Pathway wins award to replicate homeless hospital team intervention

Pathway has been selected by the Health Foundation, an independent charity, to be part of an innovative programme to improve health and social care by using novel scaling approaches to widen use of successful health and social care interventions.

The Exploring Social Franchising and Licensing programme supports four organisations to replicate interventions that they have already tested and proven to work. The organisations will employ replication techniques, social franchising and licensing, that have not yet been used widely in the UK.

The initiative from Pathway improves healthcare for homeless hospital patients, by creating NHS teams to:

  • Support and advocate for patients who are homeless in hospital,
  • Help homeless patients to find accommodation and release NHS beds,
  • Support people dealing with financial issues
  • Access help to address personal problems that contribute to their homelessness
  • Help people reconnect with lost loved ones.

The approach has been proven to improve health and housing outcomes for patients and is currently used in 11 hospitals across England. Chief Executive Officer Alex Bax said:

“We are delighted to have won the chance to participate in this programme. It’s a fantastic opportunity for us to explore, with the experts, whether we can spread our ‘Pathway hospital team’ model more rapidly, to benefit some of the most vulnerable and excluded patients the NHS supports.”

The new programme will run for one year and each project will receive up to £145,000 to develop approaches that will enable the project to spread their successful health and care intervention to other sites across the UK in future. Sarah Henderson, Assistant Director at the Health Foundation said:

“We are very excited to support four outstanding project teams and organisations, selected because of their ambition, experience of spreading successful health and care interventions, and importantly, because we think their interventions have considerable potential to be replicated using social franchising or licensing techniques.

“Working together, as part of the Exploring Social Franchising and Licensing programme, we hope to increase understanding of whether social franchising and licensing can be used to support a more sustainable and systematic approach to replicating proven health and social care interventions and the conditions under which these methods are most useful. We hope that we can enable successful inventions to be used more widely to improve care for patients and service users.”


Notes to editors

The media contact for this story is Sushma Sangyam:
020 7257 2092

About the Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.

About Pathway

Pathway works to improve healthcare for people who are homeless. We’ve helped the NHS create 11 teams of doctors, nurses and social care professionals work across England, supporting 3500 patients every year. Pathway also develops models to facilitate improvements in patient care, carries out research in new and developing areas, provides training for healthcare professionals and supports specialist commissioning.

The charity hosts The Faculty for Homeless and Inclusion Health, a network of over 1000 professionals and people with lived experience of exclusion, including vulnerable migrants, people who are homeless, from gypsy and traveller communities, or who sell sex.


Can Pathway ‘Bag’ Your Vote?

Homeless health charity asks for help in Tesco ‘Bags of Help’ fundraising initiative  

 Pathway, a local group helping homeless people with serious illnesses has been shortlisted for a major supermarket charity scheme across the City. Tesco ‘Bags of Help’ gives money raised from carrier bag sales to community projects. Pathway is one of three groups that has been shortlisted for a grant of up to £4000.  

In London there are 6 Pathway teams in hospitals helping homeless patients to find accommodation, sort out financial problems and reconnect with lost family and loved ones. Without their help, many hospitals would be forced to discharge homeless patients to sleep rough after treatment, where many become seriously ill. 

 During November and December Tesco shoppers across the City will be able to vote for Pathway and other shortlisted charities using a token given to them at the checkout each time they shop. Alex Bax, Chief Executive of Pathway said 

 “Your token in the box can make a real different to the lives of people who are homeless. A little bit of help from a Pathway team has been proven to improve health outcomes for homeless patients, and improve housing status long after the support has been given.” 

Dr Peter Buchman, Clinical Lead for the Pathway homeless team at The Royal London Hospital said:

“Votes for Pathway will make a huge difference for homeless people in Tower Hamlets, funding ‘Dignity in Care’ packages containing much needed items such as toiletries and clean warm clothes for when patients are discharged. With the help of Pathway our team supports homeless patients at The Royal London Hospital to find accommodation, sort out financial problems and reconnect with lost family and loved ones. Without this we would be forced to send them to sleep rough after treatment, where many are at risk of becoming seriously unwell again.”

