• Run by Pathway, a health care charity working with homeless people.
  • Being implemented in UK towns and cities that have significant homeless populations.
  • Will replicate a model that ensures that homeless patients receive better care and more support while in hospital, and help moving on.
  • Will develop a replication model using a social franchising or licensing approach to scale Pathway’s integrated care model for homeless people admitted to hospital.

At least 70% of homeless people have physical and/or mental health problems, and many don’t seek care until they are seriously ill. They are often repeatedly admitted to hospital and need to stay longer than those who aren’t homeless because their health is failing so badly, or they have nowhere safe to recover.

Pathway is a health charity that has developed an integrated care model to address this problem. It ensures homeless patients get better, more appropriate care while in hospital, and are linked in to support to recover afterwards. It seeks to provide support at two points – intervening in the cycle that leads homeless people to end up in hospital repeatedly, and helping people take the final step away from homelessness to access the support they need. The integrated care model brings together NHS, local authority and voluntary sector workers to improve health care for homeless patients in hospital, and line up support to recover afterwards.

Pathway’s hospital teams provide enhanced, multidisciplinary care coordination for homeless people admitted to hospital. Teams include specialist GPs, nurses and people with lived experience of homelessness who are trained to support homeless patients. Larger teams also offer support from occupational therapists, psychiatrists, and housing and social workers. 

Ten hospitals in the UK have so far implemented Pathway's integrated care model, achieving benefits such as reduced bed days and associated costs, improved care coordination and discharge planning from multi-agency working, and, most importantly improved health and quality of life for patients post-discharge. 

This project seeks to enable replication of the model in other towns and cities with significant homeless populations, enabling vulnerable patients to get the best possible health care from the NHS and the right help from other public services.

Pathway will work with individual hospital trusts and commissioners to design a team that meets their needs and implement a simple, stepped adoption model. A social franchising or licensing approach will help spread the Pathway initiative to hospitals across the UK and develop a sustainable financial model that demonstrates value for money.

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