Homeless hospital discharge nursing

homeless discharge nurses












Pathway were recently awarded a 15-month leadership grant from the Burdett Trust for Nursing to identify, network and support all nurses working across the UK in the emerging discipline of homeless hospital discharge.

Homeless hospital discharge nurses work in partnership with patients experiencing homelessness to achieve timely, holistic and compassionate assessment, treatment and discharge plans that improve health and housing outcomes.

Most of these nurses work in hospitals, although in many cases this is an in-reach intervention from community-based services. Some nurses work in Pathway teams, but many others do not. A small number of nurses that work to achieve better discharges for people experiencing homelessness are entirely based in the community.

The first clear reference to homeless hospital discharge practice was in 2003. A Department of Health document ‘Discharge from hospital: pathway, process and practice’ stated that all acute hospitals should have formal admission and discharge policies to ensure that homeless people are identified on admission, and that the discharge of homeless people should be notified to relevant primary health care and homelessness services.

Fast forward to 2019, and there are now around 25-30 specialist nurses in the UK directly involved in homeless hospital discharge (nearly all of whom have been involved in this project), and the NHS Long Term plan cited homeless hospital discharge teams (in this case a Pathway model team) as an example of good practice to reduce health inequalities.

Additionally, since October 2018, the Homelessness Reduction Act (2017) has now conveyed a ‘duty to refer’ on Accident and Emergency departments and inpatient settings for patients identified as experiencing homelessness, or being at risk of homelessness within the next 56 days. This requires patients to be referred to a Local Authority for support (with their consent). The hope is to focus acute hospitals on their responsibilities for safe discharge in this group. It may also result in the recruitment of more nurses into specialist roles.

Our Burdett funded project has revealed that homeless hospital discharge nurses need to be experts in clinical advocacy, patient empowerment, motivational interviewing, and health and housing rights. In addition, they need a broad clinical background in physical health, mental health and addictions and a good understanding of public health, and the concept of ‘making every contact count’, as well as an ability to gradually chip away to deliver systemic culture change. Having said that, to a large extent best practice has been developed locally by expert practitioners ‘doing the job’, and the evidence base is still limited.

Through shadowing and observation, interviews, and group workshops, the project has attempted to define the homeless hospital discharge nurse role clearly, including providing a breakdown of the knowledge, skills and experience required for the role with specimen job descriptions. An early vision for best practice has been defined, and local innovations have been highlighted. Continuing professional development needs have been analysed, and voluntary standards for practice are being developed.

Finally, and perhaps most importantly the project has helped the nurses to develop a shared vision of quality, and has defined this in terms of the value of a safe, effective and compassionate discharge, rather than by cost reduction per se (although the need to deliver efficiency has been taken into account).

The short report can be found here. The full report and resources developed on the project will be published and shared soon.


Pathway Team Wins National Award

The Royal London Pathway team, who support homeless people in Tower Hamlets to live healthier, better lives, has today been awarded a top accolade in the prestigious NHS Parliamentary Awards.


Led by GP Dr Peter Buchman, the Pathway team has beaten the rest of the country to pick up the acclaimed Excellence in Urgent and Emergency Care Award.


Working at The Royal London Hospital and East London NHS Foundation Trust, the team were rewarded for their tireless work improving care for vulnerable homeless people.


The NHS Parliamentary Awards sees the NHS and MPs join forces to honour some of the biggest achievements in health and social care from across the country.


Dr Peter Buchman said:

“We are absolutely delighted to win this national award. People who are homeless often have complex needs, so they can require support from multiple agencies. We work in partnership with health, social care, legal and housing professionals to really help patients get onto a better pathway in life. Thank you for recognising the work of our small dedicated team.”


Jim Fitzpatrick MP, who represents Poplar and Limehouse, nominated the team. He said:

I am absolutely delighted that the Pathway Homeless Team​ are the national winners in the NHS Parliamentary Awards. This is well-deserved and a great example of joint working between ELFT, Barts Health and the Clinical Commissioning Group to truly support homeless people who are among the most vulnerable in Tower Hamlets. Congratulations to everyone involved.”


The Pathway Team are based at The Royal London Hospital and has the ultimate aim of ensuring homeless people cared for by the hospital do not get discharged back to the street, but instead are found other options for housing, healthcare and ongoing support in the community. When an individual admitted to hospital is ready to leave, the team will work to arrange a smooth discharge to a safe place.


The team also encourage rough sleepers and people in temporary housing to register with a doctor at Health E1 Homeless Medical Centre in Brick Lane in Aldgate.


Simon Stevens, NHS England chief executive, said:

“It has once again been a privilege to celebrate with some of the extraordinarily dedicated and selfless health and care heroes who make the NHS what it is today – the much-loved institution that our patients say is what makes them most proud to be British.


“From those who have devoted their lives to helping people and supporting some of our most vulnerable, to delivering pioneering lifesaving treatments, the NHS Parliamentary awards are rightly honouring those who continue to make a huge contribution to our country, through our NHS Long Term Plan.”