 Bags of Help has already given over £36 million to nearly 8000 projects across the UK. Alec Brown, Head of Community at Tesco, said: 

  “We are absolutely delighted to open the voting for November and December. There are some fantastic projects on the shortlists and we can’t wait to see these come to life in hundreds of communities.” 

Money raised by the scheme will go towards ‘Dignity in Care’ packages, making sure patients have toiletries and pyjamas during their stay, clean warm clothes when they are discharged, and bedding and crockery if they are moving into a home for the first time.  



Notes to Editors

  1. The Bags of Help initiative is supported by money raised from carrier bag sales in Tesco stores.  
  2. Bags of Help funding is available to community groups and charities looking to fund local projects that bring benefits to communities. Anyone can nominate a project and organisations can apply online. For more information please visit: 
  3. The scheme is administered by Groundwork. 
  4. Customers can vote for Pathway at the following Tesco stores: 

90 Mansell Street, E1 8AL
Aldersgate Express, EC1A 4JQ
Bishopsgate Metro, EC2M 4LN
Cheapside Metro, EC2V 6EE
Holborn Viaduct Express, EC1A 2AT
St Botolphs Express, EC3A 7DH
Blackfriars Express, EC4Y 0AA
Smithfield Express, EC1A 9LA
Monument Metro, EC3M 1AE
St Pauls Express, EC2V 6ET 


About Pathway

Pathway works to improve healthcare for people who are homeless. We’ve helped the NHS create 11 teams of doctors, nurses and social care professionals work across England, supporting 3500 patients every year. Pathway also develops models to facilitate improvements in patient care, carries out research in new and developing areas, provides training for healthcare professionals and supports specialist commissioning.  The charity hosts The Faculty for Homeless and Inclusion Health, a network of over 1000 professionals and people with lived experience of exclusion, including vulnerable migrants, people who are homeless, from gypsy and traveller communities, or who sell sex. 

Excluded People Ten Times More Likely To Die Early

People excluded from mainstream society in high-income countries have a tenfold increased risk of early death, according to research from UCL, homeless health charity Pathway and an international team of experts.

Candles from www.sxc.huThe researchers found the mortality rate among socially excluded groups including homeless people, people who sell sex, prisoners and people who use hard drugs, was nearly eight times higher than the population average for men, and nearly 12 times for women. By comparison, mortality rates for 15–64 year olds living in the poorest areas of England and Wales are 2.8 times the rate of those living in the richest areas for men and 2.1 times the rate for women.

The two papers, published today in The Lancet journal, highlight the extreme rates of death and disease faced by excluded people and lay out clear evidence for interventions that can help save lives and prevent people from finding themselves in such desperate situations.

The first paper shows that excluded people are more likely to be murdered or take their own life, but also more likely to die from accidents, overdoses, infectious diseases, cancers, liver disease, heart problems and respiratory diseases. In total, researchers analysed data from 38 countries with the UK, USA, Sweden, Australia and Canada providing the highest amount of data.

The lead author of the first paper, Dr Robert Aldridge (UCL Institute of Health Informatics) said:

“We know that excluded populations suffer from lack of access to basic healthcare, but this new research shows the frightening extent of the problem: it’s much worse than we thought. People experiencing homelessness, those with drug addictions, prisoners and those who sell sex are far more likely to develop serious health problems and die early.”

Professor Andrew Hayward (UCL Institute of Epidemiology and Healthcare), senior author of the first paper and Pathway Trustee, added:

“It is no surprise that socially excluded groups have poor health outcomes but the extent of the disparities in wealthy countries is an affront to our values. Socially excluded groups are the canaries in the mine – they point to something toxic in our society.

Extreme social exclusion affects at least half a million people in England every year, but the true figure is likely to be much higher, as national datasets do not ask about these problems. Exclusion, and its health consequences, often result from many years of multiple problems such as poverty, adverse experiences and psychological trauma during childhood.”

