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How to... use hospitals to save the public purse

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Homelessness is reaching epidemic proportions across the UK with at least 4,700 people sleeping on the streets of England in any one night and many more in insecure accommodation and sofa surfing.

The staggering 169% increase in homelessness over the past seven years is frightening. This comes at a huge cost to life and to the NHS.

For homeless patients, compared with age-matched housed individuals:

  • A&E attendance was five times higher
  • Ward admission was four times more common
  • Duration of stay was three times longer

About 80% of homeless patients have more medical problems reaching across every specialty. While many of them are very sick indeed, few would choose to attend hospital in view of poor previous experiences, unless they had to.

As a result, the care of homeless people costs the NHS at least £85m extra each year and a horribly reduced life expectancy with an average age of death of 43 years for women and 47 years for men.

In Gloucestershire Royal Hospital, in 2013, I joined forces with the local homeless healthcare team and, with a start-up grant from the Department of Health, appointed a housing officer with links to the local council, hostels and charities.

Within the first year 114 of an estimated 180 homeless admissions were seen by the housing officer. Temporary accommodation is urgently arranged to prevent delays to hospital discharges and patients are escorted to their new premises complete with appropriate medications and follow-up arrangements.

The housing officer then works with the patient to find more sustainable housing and ensure they are seen by supportive agencies such as the drug and alcohol service, Department for Work & Pensions and dentists.

Compared with the previous year when no housing officer was in place:

  • 84% of homeless patients were housed on discharge compared to none 
  • Length of stay in hospital was reduced from 3.2 to 2.1 days
  • Estimated cost saving of £50,000

The cost of the housing officer is £28,000 per annum.

Grasping the concept of the vast improvement in compassionate care with an associated cost saving has led the local clinical commissioning group to commit to ongoing funding for the officer.

Four years of data confirms the benefits to the homeless and the hospital have been maintained. 

Strong links between the NHS and the local health authority have made the Gloucester project successful and it could quickly and easily be replicated across England and Wales.

Dr Pippa Medcalf, consultant physician and lead for homeless healthcare at Gloucester Royal Hospital

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