Pathway joins call for strategy to address health inequality

Pathway and over 90 health representatives from the Inequalities in Health Alliance (IHA), have written to the Prime Minister, calling for a cross-government strategy to address the underlying causes of health inequalities.

Now is the time for bold action to level up health as we move into the next phase of pandemic recovery. We need an explicit health inequalities strategy, with clear measurable goals, that considers the role of every department and every available policy lever in tackling health inequality.

The Alliance has been encouraged since its first letter in October 2020, by the commitments government has made that signal a welcome move towards a more joined-up approach to reducing health inequality. The Office for Health Improvement and Disparities and reference to ‘a new cross-government agenda which will look to track the wider determinants of health and reduce disparities’, the cross-government ministerial board on prevention, and the Levelling Up white paper, all hold great potential to be the catalyst needed to tackle health inequalities.

The next step would be to strengthen and underpin this work with an explicit cross-government strategy to reduce health inequalities, involving all government departments. If we are to prevent ill health in the first place, we need to take action on issues such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution.

Many deaths could have been prevented if there had been better levels of general health before the pandemic. The recovery from COVID-19 must be a turning point for the health of the nation.

The Royal College of Physicians, as convenors of the IHA, has published a short policy briefing setting out the case for a cross-government strategy to reduce health inequalities. Learn more here.


World Doctors Orchestra and Dame Evelyn Glennie fundraise for Pathway



The World Doctors Orchestra and internationally renowned percussionist Dame Evelyn Glennie, will take to the stage this October in two benefit concerts for Pathway.

The World Doctors Orchestra, formed in 2008, is an ensemble of physicians from all over the world who meet three to four times a year to perform concerts raising money for medical charities.

They are delighted to be making their first appearance on a UK stage with Dame Evelyn Glennie, to raise money for Pathway. The orchestra will be performing a mix of British and American music with optimistic and often humorous aspects to the works.

The Malcom Arnold piece was chosen to celebrate the 100th anniversary of his birth, whilst Dreamachine is a piece premiered by Dame Evelyn herself. The Bax and Elgar pieces have been chosen to complete the concert, being truly British in their setting and style, as they introduce some homemade flavours to our international colleagues.

The concerts will fundraise and increase awareness of inclusion health, and highlight the work of Pathway in supporting and co-ordinating healthcare for marginalised and excluded groups.

This will be a very special occasion as all the players are physicians from around the world, and they get to showcase one of our most celebrated British musical artists. Plus the concert will feature three vacuum cleaners, a floor polisher and a rifle. Not your average concert!

Solo percussion: Dame Evelyn Glennie
Conductor: Stefan Willich


Malcom Arnold – A Grand, Grand Festival Overture 08:08
Michael Daugherty – Dreamachine, for solo percussion and orchestra 34:26
Arnold Bax – Tintagel 14:40
Edward Elgar – Enigma Variations 35:00

Book tickets here:

New Pathway Team Launch

On Wednesday 7th July 2021, Pathway will launch a new inclusion health team in Salford.

Pathway and Salford Primary Care Together Inclusion GP Service warmly invite you to a free online Zoom event to launch the new Pathway model intervention service into Salford Royal NHS Foundation Trust.

Join us to hear directly from the staff who will deliver the service about their plans for the new team and what they hope the service will achieve for homeless patients in Salford.

The event will be opened by the Mayor of Salford, Paul Dennett and includes presentations from Salford Primary Care Together (SPCT) CEO Lance Gardner and Pathway CEO Alex Bax, among other speakers.

The event will:

  • Celebrate the work of the SPCT Inclusion Service during Covid-19
  • Highlight the work of local homelessness charity Salford Loaves and Fishes
  • Feature presentations from the established Bradford and Leeds Pathway teams
  • Include contributions from experts with lived experience, and poetry


Please join us next Wednesday for this exciting event.

Date: Weds 7th July

Time: 1pm-3pm


Meeting ID: 995 0552 7961
Passcode: 937445


Pathway joins with others condemning UK plans to remove rough sleepers


Pathway, along with Crisis, and over sixty other organisations supporting people facing homelessness across the UK, have released a joint statement condemning UK Government plans to use rough sleeping as grounds for removing someone from the country.

Home Office guidance published last month outlines that the policy should only be used in cases where someone has refused or disengaged with support and is engaged in persistent anti-social behaviour or other criminal activity.

Everyone in our society should have a safe place to live and no one should be punished for experiencing homelessness. We know that housing is a social determinant of health and people experiencing homelessness face extreme health inequalities.

Without secure accommodation, people experiencing homelessness, particularly those sleeping rough, often end up using hospital emergency departments, rather than trying to access primary care, and they are in fact six times more likely to attend hospital than the general population, more likely to be admitted, and have longer average stays due to multiple and complex needs.

Clinical staff often witness the devastating consequences of homelessness, yet strive to provide the best patient care to the most extremely vulnerable and socially excluded. These new rules could deter people from seeking help when they most need it. We need to work together to solve the impact of homelessness, once and for all.

Read the joint statement here.