The second paper outlines a range of interventions that work to help excluded people including drug treatment, case management, and psychological therapies. Broader work to tackle poverty, unemployment and housing problems can also prevent social exclusion but have been less well studied for their health effects.

“Our research shows how best we can support the most excluded. We urgently need investment and co-ordination between government, health services and social care providers to deliver high-quality comprehensive services in the community, on the streets and in institutional settings such as prisons and hospitals. Supportive values include providing time, building trust, promoting accessibility, fairness and equality. The inequity we have shown is preventable,”

said Ms Serena Luchenski (UCL Institute of Health Informatics & Pathway Public Health Fellow), lead author of the second paper. Dr Nigel Hewett, Medical Director of Pathway, Secretary of the Faculty for Homeless and Inclusion Health, and senior author of the second paper added:

“There are already examples of teams working together in the integrated way that is supported by this research. These include GP and nurse led Pathway homeless teams working in hospitals, and other services who take health care to people in hostels, drop-in centres and on the streets. The challenge in the UK is that health, housing and social care are overwhelmed by austerity and find it difficult to develop the capacity to work collaboratively.”

The researchers also highlight previous studies which have shown that “housing first models”, which give people a stable place to live before addressing addiction or mental health problems, can be effective in improving health and social outcomes and reducing crime.

“The single most important thing we can do to prevent social exclusion is to tackle poverty, particularly amongst children. This is the key structural driver of homelessness and the other forms of social exclusion considered in these papers,”

said Professor Suzanne Fitzpatrick, Director of the Institute for Social Policy, Housing and Equalities Research (I-SPHERE) at Heriot-Watt University and co-author on the second paper.

“In the UK that means, at a minimum, rolling back the current programme of welfare reform cutbacks that are set to drive child poverty up substantially in the coming years. Social housing plays a vital role in mitigating the worst effects of poverty for many families, but there is a desperate shortfall. Theresa May’s recent announcement of 5,000 extra social homes per year in England is welcome but nowhere near enough.”


Notes to editors

For more information please contact Rowan Walker, UCL Media Relations, t.0203 108 8515 or For out-of-hours enquiries (on Sunday 13 November) please call Chris Lane on +44 (0)7917 271364.

The health impact of social exclusion: a systematic review and meta-analysis of morbidity and mortality data from homeless, prison, sex work and substance use disorder populations in high-income countries’ is available to view on the Lancet website. It is an open access paper that is free to view.

What works in Inclusion Health: overview of effective interventions for marginalised and excluded populations’ is available to view on the Lancet website. It is free to access, but you will need to register for a free Lancet account.


About Pathway

Pathway works to improve healthcare for people who are homeless. We’ve helped the NHS create 11 teams of doctors, nurses and social care professionals work across England, supporting 3500 patients every year.

Pathway also develops models to facilitate improvements in patient care, carries out research in new and developing areas, provides training for healthcare professionals and supports specialist commissioning.

The charity hosts The Faculty for Homeless and Inclusion Health, a network of over 1000 professionals and people with lived experience of exclusion, including vulnerable migrants, people who are homeless, from gypsy and traveller communities, or who sell sex. | Follow us on Twitter @PathwayUK


About UCL (University College London)

UCL was founded in 1826. We were the first English university established after Oxford and Cambridge, the first to open up university education to those previously excluded from it, and the first to provide systematic teaching of law, architecture and medicine. We are among the world’s top universities, as reflected by performance in a range of international rankings and tables. UCL currently has over 39,000 students from 150 countries and over 12,500 staff. Our annual income is more than £1 billion. | Follow us on Twitter @uclnews | Watch our YouTube channel


‘A Second Class Ending’

CQC and Faculty paper highlights ways to improve end of life care for homeless people

An image of a shadowy bed, with half light from a windowA report released today by the Care Quality Commission, drawing upon research from the Faculty for Homeless and Inclusion Health, raises concerns that homeless people are struggling to access the care they need as they face the end of their lives.

