Hospital discharge for people experiencing homelessness: how can practice be improved in the context of funding cuts?

Hospital Discharge for people experiencing homelessness: how can practice be improved in the context of funding cuts?

Since 2016, a key research topic within our Health Inclusion theme has been experiences related to homelessness, which has led to various reports and publications. Our latest paper, published earlier this year, focused on stakeholder views on how to improve practice around hospital discharge for people experiencing homelessness, in a ‘deprived’ setting (Available here).

As we were working on the revisions for the paper (following feedback from reviewers), the importance of recognising and contextualising the research within that setting became even clearer – so much so, it was incorporated into the title of the revised paper. Marmot et al. (2020) emphasise that years of austerity policies had seen large funding cuts across England, which were most severe in deprived areas and those outside London and the South East. This has undermined the capacity of local authorities to improve the social determinants of health (i.e., the conditions in which people are born, grow, live, work and age). Our paper explores some of the challenges for hospital discharge and homelessness in this wider context of reduced public funds and limited appropriate accommodation.

Why is this important?

It is well established that homelessness, particularly chronic homelessness, is profoundly detrimental to health. This is clear when we look at life expectancy for people experiencing homelessness which is 45.9 years in males and 43.4 in females, compared to national averages of 76.1 years and 80.9 years respectively (Office for National Statistics, 2020).

For people experiencing homelessness, there are various barriers to accessing primary health care (i.e., GP practices), which means that minor health issues can go untreated and escalate, resulting in more frequent visits to hospitals (VOICES, Healthwatch Stoke-on-Trent, Expert Citizens, 2016). The discharge of this group from hospital to appropriate settings has been recognised as historically poor (Albanese et al, 2016), which can contribute to a ‘revolving door’ of hospital admissions and discharges.

What did we do?

We interviewed 27 stakeholders with knowledge and experience of working with people experiencing homelessness in Stoke-on-Trent. An important part of the research was speaking to people from across the system of support, including the local authority, third sector and NHS. We also held a stakeholder workshop where we presented the research and preliminary findings to a wider group of stakeholders for discussion and reflection.

What did we find?

In the paper, we report three main themes:

1. A plan in place: The need for better planning and communication with the third sector

Within the context of limited resources and spending cuts over the last decade, it was recognised that other non-statutory or ‘third sector’ organisations, including community and voluntary groups and charities, have stepped in – and up – to help people experiencing homelessness when other statutory services failed to. Stakeholders reported that improved planning and communication between all organisations would help, given that the services were often found to work in silos.

2. A (safe) place to go? Training to improve awareness and ‘upskill’ hospital staff

This related to the need to improve awareness and ‘upskill’ hospital staff to work more effectively with people experiencing homelessness, including understanding their needs, the wider support available. For example, staff needed greater awareness regarding access to local temporary accommodation, and which homelessness related support roles and support services were currently still operating and the requirements of the Homelessness Reduction Act 2017 (which was relatively new at the time of data collection).

3. The need for (re)investment in outreach and flexibility for people experiencing chronic homelessness

Running through the research was a sense that the mainstream healthcare system is not well suited to meet the needs of people experiencing chronic homelessness. Stakeholders emphasised the need for (re)investment in a different approach, based on outreach, flexibility, trust and prevention. All were described as key elements of the (at the time) decommissioned Homeless Matron role. It was clear that this loss was perceived to have left a gap in provision for people experiencing homelessness. The role was subsequently reinstated following strong local advocacy and further work by CHAD (Available here).

What next?

While recognising the challenges faced by hospitals, especially within the context of funding cuts, the paper highlights the need to recognise the contribution of third sector organisations in providing valuable support to people experiencing homelessness in the community, including after discharge; improved communication from hospitals would help such organisations to work in a more planned and proactive way.  Working together to develop site-specific checklists for practice before discharge (and as early as possible) may help to ensure appropriate measures are in place.

In Feb 2022, we shared insights from this research at a VOICES* workshop designed to co-produce recommendations for hospital discharge pathways locally, based on a range of personal and professional experiences; you can read the recommendations from that report Coproducing Hospital Discharge Pathways in Stoke-on-Trent by VOICES – Issuu, which are being taken up through the Stoke-on-Trent Changing Futures programme.

 

* VOICES (Voices of Independence, Change & Empowerment in Stoke-on-Trent) was one of 12 local partnerships in England, funded by the National Lottery Community Fund’s Fulfilling Lives programme, to provide support and change systems to improve the lives of people experiencing multiple disadvantage.  VOICES ran from April 2014-March 2022.

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