Established 2005 Registered Charity No. 1110656

Scottish Charity Register No. SC043760

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Enlightened hospital policy

April 15 2011
Homeless patients benefit from joined-up thinking


When a female homeless patient was discharged from University College Hospital London recently, she might have expected this to be the point where her care ended. Instead, a London Pathway nurse accompanied her from UCHL to the station and sat with her until her train arrived.

Alex Bax, chief executive of the London Pathway charity, explained: "We plugged her back into Aberdeen Social Services. We arranged the travel and then made sure she could get on the train."

This case study is just one example of range of care being offered to homeless patients by the London Pathway at University College London. The project is overhauling the way homeless patients are cared for at the hospital in an attempt to cut UCHL’s high admission rate and reduce lengthy hospital stays. Although there were guidelines for discharging homeless patients, as we’ve reported in the past, they are only guidelines and practical solutions offered.

Currently the medical problems caused by unstable living conditions mean that homeless people are admitted to hospital four times as often as those who are permanently housed and, on average, their stay there is twice as long. The result is that medical care for homeless men and women costs eight times as much as that for the housed population.

The London Pathway project changes the care given to homeless patients so that it better addresses the causes of their medical problems. It offers patients a more complete or ‘holistic’ care package, which considers needs arising from their homelessness as well as immediate health concerns.

The project was established because the existing medical care did not seem to address the homeless patient’s non-health related problems, such as drug or alcohol addiction or mental health issues. Yet these issues all contribute to homeless patients’ health problems and, because they were not being identified, medical problems would persist. "Homelessness is co-related with health problems," said Bax. "If clinicians think about the homeless status of a patient, it may help them to understand why the patient is not getting better or keeps coming back to hospital."

Under the new programme of care being implemented by the London Pathway project, staff spend considerably more time with homeless patients, trying to find solutions to their particular needs. This might mean helping a patient to acquire new identification papers, arranging for them to move to a better shelter or helping them enrol on a detox programme.

"We try to use the time in hospital to put the best plans we can in place around and with the patient," Bax said. "So they have the best chance of not coming back to hospital - and hopefully a pathway off the street."

Alongside the nurses, the project has also introduced "care navigators" - formerly homeless people who can draw on their own experience to help guide homeless patients through the hospital process.

An in-house review of the project published in February this year, indicates that its changes have had some effect. The report states that the average time a homeless person stays in hospital has fallen by 3.2 days, saving the hospital £300,000. Additionally, 10 times the number of homeless patients now leave UCLH with a multi-agency plan in place

The project has received a grant from the Heath Foundation charity to be implemented in more hospitals. London Pathway’s chief executive has said that by September this year, the project should be running in two additional hospitals, Brighton and Sussex University Hospital Trust and Royal London Hospital,

Bax added that the project also hopes to increase post-discharge support for homeless people. This could involve building a sanctuary centre, offering care for those who are deemed healthy enough to leave hospital but are not yet able to return to the streets or hostels.

"More could be done to physically and metaphorically hold people’s hands after they leave hospital," Bax said.

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