People whose needs are the most overlooked are often those who are least able to advocate for themselves. A Second Class Ending highlights problems including fragmented support, inadequate services and few genuine options for homeless people in their last weeks and days of life, leaving many without the support they need.

However it also highlights numerous examples of good practice, where health and social care providers, palliative care specialists and homelessness staff have worked together to meet the significant needs of people facing this situation.

Dr Briony Hudson, Pathway Fellow and Research Associate at Marie Curie Palliative Care Research Department at UCL, comments:

“Enormous pressure is currently being placed on hostels who struggle to support people with very poor health, due to a lack of alternatives. Options for place of care and multidisciplinary working are key to improving quality of life for people experiencing homelessness, especially towards the end of their lives. We’re delighted to see the examples of good practice and joint working highlighted in this report, and there are many lessons to be learned from them.”

Stan Burridge, Pathway’s Expert by Experience Lead, was homeless for almost 20 years. He recently documented his experience of trying to see a GP whilst he was homeless for the BMJ. Stan said:

“Seeing a GP who understood homelessness was the first step to getting my life back on track. Without him, I think my health would have continued to the spiral out of control, and I could have ended up as one of the many homeless people who die an early death.”

Read the CQC report

Is Your Surgery ‘Homeless Ready’?

Pathway in the BMJ

Pathway’s Expert by Experience Lead, Stan, has been making waves with his latest article in the British Medical Journal (BMJ). Entitled ‘Three forms of ID and a Letter from God‘. His piece outlines the struggles faced by people who are homeless, who need to see a GP.

The majority of people who are homeless have a physical or mental health problem, but incorrectly enforced regulation around proof of address prevents many from accessing support. Possibly as a result, people who are homeless use A&E 6 times more than people with a home.

Stan’s passionate article is based on his own experiences of life on the streets, and his subsequent recovery, assisted by a specialist homelessness GP. The article is part of Pathway’s ongoing work to help GP receptionists to support registration for people who are homeless.

Access free homelessness training for GP receptionists
Download the Faculty of Homeless and Inclusion Health National Standards for GP Receptionists

Charities Make Plea for Homeless Patients

A coalition of homeless health experts are calling upon Secretary of State Jeremy Hunt to help homeless hospital patients ahead of the new Homelessness Reduction Act.

78% of people who are homeless have one or more health problems, but fragmented NHS IT systems struggle to recording patient’s housing status or alert housing departments. In some cases patients have been discharged straight from hospital to sleep on the streets,.

The average age of death for a homeless man is 47, for a woman it is 43. To help prevent these deaths, and unsafe discharges, homeless health charity Pathway, Crisis, The London Homeless Health Programme and Professor Andrew Hayward, Director of the Institute of Epidemiology & Health Care and the Farr Institute for Health Informatics at University College London are calling for a small change to NHS IT systems, so that people entering hospital are asked where they are living, and if they are at risk of homelessness.

In 2018 the new Homelessness Reduction Act will place obligations on NHS organisations to refer patients who are at risk of homelessness for help. To make this change in time the NHS needs to act urgently to agree a standard way to record housing status.

Alex Bax, Pathway Chief Executive said:

“This simple change could help thousands of people who are homeless and in hospital get the support they need to put life back together, and help prevent many people from becoming homeless.”

Changes to systems are likely to be required ahead of the Homelessness Reduction Act, coming into force next April, which requires public bodies to help people at risk of homelessness. Specialist homelessness nurse Samantha Dorney-Smith said:

“It’s vital that health services support people who are homeless. We want people to know that health services care, and we’re here to help. Without the right support we know that homeless people often face an early death in tragic circumstances.”

Interviews and case studies are available on request


Cat Whitehouse, Communications Officer
020 3447 8780


Notes to Editors

  1. A letter entitled ‘Making homelessness visible in the NHS’ was sent to The Rt Hon Jeremy Hunt MP, Secretary of State for Health on 18th October 2017 (file enclosed).
  2. The letter was accompanied by a technical note, detailing the change required to NHS IT systems (file enclosed).
  3. The Homelessness Reduction Act received royal assent on 27th April 2017 and comes into force in April 2018.
  4. One of the provisions in The Act places a duty on statutory bodies to refer people at risk of homelessness to services that can support them.

