Seven out of 10 homeless people who end up in hospital are discharged back onto the streets, according to our latest research published this week. Homeless clients are often discharged without their underlying health problems being addressed, damaging their health and costing the NHS money. All this could be avoided.
It's well known that being homeless can harm your health, especially if you end up sleeping rough. Life on the streets can make you vulnerable to disease, mental health and physical issues. Many people arrive on the streets with existing health issues; the longer they spend out, the more these problems can multiply.
Every day, the NHS feels the impact of this. According to research we undertook in 2010, in a six month period 40% of homeless people used accident and emergency at least once, and nearly a third were admitted to hospital.
Yet despite the heavy, and at times inappropriate, use of acute services by homeless people, not enough NHS services use this opportunity to get their needs properly assessed and work with others to plan for life after hospital.
In 2003, the Department of Health and issued guidance recommending that all acute hospitals should have policies that help identify homeless people on admission and ensure that homeless services are contacted. A Homeless Link survey carried out in 2010 indicated that only 39% of areas had these policies in place.
While things have improved, this week's report finds that in too many areas it is an issue that is still being ignored.
Yet where NHS services do take this issue seriously it can result in significant benefits. The approach taken by UCL Hospitals Pathway Homeless Team is just one example.
Set up in response to a concern that homeless patients were being discharged with little support, UCLH now checks the housing status of patients on admission. Homeless patients are assessed and a care plan drawn up with other agencies. Patients also get support from mentors, whose own experience of homelessness makes them well placed to support and challenge homeless patients while in hospital.
By personalising its services to homeless people's needs and working with other services in the community, UCLH has reduced total bed days relating to homeless admissions by a third – saving £100,000. Because of its success, this model is now spreading to other hospitals.
So what needs to change? Our report sets out some good advice and best practice for hospital staff. Not everywhere needs a UCLH approach (some areas won't see enough homeless people to warrant it) but every hospital can take action.
Frontline NHS staff can help identify people who are homeless or at risk of losing their home by asking the right questions. Hospital managers can build up strong links with partners such as homelessness charities and local authority housing teams, so they can become involved immediately if someone is identified as homeless.
More fundamentally, councils, the NHS and the voluntary sector must work together. The NHS can play a first role in helping to identify homeless people and not discharging them straight onto the street, but ultimately only finding appropriate housing for homeless people will reduce unplanned readmissions to accident and emergency, improve the health of homeless people and save the NHS money.
Alice Evans is head of policy for Homeless Link Guardian Professional.
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