The Royal London
From September 2014 the service has been funded by Tower Hamlets CCG and provided by Health E1-Homeless Medical Centre, a specialist primary health care service for homeless people, managed by East London NHS Foundation Trust. Funding beyond March 2015 is subject to the commissioning cycle. The service currently has funding for 4 GP sessions, 2 full time nurses and a part time administrator. Barts Health currently fund a social worker post seconded into the team and the London Borough of Tower Hamlets Housing Department commission a “Routes to Roots” service from Providence Row (based at the Dellow Day Centre) comprised of 2 housing workers who can support the team with rough sleepers and insecurely housed people without a local connection to Tower Hamlets.
For homeless patients with a local connection to Tower Hamlets the team is supported by Tower Hamlets Floating Support (Look Ahead) and THSORT rough sleeper outreach (Thames Reach). The team deals with around 900 admissions of homeless patients a year. The results of the randomised controlled trial are yet to be published, but are expected to show an improvement in health outcomes for homeless patients receiving Pathway care.
Brighton and Sussex University Hospital
Kings Health Partners
The Urban Village Medical Practice offers a comprehensive primary care service for 8,500 patients in the inner City, including 700 homeless patients.
They set up the mpath service in June 2013 with funding from Central CCG to improve patient experience and health outcomes for homeless people by working across primary and secondary health care boundaries. The service works with homeless people admitted to Manchester Royal Infirmary (MRI) and who frequently attended A&E. The service consists of one (whole time equivalent) GP, a nurse, a service manager, two case managers, and a housing worker.
During the first six months of Better Care funding the service worked with 216 of the 272 (79%) homeless people admitted to the MRI, achieving 43% fewer A&E attendances (down from 1089 to 618); 39% fewer non-elective admissions (down from 409 to 249); a 66% reduction in bed days (down from 3647 to 1211); and 39% fewer repeat admissions within 28 days (down from 409 to 248).
In 2016 the service audited the needs of homeless patients in the area, producing a comprehensive analysis with a series of recommendations for future services. The audit can be downloaded here.
The Bristol Homelessness Engagement Team is made up of staff from the NHS, Bristol City Council and St Mungo’s. The team work at the British Royal Infirmary, run by University Hospitals Bristol Trust. Lead practitioner Lucy Harrison has been leading the team since it started operating in January 2017. Council social care practitioners assess homeless ‘clients’ to see what they need and how they can be helped when they are ready to leave hospital. And St Mungo’s outreach workers then look to find suitable accommodation. This team was spearheaded by Dr Kate Rush, Associate Medical Director at the BNSSG CCG, which oversees the NHS in the Bristol area. Dr Rush formerly worked as a GP in inner city Bristol, mainly in substance misuse, and could see there was a need for homeless people to get timely help with all their needs after they presented in hospital.