About Pathway

Pathway works to improve healthcare for homeless people. The charity has helped the NHS to create teams of doctors, nurses and social care professionals within 11 hospitals across England, supporting over 3500 patients who are homeless every year.

Pathway develops models to facilitate improvements in patient care, carries out research in new and developing areas, provides training for healthcare professionals and supports specialist commissioning.

The charity is also host to The Faculty for Homeless and Inclusion Health, a network of over 1000 professionals and people with lived experience of exclusion, including vulnerable migrants, people who are homeless, people from gypsy and traveler communities and people who sell sex.

Joint Statement on Inclusion Health

Leading health professionals have issued a joint statement on inclusion health calling for joined up thinking on homelessness, exclusion, inequality and health in the wake of the Homelessness Reduction Act.

The statement, from The Academy of Royal Medical Colleges (the coordinating body for all 24 medical Royal Colleges and Faculties across the UK) and The Faculty for Homeless and Inclusion Health, recognises inclusion health as a discipline and commits all Royal Medical Colleges to redressing “extreme health and social inequities among the most vulnerable and marginalised”.

In light of the statement, The Faculty will be working with the Royal College of Physicians and other key partners to help clinicians understand their duties to refer patients for support under the new legislation. Dr Nigel Hewett, Secretary to the Faculty for Homeless and Inclusion Health said:

“Faculty members come from across the NHS and beyond. They work together to get the best outcome for their patients. Every discipline in healthcare has a contribution to make to the care of our most vulnerable fellow citizens. The recognition of our shared responsibilities in this statement is a huge leap towards that goal.”

The Homelessness Reduction Act received Royal Assent on 27th of April. It’s provisions are expected to come into force in 2018.

Click here to download the joint statement (external website)

Health Heroes Against Homelessness

North-west professionals tackle homelessness & health

A group of passionate health professionals are meeting in Manchester next week to discuss the city’s worsening homelessness crisis.

The regional meeting of the Faculty for Homeless and Inclusion Health, will bring together doctors, nurses, mental health professionals, hostel workers and commissioners to look at new ways of providing support to people who are homeless who have mental health problems. Over 70% percent of people who are homeless have a physical or mental health problem. People who’ve lost their home are more likely to suffer depression, more likely to feel suicidal and are more likely to suffer from serious illnesses such as epilepsy, diabetes and emphysema.

Rachel Brennan, Manager of the Homeless Service at Urban Village Medical Practice who are hosting the meeting said:

“Every day we see patients who are struggling with homelessness and horrendous health problems. All of us need good healthcare, but it’s especially vital that patients who’ve fallen through the net can get the support they need to get back on their feet.”

Michael is a patient at the practice. He slept rough in Manchester on and off for 4 years, until his health deteriorated and he was hospitalised. With the support of the hospital homeless service, Mpath, Michael got into a hostel and got healthcare and drug treatment. As his health and stability increased, he leapt at the chance to move into his own home. He now manages his health conditions with a local GP practice. Michael said:

“Without help from Urban Village and other supporting staff I think I would have died on the streets. Through the practice I’ve completed Hepatitis C treatment, come off alcohol and drugs and got my own place. I can’t thank everyone enough for their help.”

Alex Bax, CEO of Pathway, who host the Faculty of Homeless and Inclusion Health said:

“Good health services can change the lives of people who are homeless. The best services bring together health, housing and social care. Andy Burnham’s commitment to join up services across the city is an amazing opportunity for change.”


Pictures are available on request.