Homeless hostels get valuable support from palliative care specialists






Palliative Care specialists bring support to hostels in new pilot project, helping staff to better assist patient choice in end-of-life care. 

The majority of deaths among people experiencing homelessness occur with little or no palliative care support. It often falls to frontline homeless hostel staff, who are not health or social care professionals, to support people with very complex needs who are extremely sick. People living in hostels are often referred to hospital rather than asked about their preferred place of care. This project has enabled hostels to better facilitate greater patient choice.

In the first undertaking of its kind, researchers at the Marie Curie Palliative Care department at UCL (University College London) and the homelessness charity Pathway, partnered four homeless hostels in London with palliative care specialists from St Christopher’s and St Joseph’s Hospices.

The palliative care specialists were trained in some of the unique complex issues affecting people experiencing homelessness to become homelessness champions. These champions then attended the hostels for a couple of days a month to provide support for staff and residents in facilitating access to palliative care and other key services for people with deteriorating health.

The Marie Curie Palliative Care UCL researchers provided in-reach support by helping hostel staff to:

  • identify palliative care needs
  • refer patients to dedicated palliative care teams and one-to-one health care provision
  • refer patients to other care professionals
  • provide specialist care equipment
  • advocate for social care
  • refer to high support nursing homes when necessary

“I’ve seen so many people die, so much of it over the last 19 years. We have been working in isolation for such a long time and people don’t really know how hard it is to work here.”Hostel staff 

At the beginning of the project, the champions underestimated the needs of people living in the hostels and were shocked by residents’ lack of access to care.

One of the champions from St Christopher’s reflected: 

“I felt confusion when I first went in. I was shocked at the high level of need at the hostel and how much the staff in the hostel were expected to do. There were residents with physical care needs, emotional care needs, mental health needs, financial needs, needing a collective cross agency approach but hostel staff were left to do it. I couldn’t get my head around it as it’s not a residential home it’s not a care provider, it’s a homeless hostel.” 

Some hostel workers were initially sceptical about the potential benefits of the partnership with the hospice.

A Service Manager from one of the hostels said: 

“I had pre-judgements about us allowing people to die within the service, as I was concerned about the impact it would have on staff. Now, I can’t see our homelessness champions not being part of our support network. We’ve gained so much knowledge and confidence, particularly in practical tools that we now regularly implement, such as monitoring our residents’ health and recording information. What we have learnt during the partnership is vital to the work that we do and the training we received has been invaluable.” 

This project has demonstrated how supportive this partnership has been for hostel staff and how isolated they had previously been when supporting residents with complex needs and advanced ill health. The collaboration has helped develop a person-centred approach to care and a recognition of when more health or social care input is needed. Hostel staff have been empowered by support from the champions. This has increased their knowledge and understanding about health and social care issues and rights, and has enabled them to advocate more effectively for what residents need.


Briony Hudson, Senior Research Manager at Marie Curie, said:  

“This research demonstrates one model of how palliative care professionals can support people experiencing homelessness in their local area by providing in-reach support to both staff and residents. By becoming a familiar face within the hostel, opportunities for engagement and developing the trusting relationships that are so important when supporting people who have experienced exclusion emerge. What was clear from this research is that supporting people with complex needs is not just a role for palliative care, but requires input from a range of professionals and services to truly be able to offer person centred care and support for people towards the end of their lives”. 


Caroline Shulman, General Practitioner in Homeless and Inclusion Health, Pathway research fellow and Honorary Senior Lecturer at UCL, said: 

“People residing in UK homeless hostels experience extremely high rates of ill health, with multiple complex needs, frailty and age-related conditions at a young age. However, they seldom receive palliative care with the burden of support often falling to hostel staff. This was why it was crucial we carried out this project, to try and get support for hostel staff and for residents with complex or advanced ill health. We are delighted with how input from the palliative care specialists from St Christopher’s and St Joseph’s hospices have enabled residents to receive a more person-centred approach to their care. Building on experience from the Covid-19 pandemic, we are now exploring how we can extend and enhance this work to include a remote platform for sharing learning, within a multi-professional group, to improve support for this marginalised group.” 

– ENDS      –


Homeless people die on average 30 years younger than people who are housed.  In 2019, the Office for National Statistics (ONS) reported that 778 people who were street homeless or in emergency shelters died in England and Wales with the mean age of death being 45.9 for men and 43.4 for women. This is more than 30 years younger than the general population.

While this project represents promising first steps in reducing inequity in palliative care access for people experiencing homelessness, there is a need for this marginalised group to have real and meaningful choice over the care they receive and where they receive it.

The research paper is now available to view on SAGE Journals here. The Oak Foundation funded this research.

For further information contact: 

Dr Caroline Shulman, General Practitioner in Homeless and Inclusion Health,

Dr Briony Hudson, Senior Research Manager,


Pathway is the UK’s leading homeless healthcare charity. Pathway works to improve the quality of healthcare homeless and excluded groups receive by developing and sharing best models of care like the Pathway hospital teams; increasing specialist skills of workers in healthcare; influencing policy; and reducing stigma in healthcare against people experiencing multiple exclusion.