The NHS parliamentary awards ceremony saw twelve winners honoured on Wednesday 10th July at the Palace of Westminster’s Terrace Pavilion, hosted by Dr Sara Kayat, NHS GP & TV Doctor.

BBC Fame for Pathway Team

Pathway has been featured on the BBC News front page, and in a BBC World Hacks episode, with a video and radio programme about homelessness and healthcare.

The Pathway team at the Royal London Hospital spent a day with journalists, explaining how their work helps patients who are homeless:

  • find somewhere safe to stay,
  • reconnect with lost loved ones,
  • obtain lost identification documents,
  • get help with financial and legal issues,
  • find support to address any problems that contributed to losing their home.

Featuring alongside the homelessness hospital team, Patients Jacqueline and Gary kindly agreed to take part, with Lola the dog, who proved to be a canine superstar.

World Hacks is an innovative weekly BBC programme, exploring how we can solve the world’s problems.

Listen to the radio show about Pathway

Watch the short video about Pathway.

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.

The Passing of a Friend, Alister Ferguson

Alister Ferguson
Alister’s portrait from the Stories of Rebirth Project

Pathway ‘Expert by Experience’ Alister Ferguson has passed away at the age of 57.

Alister became involved with Pathway in 2013, and made a large contribution to the development of the EbE programme. His great honesty made him a fantastic example of the way that people with a ‘lived experience’ bring that missing ingredient to the table. He represented Pathway on many occasions, and was a regular face at International Symposium on Homeless and Inclusion Health.

Alister spent a large part of his childhood in children’s homes and his history of homelessness went back to the 1970’s. Despite this difficult history, he focused on the positive, and would often wax-lyrical about his exploits, good and bad. It was easy to be charmed by his ability to bring humour seamlessly into his story-telling.

His lively lectures with year 1 and 2 medical students means that doctors of the future will have a greater understanding of the needs of homeless and excluded people.

His hard-hitting education work with the Stories of Rebirth project helped to challenge public opinions about homelessness.

Alister proudly displaying his invitation to the House of Lords

As a result of his work he was invited for tea at the House of Lords with Lord Victor Adebowale, Chief Executive of Turning Point, a moment he later said was one of his best experiences.

Alister recently took part in discussions about Pathway’s approach to including Experts by Experience, making valuable contributions from his insights over the last 3 years. We have compiled this work into a handbook for  involving people with lived experience of homelessness in the running of services. It is fitting that such an important step forward for us as an organisation has Alister’s input so heavily embedded in it.

The whole team are shocked at this sad news.  We can only reflect on the difference he made to our work, and the privilege we feel that he gave so much and allowed us to be part of his life for a while.

His legacy will live on.

Stan Burridge, Expert by Experience Project Lead

Pathway in the BMJ

A Voice From the Streets about Spice

A hand rolled cigarette on a table Pathway Experts by Experience have been working with the British Medical Journal (BMJ) to help doctors recognise and understand the effects of street drugs known as ‘novel psychoactive substances’, and spot their use in patients.

‘Spice’, one of the most common ‘legal highs’, is known to lower inhibitions and heighten senses, but can also cause uncontrolled vomiting, hallucinations and violent outbursts. The drug is cheap and easily available, leading to high levels of use amongst homeless people seeking a way to escape their life circumstances.

Ian Millar, the author of the article, is a formerly homeless person who is now working in hostels and day centres. He is part of Pathway’s Expert by Experience (EbE) programme,  which trains and supports people who have been homeless to educate healthcare professionals about patient care.  Ian told the BMJ

“Last March I visited a hostel with 70 residents, four of whom were regular users of Spice. This year I stayed in a hostel with 30 residents, and more than half were daily users.

Homeless health specialists have voiced concern about the drug which also impacts upon anti-retroviral medication, raising added concerns abut users with HIV. It also interacts with antidepressants and other mental health medication.

Pathway Lead GP Chris Sargeant said:

“Novel psychoactive substances are highly variable, both in strength and the content, making it almost impossible to predict their exact effects. We have seen a worrying rise in suicide levels amongst homeless people who are heavy users, which may warrant further investigation.”

Dr Sargeant will be leading an RCP accredited CPD day on this and other important issues for members of the Faculty for Homeless and Inclusion Health later this year. For details email info@pathway.org.uk

Read the BMJ article

Read more about Pathway teams and their work

And The Winner Is… Pathway!

Pathway’s Winning Awards!

An image of a smiling nurse, Florence Cumberbatch.
Florence Cumberbatch, Homelessness Nurse

It’s been a great first half of the year at Pathway, with awards all round. Nurse Florence Cumberbatch, who is part of the UCLH Pathway Team was awarded a commendation as Employee of the Month, following nomination by numerous staff and colleagues. Florence has been part of the team working exclusively with homeless patients since 2009. Her dedication and hard work have helped hundreds of patients recover from illnesses and injuries resulting from homelessness.

