Professor Aidan Halligan started looking at the quality of care received by homeless patients at University College Hospital (UCLH) in London in 2008. He had joined UCLH as Director of Education with a particular remit to think about how the hospital’s culture influenced patient care. Aidan came across a shocking failure in the care of one homeless patient which seemed to have roots the culture of a team and the attitudes of staff. He decided to investigate how it was that a well-resourced institution with highly trained, skilled and motivated staff could fail patients from this most vulnerable group.
With support from the hospital’s Chief Executive and a grant from the hospital charity Aidan invited Dr Nigel Hewett (a GP from Leicester who had spent his career caring for homeless patients) to come to UCLH. Nigel quickly carried out a clinical audit of homeless patient admissions and convened meetings with people experiencing homelessness who’d been in hospital in London. In early 2009 Nigel was joined by nurse Trudy Boyce to launch a pilot service with a simple objective: to improve care for homeless patients admitted to the hospital. Elsewhere on this site you can read much more about the founding ethos of a Pathway team, about teams’ commitment to putting compassion, care and building trust with patients at the centre of their work and about the power of strong clinical advocacy. By the end of 2009 Nigel published data showing outcomes had improved for homeless patients at UCLH.
Aidan decided that a small independent charity, working alongside the NHS, would be the best way to build on the learning emerging from the first ‘Pathway’ team and to drive change across the UK’s health system. In the autumn 2009 he invited Alex Bax (who was just leaving his role as health policy advisor to the Mayor of London) to join the team to help Aidan develop this ambition.
In April 2010 ‘The London Pathway’ registered as a not-for-profit company limited by guarantee. The name referenced our starting point and our focus on improving care pathways for homeless patients. In November 2010 we achieved full charitable status and held the first meeting of Pathway’s Board of Trustees. Aidan became Chairman. Other founding Trustees included Sir Ian Kennedy and Sir Peter Dixon. In the same year we won our first significant grant from the Health Foundation to explore how to replicate and spread the Pathway Team model, and with funding from NIHR we launched a two-site randomised controlled trial of the Pathway Team intervention. The research funding supported the launch of two new Pathway teams, at the Royal London Hospital in East London and in Brighton and Sussex University Hospital.
By 2011 we were working with NHS partners in Bradford, Brighton and Manchester and we decided to change our name to ‘Pathway’. The same year we launched the Faculty for Homeless and Inclusion Health, the first national professional network for inclusion health practitioners. Under Aidan Halligan’s Chairmanship sixty NHS colleagues and people with lived experience came to an inaugural meeting in the Education Centre at UCLH. Aidan challenged them to develop a shared a set of standards to define good quality care for inclusion health groups. We published the first crowd-sourced edition, edited by Nigel Hewett, by the end of that year.
In 2012 we launched our Care Navigator training programme at UCLH, recruiting and training our first colleague with lived experience of homelessness to work in the hospital team. With funding from the Mayor of London we also began work on a detailed assessment of the need for specialist intermediate care for homeless patients (using the American term ‘medical respite’ to differentiate the provision from more mainstream services). We also supported the launch of new teams across South London, in Guys and St Thomas’ Hospital, at Kings College Hospital and (a little later) at South London and the Maudsley NHS Trust.
In 2013 we held the Faculty’s first International Symposium on Homeless and Inclusion Health. Just under 300 delegates attended from across the UK, Europe and the US. Our annual conference has gone on to become the annual get together for all who work in inclusion health and has stimulated myriad partnerships, research ideas and collaborations.
In April 2015 Aidan Halligan died suddenly. His loss was a huge shock to everyone at Pathway but by then the charity was on a firm footing (thanks to a core grant from the Oak Foundation) and had begun to have real impact across the world of the NHS, making change happen for our patients. In 2016 Leslie Morphy OBE became Pathway’s second Chair.
You can read a fuller account of Pathway’s foundation and our first ten years in our 2020 review.
Professor Aidan Halligan, MA MD FRCOG FFPHM MRCPI FRCC was the founder and chair of Pathway. He was a husband, father, surgeon, the Principal of UCLH Staff College, and Director of Integrated Clinical Care at Central Manchester University Hospitals. Aidan died suddenly and unexpectedly on 27 April 2015.
Aidan’s talents and expertise were formidable. During his lifetime he held positions as a Professor of Gynaecology and Obstetrics, Director of Education at University College Hospital London (UCLH), Director of Clinical Governance for the NHS, and was the youngest Deputy Chief Medical Officer for England. At the time of his death he was Chairman of Pathway, had launched The Staff College, was Director of Well North and also Honorary Colonel of 256 Field Hospital.
He also made lifelong friends, ranging from formerly homeless people, to national system leaders.
What you permit, you promote.
Professor Aidan Halligan
Aidan was a passionate advocate for values-based leadership, and used his work with the army to shape a programme of learning for medical professionals that called for vocational motivation and transparent accountability, underpinned by compassion, recognising that “people measure their behaviours and beliefs by those around them”.
Aidan once wrote that “Doctors and nurses are not managed into patient care, they are led”. He embodied that sentiment, engaging with homeless healthcare and even hopping down from the stage during a speech to offer his contact details to a patient who had received poor care at his hospital.
His charm made him a compelling public speaker, and he shared his wisdom through vignettes of the world he saw around him.
You get your authority from how much you care.
Professor Aidan Halligan
Despite his powerful position, Aidan never lost sight of patients as the most important people in healthcare. He used his eminence to change health systems, creating models of care that placed patients at their heart.
Doing the right thing on a difficult day.
Professor Aidan Halligan
Aidan’s death has left a huge hole in many lives and organisations. His legacy is a plethora of projects and teams, learning and leadership, dedicated to changing the face of healthcare in his memory. The Faculty for Homeless and Inclusion Health continues to expand, bringing together professionals who care about vulnerable patients, and setting the highest standards for the services that support them.
There are now Pathway homeless hospital teams across the UK, and the charity works with international colleagues all over the world; sharing and spreading our understanding of inclusion health. The charity is now carrying out research into end of life care for homeless people, taking Aidan’s message of compassionate leadership into new fields, with a view to a more permanent memorial with donations made following his death.
When Aidan began Pathway in 2009, we could not have foreseen the impact it would have. We can only hope to live by the words he spoke at his last conference:
If you believe in it, then you will make it happen.
Professor Aidan Halligan