Hospitals discharging homeless people onto the street

More than 70% of homeless people are being discharged from hospital back onto the streets, damaging their health and costing the NHS money, a report published today indicates.

The report, from Homeless Link and St Mungo’s, has found that NHS staff can improve health outcomes for homeless people and save the NHS money by ensuring all patients have somewhere appropriate to stay when they are discharged from hospital.

Paul Burstow, Care Services Minister, acknowledged these findings during a visit to the Pathway homeless team at University College Hospital (UCH) in London today. The dedicated homelessness team at UCH were named as an example of best practice in the report, which comes from an in-depth study of 85 homeless people, hospitals, local authorities and homelessness agencies.

Improving Hospital Admission and Discharge for People who are Homeless is a guide for hospitals on the treatment of homeless patients. Best practice advice for hospital staff includes:

  • NHS hospitals must identify people who are homeless or at risk of becoming homeless: frontline staff need to ask the right questions to find out if a patient is homeless or at risk of homelessness.
  • NHS staff should involve key partners immediately, e.g. hostels, outreach teams, local authority housing teams: Every ward should have access to the homeless persons’ database and a list of up-to-date local homelessness agencies, and should notify these contacts when they admit someone who is homeless to avoid them losing their tenancy.
  • Local authorities, NHS and the voluntary must sector must work together: finding appropriate housing for homeless people will reduce readmissions to A&E, improve patient experience and save the NHS money.

Commissioned by the Department of Health, the report was produced to inform the National Inclusion Health Board and delivers the Ministerial Working Group on Homelessness commitment to identify what more must be done to prevent people at risk of rough sleeping being discharged from hospital without accommodation.

CASE STUDY: The London Pathway, University College Hospital

Some homeless patients who took part in the study reported having a more positive experience. Many of these were at hospitals with dedicated homelessness teams, such as Arrowe Park Hospital in Wirral, and University College Hospital (UCH) in London.

UCH follow the London Pathway approach, providing a dedicated team that works with homeless patients. By personalising their services to homeless people’s needs and working with other services in the community they were able to reduce total bed days relating to homeless people’s admissions by one third, and make cost savings of £100,000.

Their service includes:

  • GP led ward round for all homeless patients, supported by a Pathway homeless health nurse practitioner, to co-ordinate all aspects of care and make plans with the patient for discharge
  • joint working between medical staff and other agencies involved with the patient to plan for life after hospital
  • support from befriending and mentoring Pathway Care Navigators, whose personal experience of homelessness makes them well placed to support, challenge and mentor homeless patients in the hospital

London Pathway is now spreading this model to other hospitals in London and beyond. Find out more: www.londonpathway.org.uk/

Matt Harrison, Interim Chief Executive of Homeless Link, said:

“The homeless sector has been working to improve the health outcomes for homeless people for years, yet they still experience some of the poorest health in our communities.

“The findings from this report are extremely disappointing. Failing to meet homeless people’s health and housing needs is costly to individuals, but also to the NHS as life on the streets means they continue to be readmitted to hospital.

“No one should be discharged from hospital to insecure or inappropriate accommodation. We call on all agencies to take a step to end homelessness by ensuring everyone has somewhere suitable to go when they leave hospital, with support in place for their on-going medical care.”

Charles Fraser, CEO of St Mungo’s and a member of the National Inclusion Health Board, said:

“It is crucial that the NHS does not lose sight of its responsibilities towards those in the most parlous circumstances. This report must not only prod its conscience, but stir it into action. The hospital sector has to improve, and improve quickly, but we must not lose sight of the fact that better facilities in the community will help hospitals get their discharge practices right. There are examples of what can be done, and proposals for what else needs to be done, and the funding and commissioning system must support and enable them.

“The excessive and disproportionate ill-health of homeless people should be a source of shame. This issue must not be left solely to the discretion of local commissioners, but must be a specific priority for the NHS Commissioning Board and for Public Health England in how they tackle health inequalities.

Alex Bax, Chief Executive of Pathway, says:

“Our team at UCH are delighted to have the chance to show the Minister our work with homeless people in the hospital. We hope Mr Burstow will have time to hear more about the huge barriers staff working with homeless patients have to overcome, helping homeless people get the best possible care while they are in hospital and battling the multiple bureaucracies that surround homeless people lives.

“We welcome the report being published today and look forward to working with the Department of Health to get its core recommendations implemented right across the NHS. With the right teams in place we can change an emergency hospital admission from just another crisis in a homeless person’s life, to an opportunity for change.”

Professor Steve Field, Chair of the Inclusion Health Board, said:

“I am delighted that the Government is responding positively to this report, calling for more to be done to prevent homeless people being discharged from hospital back onto the streets.

“Inclusion Health is bringing partners together to identify what more must be done to better reflect the needs of homeless people in the commissioning of health services and to improve their access to and outcomes from health services. This report sets the challenge to improve hospital discharge arrangements for the homeless and helpfully provides advice on how to do so.


Paul Burstow, Care Services Minister, said:

“We commissioned this report to expose poor practice and share best practice. What it reveals is too many hospitals simply discharging homeless people back to the streets. Patching a person up and sending them out without a plan makes no sense.

"The good news is the report shows that there are hospitals doing brilliant work to join up care and support and reduce the cycle of revolving door admissions. I am challenging the rest of the NHS to learn from the best and make it the norm.”