Cat Whitehouse, Communications Officer
020 3447 8780


Notes to Editors

  1. The Faculty for Homeless and Inclusion Health Regional meeting will take place on 26 July 2017, 17:00 – 19:30 at Urban Village Medical Practice, Ancoats Primary Care Centre, Old Mill Street, Ancoats, Manchester, M4 6EE.
  2. Inclusion health is a discipline focusing on the health needs of  people who are homeless, vulnerable migrants, gypsy and traveller communities and people who sell sex, groups that all struggle to access healthcare, but often have serious health problems.
  3. The Academy of Royal Medical Colleges has recently made a joint statement on inclusion health with The Faculty, committing all 24 of the UK and Ireland’s Medical Royal Colleges and Faculties to reducing inequality.


About The Faculty

The Faculty for Homeless and Inclusion Health is a network of over 1000 professionals working in inclusion health – a discipline supporting

  • People who are homeless
  • People who sell sex
  • People from gypsy and traveller communities
  • Migrants who are vulnerable

Members include doctors, dentists nurses, social workers, public health experts, support workers, researchers, commissioners and people with lived experience of exclusion. Faculty membership is free, and offers research and updates on inclusion health issues, a network of regional meetings and training events and consultation around the National Service Standards for Homeless and Inclusion Health, endorsed by the Royal College of Physicians. The Faculty is hosted by Pathway, a charity helping the NHS to support homeless people.

Homeless and Inclusion Health Symposium 2018 Call for Papers

Dr Arvind Madan addresses Homeless Health 2017

Homeless and Inclusion Health 2018 will take place in London on 7th – 8th March. We are seeking presentations of interest to our audience of professionals drawn from medicine, mental health, housing, public health, research and commissioning and Experts by Experience who have lived through exclusion.

Presentations should be 15 minutes long, followed by 15 minutes of discussion. Submissions will be assessed by a committee from the inclusion health field.  Areas of interest include academic papers, data describing services or clinical issues, interventions drawn from practice, evidence of service user involvement and the use of multidisciplinary approaches. Preference will be given to members of The Faculty of Homeless and Inclusion Health. The committee looks favourably upon submissions from people with lived experience of exclusion.

A 200 word abstract, made using the enclosed Excel template, should be sent to by Friday 11 August 2017, 10am.

Click here to book delegate tickets for Homeless and Inclusion Health 2018. Early bird rates are available until August.


Successful submissions will be offered one free ticket per paper for the lead speaker on the day of their workshop, and a reduced price ticket for the other day of the event. Additional speakers are eligible for a reduced fee for the day(s) of attendance.

All presentations at the conference may be recorded and/or filmed, all presenters must agree to this unless there are safety concerns in doing so.

The charity has limited resources and prioritises supporting Experts by Experience (EbE) to attend the symposium. As such we cannot pay travel and hotel costs for speakers unless they are part of the EbE programme and/or there are extenuating circumstances. If this applies to you please indicate this on your submission.

As a thank you for submitting your work, if your paper is not accepted then the Faculty will offer you the Early Bird Delegate Rate, even if this has expired.

Homeless Patients Are Dying Without Support

Research published today reveals that homeless people who are terminally ill are falling between cracks in services, and not able to access the same level of support as others.

Researchers from Pathway, Marie Curie Palliative Care Research Department at University College London (UCL), St Mungo’s and Coordinate My Care worked with homeless people and care professionals and found that many homeless people who may be approaching the end of their lives are living in homeless hostels.

The study is the largest of its kind and the first to describe the lack of appropriate services for homeless people in the UK, from the perspectives of homeless people and those supporting them.

It showed that hostel staff often end up caring for some of the sickest homeless people, despite not having the palliative care training or support to do so.  As a result, huge burdens are placed on hostel staff who do their best to manage with minimal support and very limited resources.

One hostel staff member commented:

“At least three times a shift we check she’s okay.  It’s hard … particularly on weekends and nights when we only have two staff … it’s a big hostel … you really can only do so much … this isn’t an appropriate environment, but it’s the best we have”

Dr Caroline Shulman, Pathway and Marie Curie Palliative Care Research Department, UCL, who led the research, said:

“Hostels provide temporary accommodation. They are not designed to meet the needs of seriously or terminally ill residents. Hostel staff often struggle to secure additional support from social services or palliative care services for their residents who have complex problems.”

