildmay, the aim is that patients will be supported by specialist homelessness charities such as Pathway.
Complex care planning and discharge liaison
Links to community services
Housing and benefits advice
Help to recover important documents such as birth certificates, passports etc
Support and collaboration with other clinicians e.g. advice on drug interactions
Referral for addictions support
Help with GP registration
Fresh clothes, shoes and other basics (for example where these have been destroyed because of infection/infestation)
Help to reconnect with loved ones
Many people who are homeless or rough-sleeping have complex combinations of physical illness, mental illness and substance misuse problems, and histories of trauma and abuse. They are some of the most vulnerable people in society. Traditional systems of health and care often struggle to meet their needs.
Rough sleeping is at the extreme end of homelessness. The Greater London Authority’s Combined Homelessness and Information Network (CHAIN) system - managed by the charity St. Mungo’s - separately monitors the numbers of people who sleep rough in London.
From 2017 to 2018 around 7,484 people were seen sleeping rough in London by outreach workers over the course of that year. The CHAIN data reports that rough sleeping has almost doubled in the capital since 2010 (up 88%).
1 in every 200 people in Britain is homeless and sleeping on the streets or stuck in temporary accommodation, including hostels and B&Bs
The longer a person experiences homelessness, particularly from young adulthood, the more likely their health and wellbeing will be at risk
Co-morbidity (two or more diseases or disorders occurring in the same person) among the longer-term homeless population is not uncommon.
This is further damaging their health and increasing costs to the NHS through ‘revolving door’ admissions.
Most charitable work around rough sleeping and homelessness centres on social welfare, so a step-down service from acute hospital care for respite, recovery and palliative care is urgently needed.
The number of people who are homeless being treated in hospitals is not accurately known, nor is the number ‘discharged to the street’.
However, the homeless healthcare charity, Pathway, found that a total of 2,851 homeless patients were admitted in one year.
High-intensity care and end of life care is required from a much younger age with many needing a safeguarding approach.
There is a clear inequality in provision, with the frailty-age in this group similar to those in their 80’s, but little, if any, service provision similar to the six weeks of funded intermediate care an older person would receive, if they couldn’t be discharged home.
No step-down facilities exist for patients who are homeless with extremely complex and high health needs and traditional intermediate care units feel unable to cope with the triple whammy of mental, physical illness and substance misuse.
There are only a small number of step-down services, such as Gloria House (6 beds) and Olallo House (2-4 beds), which take patients where the health needs are lower, and there are a small number of floating support services in Westminster and Lambeth.
Mildmay has developed partnerships with a number of homelessness charities, such as Pathway, already doing incredible work across London, and we are working together with them to make a truly game-changing difference to the lives of people who are homeless in London.
2015 research by Crisis drawing on large studies on homelessness across Britain suggests that tackling homelessness early could save the government between £3,000 and £18,000 for every person helped.
We are establishing relationships with homeless healthcare providers and experts for clinical sponsorship, governance, training and mentorship.
Healthy London Partnership
Greater London Authority
NHS Trusts and Commissioning Groups and other statutory bodies
Local Authority housing and adult social care agencies in Tower Hamlets, Hackney, Newham, Westminster, etc
Sector charities such as Pathway
A 2010 government study of the use of healthcare by single homeless people reported that they are 3.2 times more likely than the general population to be an inpatient admission, at an average cost that is 1.5 times higher.
This implies a gross cost of £76.2 million per year, rising to £85.6 million when outpatient usage and accident and emergency attendances are added estimates equivalent to annual costs ranging from £24,000 to £30,000 (gross) per person.
Header image by Jonathan Rados
They will work to improve the quality of care for homeless hospital patients through specialist advocacy, support, and quality discharge interventions.
The Housing Worker's salary will be funded through charitable fundraising and donations.
Details will be added once the role has been recruited and the salary agreed.
Registered Charity no: 292058
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