Pathway volunteer Elizabeth Clowes was awarded a Highly Commended in the Small Charities Coalition awards for Britain’s Best Volunteer. Her extraordinary work, creating tools to help frontline professionals assess the mental health of people sleeping on the streets, saw her reach the final 20 applicants of the competition.  Read more about Elizabeth’s work.

Last week Pathway won the London Learning Consortium (LLC) Employer of the Year Award.  Pathway has worked with LLC since 2013, we were nominated for our work training formerly homeless people to become with Care Navigators for homeless hospital patients.

And Giving Them too!

We’ve also been giving awards. Two honorary fellowships to the Faculty of Homeless and Inclusion Health were presented at this year’s International Symposium. Nurse Jane Grey and Dr Les Goldman were recognised for their career-long commitment to healthcare for homeless people.

These awards not only reward and acknowledge the hard work and incredible compassion we see from clinicians every day, but demonstrate the important role of inclusion health in continuing a long tradition of fairness in the NHS.

Pathway Joins Lead London Home

Pathway is joining Crisis, Cardboard Citizens, and 20 other homelessness charities across London in the Lead London Home campaign.  The charities are calling upon the next Mayor to prioritise ending homelessness.

Over 7500 people were reported sleeping on London’s streets last year.  Over a third of homeless people have lost rented accommodation. Homelessness has a devastating effect on physical and mental health, with over 70% of people who have lost their home reporting health issues.

Pathway calls upon the new mayor to commit to Leading London Home.

A Happy New Year, A Happy New Partnership

A gavel on a hospital bedJanuary 2016 marks the beginning of a new and innovative partnership between the housing team at London law firm Hodge Jones & Allen (HJA) and the Pathway homeless healthcare service based at University College London Hospital (UCLH).  The Pathway team at UCLH benefits from a close relationship with social workers, housing officers, mental health teams and local charities but often need specialist legal insight to advise on the housing rights of patients once they leave hospital care.

Since 2014 Pathway has received pro bono legal advice from Hodge Jones & Allen. Thanks to a three year grant from Trust for London this legal assistance has been formalised, ensuring the best possible service for Pathway patients. Solicitors at HJA will provide regular updates to Pathway on changes in the complicated area of housing law as well as offering specific advice for patients in need of particular legal insight or representation.


Alex Bax, Chief Executive of Pathway, said:

“I am delighted to launch this new partnership with HJA. This is the first time homeless patients have been offered legal advice during their care, helping them to recognise the options open to them as they recover. As the work builds up we will be monitoring what this does for individual patients, and work with HJA to see what general lessons we can learn about the way the law impacts on the lives of sick homeless people.”

Ed Veale, a housing solicitor at HJA, commented:

“It is a privilege for HJA to partner with Pathway in such a unique way. We have been very impressed with Pathway’s commitment to the long-term welfare of their patients after they have been discharged from hospital. With our housing team providing in-depth legal advice to the Pathway Team, we look forward to ensuring that the housing rights of some of the most vulnerable people in London are upheld. Pathway’s approach in providing holistic support to their patients is brilliant, and we are thrilled to be able to play a key role in their ongoing work.”


About Hodge Jones & Allen

Hodge Jones & Allen LLP has represented ordinary people caught up in the most extraordinary events for almost four decades. To this day the firm remains committed to providing first-class legal help to individuals and organisations alike, based on a strong set of ethical values that permeate throughout the firm. Patrick Allen was the first managing partner and still leads the firm with passion and enthusiasm 38 years on.

Hodge Jones and Allen employs over 220 staff, based in Euston NW1. The firm’s team of specialists deal with Personal Injury, Medical Negligence, Industrial Disease, Civil Liberties, Criminal Defence, Court of Protection, Dispute Resolution, Employment, Family Law, Military Claims, Serious Fraud, Social Housing, Wills & Probate and Property Disputes.

  • Recognised as a Tier 1 firm across a number of disciplines by Chambers UK
  • Named as a leading firm by The Legal 500
  • Listed as number 137 in the Lawyer UK 200
  • Shortlisted for firm/not for profit agency by Legal Aid Lawyer of the Year Awards 2014
  • Shortlisted for law firm of the year by Halsbury Legal Awards 2014

Press enquiries to:

HJA Press office
Anna Younger/ Tal Donahue/ Alex Spurgeon
020 7269 1430


Homeless Healthcare First Steps for Accident & Emergency Units

Pathway and the Faculty for Homeless and Inclusion Health (FHIH) have been working with the Royal College of Emergency Medicine (RCEM) and the Royal College of Physicians  to publish exciting new research into the experience of homeless patients in Accident and Emergency Units.

23 Accident and Emergency Departments audited all homeless patients using their services for 2 weeks, investigating the care they received, and onward referrals that were made.

This us the first time that a national multi-centre clinical audit of ED care for homeless people has been carried out in the UK.

Secretary to the Faculty for Homeless and Inclusion Health, Dr Nigel Hewett, said:

“RCEM is working with the Faculty to encourage more ED’s to improve their care of homeless people.  An effective response to this complexity requires multi-agency coordination and links to appropriate services and support.”

Download the press release

Download the full reports from the RCEM website