Many homeless people die young from conditions such as advanced liver disease, often complicated by mental health problems and/or drug and alcohol issues. There are differences in the type and amount of support available for this group across London, with some innovative attempts to deal with this extremely challenging problem. However the researchers found that overall, homeless people with advanced ill health rarely receive adequate care and support in the community. This results in repeated unplanned and emergency hospital admissions in the last months, weeks or days of life, which can be very distressing.

One of the participants with experience of homelessness commented:

“There’s been a few guys that were in hospital, told they were dying …. They didn’t want to go to any hospice, they didn’t want to … stay in hospital, they wanted to die in the homeless hostel”

The research calls for urgent action to improve collaboration between health, housing, social services and the voluntary sector, with extra support for hostel staff. It also makes recommendations for a specialist health hostel, with staff that not only understand the complex needs of homeless people but can also offer adequate 24-hour support for people with serious illnesses, including those who are dying.

As one of the hostel residents observed: 

“You’ve got to walk past those people.  They half block the stairwell, you have to edge your way past.  It’s kind of … in your face.  Erm, yeah, it becomes part of the furniture.  But it disturbs me as a person…”

Professor Steve Field, Chief Inspector of General Practice at the Care Quality Commission, said: 

“As a GP I have seen how the lack of appropriate and sensitive services can mean that homeless people are denied the compassionate healthcare, dignity and respect that they deserve at the end of their lives.

“This research makes it clear that by working together, healthcare services and the wider system – such as housing, social services and the charity sector – have a vital role to play in improving the quality and co-ordination of care for homeless people as they reach the end of life. Everyone has the right to safe, high-quality, and compassionate health and social care. Through our inspections we have seen services that are providing outstanding care to people who do not have secure housing but it takes strong, responsive leadership and dedicated staff.

“In the coming months CQC will be publishing a detailed report making recommendations on how we as a society can meet our responsibility to the most vulnerable people in our communities who are currently being let down at a time when they need help and support the most.”

The research, published in the journal Palliative Medicine, was funded by the Oak Foundation and supported by Marie Curie, Pathway and Coordinate My Care.

Click here to download the paper from Palliative Medicine (free).


Notes to Editors

Case studies and interviews available on request.

Additional quotes:

Alex Bax, Chief Executive at Pathway, sad: “Pathway is delighted to support this ground breaking research. We knew that homeless people’s experience of care at the end of their lives was often poor, but this new study shows how all parts of the system working together could make things much, much better. The voices of homeless people and the staff who work with them come through loud and clear. Towards the end of life everyone wants to be treated with dignity, respect, kindness and compassion. And homeless people are no different.”

Simon Jones, Director of Policy and Public Affairs at Marie Curie, said: “The majority of people tell us that they wish to be cared for and die in comfort, where they normally live and surrounded by their loved ones. For most people, this means their own home. This important study highlights that for homeless people, home represents something completely different – a hostel, or on the street.  Everyone deserves compassionate care and a dignified death, regardless of where they normally live, or their personal circumstance.”

Niamh Brophy, Palliative Care Coordinator at homelessness charity St Mungo’s, worked on the research. She said: “People who are homeless do not gain access to palliative care until very late in their illness, if at all. Often their choices for care are limited, and their death is more likely to be perceived as sudden, untimely and undignified.

“In recognition of this complexity, St Mungo’s provides the unique service of having a dedicated Palliative Care Coordinator. My role centres around giving our residents with serious health concerns the opportunity to choose their treatment, the chance to reconnect with loved ones, and the possibility to die in a dignified, comfortable way in a place of their choosing.”

The Oak Foundation said: “We are pleased to support the research to improve end of life care for people who are homeless or vulnerably housed. This work is key to strengthening the links between the homelessness sector and health providers.”


