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National Homeless Advice Service

6 Things We Learned At The NHAS & Pathway Homeless Hospital Discharge Event

Posted by natalie_pearson August 02, 2019

NHAS, in partnership with Pathway (the homeless healthcare charity), ran a staff learning event in July, for professionals working to improve homeless hospital discharge.

Richard Lee, NHAS Trainer, kicked the day off with a vulnerability law seminar. (You can book onto this webinar yourself via our training portal) Up next was Simon Favell, Wellbeing Partnership Manager, stressing the importance of organisations sharing information. Following on from Simon was Melu Mekonnen, Senior Housing Liaison Officer at Pathway, who shared his tips on how to overcome a lack of funding through good working relationships with local authorities, social services etc.

Wrapping up the morning session was Paul Wilding, Systems Change Manager at Oxford City Council. He discussed the Trailblazer project which works closely with local authority housing teams, health (including the Mental Health Partnership), social care and criminal justice teams to reach those who are at risk of homelessness, and prevent it at the earliest possible point.

Dr Michelle Cornes, Senior Research Fellow at Kings College London, started the afternoon session with results of the NIHR study on homeless hospital discharge practice. Sam Dorney, Nursing Fellow at Pathway, then presented the success of the Pathway model including less rough sleeping and improved housing outcomes on discharge.

Delegates then split into groups to discuss the challenges they face in their roles and potential solutions. Below are some of the key issues and solutions discussed.


Key Challenges

1. Lack of Homelessness Understanding in Hospitals

Delegates highlighted a lack of screening and early identification of a patient’s homelessness status to enable housing work to be done in a realistic timeframe was mentioned on several occasions. A key challenge to workers based in hospitals, was patients being described as ‘medically fit’, without the clinicians responsible for this description considering the impact that homelessness might have on this ‘medically fit’ descriptor, and there was considerable discussion about what ‘medically fit’ means.

2. Lack of integration of across health, housing, social care and the voluntary sector

Lack of integration between services was the next most commonly described challenge. When directly asked during the feedback session nobody felt they had good working relationships across the combination of health, housing and social care. Some had good health and housing relationships, some had good housing and social care relationships etc, but nobody could claim a successful integration of all three. In many cases services were perceived to be working against each other, and gatekeeping - primarily due to funding constraints.

3. No recourse to public funds

Clients with no recourse to funds were seen by most front-line practitioners, and were an ongoing challenge, although there was a general feeling that this was a political and complex issue that had no easy solution.


Potential Solutions

1. Education of Hospital Staff

More education of hospital staff about the complexity of the housing process, the health consequences of homelessness, and the Homelessness Reduction Act duties was mentioned several times as an intervention that was needed. In particular the need to get across to staff that the responsibility for the HRA lies with all hospital staff, and not just specialist staff was emphasised.

2. Improved Integration

Multi-disciplinary and multi-agency meetings were felt to be a core intervention to support integration, and some services had effective, regular MDTs in place. However, investing time to improve partnerships, and build new links, protocols and pathways was felt to be vital. However, most services seemed to report limited time to do this work and felt that more time was needed to be allocated to do this.

3. Pan London response to No Recourse to Public Funds

It was suggested that a pan London response to transient patients with no recourse to public funds was needed, where the number of NRPF patients with deteriorating health conditions is high.

The event was a great platform for networking and sharing best practice. We would like to thank everyone who attended and each of the speakers.

Our free Autumn Roadshow dates have now been finalised and include a line-up of expert speakers, workshops, updates on the most recent housing legislation and a networking lunch. We will be in Liverpool on the 17th September, Newcastle on the 24th September and London on the 3rd October. The Autumn events are most suited to local authority and voluntary advice agency staff, but do encourage our health, prison and probation and DWP colleagues to attend.

To register your interest please email nhas@shelter.org.uk

We will be running further Health and Prison/Probation focused roadshows later in the year, so please sign up to our ebulletin to be amongst the first to hear.