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Homelessness and hospital discharge and integrating intermediate care: stress points for people, processes and place

2022 Conference Presentation

8 September 2022

Homelessness and hospital discharge and integrating intermediate care: stress points for people, processes and place

Michael Clark , London School of Economics & Political Science , United Kingdom

Michelle Cornes, King’s College London
Elizabeth Biswell, King’s College London
Jo Coombes, Independent, Expert Focus
Stan Burridge, Independent, Expert Focus
Michela Tinelli, London School of Economics & Political Science
Raphael Wittenberg, London School of Economics & Political Science


People who are experiencing homelessness generally face multiple forms of exclusion from society and poor health, often dying considerably younger than the rest of the population. The combination of stigma and a lack of fit and integration of local systems of care and related support regularly result in people who are experiencing homelessness finding it difficult to engage with care services and practitioners in the first place, and then to find suitable "pathways' through services that provide long-term care suited to their needs and circumstances. A major difficulty is integrating the support that individuals to holistically address their needs. For example, support for physical health needs (which may be multiple and complex) is likely to also require support for accommodation that is suitable for the person and their immediate recovery needs, and potentially also their longer-term care. This may also be overlaid with needs for mental health and/or substance abuse issues. Many local services have struggled with integrating arrangements that support people in these circumstances in a timely and high-quality manner. Working across complex practice and organisational boundaries and securing sufficient resources, especially of suitable accommodation, have been such persistent issues that the whole practice area has been described as a "wicked issue'.

The point of discharge from a hospital stay is an excellent focal point to consider many of the issues that current systems present to better care for people experiencing homelessness. Discharging from hospital someone who is experiencing homelessness presents many stresses for people (the person themselves, but also many staff), to local processes, and to local places. It has been recognised that too often this has meant poor discharge arrangement for individuals, resulting in poor outcomes for people and for local systems. It has too often has meant poor consideration of a person's immediate care after discharge, discharge to inappropriate places for care needs (often back to the street) and no arrangements for after-care in the medium term. Models of better hospital discharge have been developed and evaluated, demonstrating improved outcomes for individuals and better use of local resources, such as by avoiding unnecessary readmissions resulting from poor after care. As is often the case though, there was a national gap in bringing this evidence to improve practice in localities across England.

In this presentation we will draw on evidence from a national study of hospital discharge arrangements to identify insights from a national programme aimed at stimulating evidence-informed improvement to local systems to deliver high-quality discharge arrangements for people experiencing homelessness.