About the research

  • Homelessness includes not only people who are sleeping on the streets, but also those in insecure or temporary accommodation such as hostels.
  • Participants were recruited across three London boroughs, Lambeth, Hackney and Westminster, selected for their high volume of both homeless people and homelessness services.  Frontline homelessness providers and health and social care professionals were recruited through the research’s team existing connections.
  • 127 participants took part. Over a third (n=39%) of the homeless participants had been homeless for more than five years; 86% reported having slept rough and 71% reported currently sleeping in hostels, most of the time.

recent CQC report acknowledged that people from certain groups in society, including homeless people, experience poorer quality care at the end of their lives and that more must to done to tackle the problem.

Key findings

  1. In London, appropriate services for homeless people with advanced ill-health are lacking. Facilities that can meet the physical and emotional needs of homeless people with advanced ill health, who may continue to misuse substances, are needed.
  2. There is currently a large emotional, and practical burden on hostel staff in supporting homeless people with advanced ill-health due to lack of appropriate alternatives. Homeless people, and those supporting them struggle to access the services required.
  3. There is a conflict between the recovery-focused nature of many services and the realities of health and illness for homeless people that creates a lack of comprehensive person centred care.
  4. Collaboration between health, housing and social services, the promotion of multidisciplinary working including hostel in-reach and greater training and support are urgently needed for professionals and those working with homeless people as their health deteriorates.

About the partners

Marie Curie – care and support through terminal illness

Please note – we are now called ‘Marie Curie’ (not Marie Curie Cancer Care)

Marie Curie is the UK’s leading charity for people with any terminal illness. The charity helps people living with a terminal illness and their families make the most of the time they have together by delivering expert hands-on care, emotional support, research and guidance.  Marie Curie employs more than 2,700 nurses, doctors and other healthcare professionals, and with its nine hospices around the UK, is the largest provider of hospice beds outside the NHS.

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The Marie Curie Palliative Care Research Department at UCL is an internationally recognised centre of research with a team of over 20 full-time researchers. The department receives core funding from Marie Curie and also undertakes research funded by the National Institute for Health Research (NIHR), the Alzheimer’s Society and other research funders. The department has particular research strengths in the areas of palliative care for people with dementia, prognostication in advanced cancer and the management of cancer-related fatigue.


Pathway works to improve healthcare for homeless people. The charity has helped the NHS to create 11 homelessness teams in hospitals across England, supporting over 3000 patients every year. Pathway also develops models to facilitate improvements in patient care, carries out research in new and developing areas, provides training for healthcare professionals and supports specialist commissioning. Pathway hosts The Faculty for Homeless and Inclusion Health, a network of over 900 health and social care professionals providing support for homeless people, vulnerable migrants, gypsy and traveller communities and people in the sex industry.

St Mungo’s

St Mungo’s provides a bed and support to more than 2,600 people each night who are either homeless or at risk of homelessness. As a charity and housing association, we work to prevent homelessness, through more than 250 projects including emergency services, supported housing, specialist physical and mental health services and advice, skills and work services. We believe everyone should have a place to call home and be able to fulfil their hopes and ambitions.

St Mungo’s Palliative Care Service started in 2007, and since then we have

  • Provided more than 190 residents with end of life care support including bereavement support
  • Delivered training about homelessness and end of life care to more than 300 staff
  • Developed an online Resource packaimed at supporting staff working with people who are homeless
  • Forged greater links and partnership working with services such as a multidisciplinary working group set up to identify earlier on those residents whose health may be deteriorating
  • Partnered on collaborative research and training development with UCL, Marie Curie and Pathway

Coordinate My Care (CMC) 

Coordinate My Care is an NHS urgent care clinical service developed from the concept of a multidisciplinary digital end of life care plan to an urgent care plan for all vulnerable patients. CMC was established in May 2012 to address the need for patients to have integrated, coordinated and quality care. The CMC service is implemented successfully across the 32 London CCGs where it has provided quality improvements and a reduction in unnecessary hospital admissions. As of June 2017, 41,565 care plans have been created.

Palliative Medicine

Palliative Medicine s a highly ranked, peer reviewed scholarly journal dedicated to improving knowledge and clinical practice in the palliative care of patients with far advanced disease. It reflects the multidisciplinary approach that is the hallmark of effective palliative care.