St Mungo’s Hospital Discharge Network (HDN) provides places in our hostels for people who are homeless or at risk of homelessness and need additional support to manage their health when leaving hospital. The service consists of a hostel bed with support and clinical care from a team of health and homelessness professionals.
People who are homeless have worse health than most, and face barriers to accessing healthcare when they need it. Unplanned use of hospital services is common.
2010 Department of Health (DH) research found that people who are homeless attend A&E five times more often than the local average, and their hospital treatment costs are four times higher.
Unplanned use of health services is exacerbated when people who are homeless or at risk are discharged from hospital onto the streets or into unsuitable or unsafe accommodation without support to recover.
Many people who are homeless enter a cycle of repeated hospital readmissions (DH Office of the Chief Analyst (2010) Healthcare for single homeless people).
In 2013 the Government invested £10 million to improve services for people who are homeless and leaving hospital. Fifty-two pilot projects were launched. Two St Mungo’s projects were recommissioned in Camden and Hackney.
The Hospital Discharge Network (HDN) offers safe accommodation for people who are homeless with clinical support to recover from their hospital stay, engage with health and care services and find a suitable place to live. Support is provided by a multidisciplinary team, including:
- nursing care
- in-house GP sessions
- health workers
The HDN was launched in June 2014 and has supported 63 clients (September 2015).
Initial evidence from the HDN indicates positive progress.
Clients using the service have fewer A&E attendances and emergency hospital admissions during their stay, and are more engaged with planned healthcare through outpatient appointments and community health and social care services.
In Hackney, clients were 82% less likely to be admitted to hospital during their stay at the HDN than during the three months before their stay, and 56% less likely to visit A&E.
In Camden, clients were 63% less likely to be admitted to hospital during their stay at the HDN than in the three months before their stay, and 48% less likely to visit A&E.
34 clients have been supported to move on from the two services into appropriate accommodation, including supported and sheltered accommodation, registered care and detox or rehab facilities.
(Data is for the period from June 2014 to end Q2 2015/16 (Sept 2015). For further information, please see our forthcoming Recovery Results briefing.)
The HDN addresses multiple needs in a single service, requiring a comprehensive set of partnerships across health and housing. Clients have a range of complex health issues, including physical and mental health and substance use problems, that other ‘single-track’ services struggle to address.
Our services in Hackney and Camden are working closely with hospitals, outreach workers, GP practices, community nurses, drug and alcohol services, mental health services, and local authority social care and housing services to identify suitable clients for referral and create effective support systems.
GP support is provided in partnership with the Greenhouse Practice and Camden Health Improvement Practice (CHIP).
Too many people are still being discharged from hospital to the streets or into unsafe accommodation. A 2012 study found that only a third of people interviewed had received support for their homelessness when they left hospital.
A safe place to stay is crucial to allow people who are homeless to recover from illness and treatment, maintain their health and prevent readmission.
Our Hospital Discharge Network (HDN) offers temporary accommodation and clinical support for a target stay of 12 weeks, with support from homelessness workers to find safe longer-term accommodation where clients can manage their health and social care needs.
Our contribution to improving health
We believe the project contributes particularly to the following outcome indicators:
- NHS outcome 3b/ PHOF 4.11: emergency readmissions within 30 days of discharge from hospital
- NHS outcome 2.1: proportion of people feeling supported to manage their condition
- NHS outcome 4.4: access to primary care services
Clients are supported to access appropriate health and social care services in a way that is planned and meets their needs.