The Marie Curie Palliative Care department at UCL works to develop and evaluate new ways of improving the care of people with terminal illnesses.

The Oak Foundation commits its resources to address issues of global, social and environmental concern, particularly those that have a major impact on the lives of the disadvantaged. With offices in Europe, India and North America, they make grants to organisations in approximately 40 countries worldwide.

Pathway response to the report of the Commission on Race and Ethnic Disparities


The Government’s recent report of the Commission on Race and Ethnic Disparities (CRED) suggested that structural racism in the UK does not exist. We are extremely disappointed that this report has sown more division in society rather than increased our shared understanding of the impact of racism.

It is unfortunate that the report failed to fully take note of all the compelling evidence that racial disparities, particularly in health, are very significantly driven by structural social and economic factors, which include racism.

Pathway fully supports The Runnymede Trust response and open letter on this report.

Read our full statement here.


Charities Crisis and Pathway to merge to better tackle homelessness and health inequalities

Pathway with Crisis logo

Under Embargo 00:01 Tuesday 9 March

Contact: Crisis media team on 020 7426 3880,, or 07973 372587 (out of hours)

Charities Crisis and Pathway to merge to better tackle homelessness and health inequalities


News has been welcomed by organisations from across the health and homelessness sector


The national homelessness charity Crisis and Pathway, the leading homeless healthcare charity, announce that they are to merge in a bid to tackle the stark health inequalities experienced by people who are homeless and ensure that the healthcare system plays its part in ending homelessness across Great Britain.


The merger, which will see the charities maintain their own operations and existing identities, will build on the existing collaboration between the two organisations and make them a stronger, more united voice in their mission to address the health and support needs of people experiencing homelessness.


The two charities are coming together at a time when the coronavirus pandemic has highlighted how essential it is that homelessness is seen as a public health issue. Meanwhile opportunities to resolve and prevent homelessness through the healthcare system are routinely missed. The most up to date figures for 19/20 show that 2,950 people were discharged from either a general or psychiatric hospital with no home to go to.


Pathway and Crisis will work together to ensure that the health service, through all its contacts with people experiencing homelessness, fulfils its potential in actively resolving homelessness. The two charities will continue to advocate for policy responses to homelessness that save lives, reduce health inequalities, and promote positive health outcomes for people who are homeless.


The merger, which has been approved by both Boards of Trustees, aims to:


  • Increase the number of dedicated hospital teams that work with patients who are homeless across the country, to ensure they receive better quality care and are not discharged from hospital into homelessness.
  • Work with the NHS and wider health and social care services to help them prevent homelessness through evidence-based programmes such as Housing First and Critical Time Interventions that will ensure people get the support they need to leave homelessness behind for good.
  • Campaign for the changes needed to save lives and demonstrate the positive health outcomes of immediate access to good quality emergency accommodation
  •    Fill in knowledge gaps in inclusion health and homelessness research, including how to improve services, narrow health inequalities, assess the impact of government policies and the solutions needed to end homelessness for good.

The services both charities provide will continue unchanged for the time being. Longer-term, the two charities will look to enrich their services by combining expertise – for instance, Pathway teams being in place where Crisis Skylight centres are based.


Jon Sparkes, Crisis Chief Executive said: “Having worked together successfully for many years, this merger is an exciting opportunity for both charities to combine our expertise, resources and voices at a time when people experiencing homelessness need us more than ever.


“The pandemic has further exposed how dangerous it can be for our health when we don’t have somewhere safe to call home, yet far too often people are discharged from hospitals with nowhere to go. We are determined to see this change and will be working together to ensure that the NHS and wider health and social care system plays its part in helping to achieve our shared goal of ending homelessness for good.”


Alex Bax, Pathway Chief Executive, said: “Pathway was founded on the belief that the NHS has a huge part to play in preventing and ending homelessness. By joining together with Crisis we will be able to do even more to support front-line NHS colleagues, build the skills and knowledge of NHS staff, and show how health, housing and care services working together is the best response to homelessness. Leading organisations from across the homelessness and health sector back our merger, believing it will bring real change to people facing homelessness now and in the future.


Richard Murray, Chief Executive of The King’s Fund said: “I am pleased to welcome this new relationship between Pathway and Crisis. Pathway have played such an important role in helping the NHS improve services for homeless people and bringing their skills and experience together with Crisis offers real opportunities to cement and extend their impact. This should be a win-win for both organisations and the people they serve.”


Lord Victor Adebowale, Chair, NHS Confederation said: “This is excellent news. Over the last ten years Pathway has built its credibility within the NHS, bringing the care and treatment of homeless patients into the spotlight and focussing attention on the most extreme health inequalities that we face. At the same time Crisis has built the evidence base to show how ending homelessness in the UK is achievable. I can see huge value now in the two charities working together, helping the NHS with practical service improvements for homeless patients, while campaigning for wider structural societal and system change.”


Professor Andrew Goddard, President of the Royal College of Physicians said: “The RCP welcomes the new partnership as Pathway has played a key role in putting the health of homeless people firmly on the agenda of the NHS. Crisis is to be commended for providing the stability that will make sure this work continues.

The impact of the pandemic on charities has been significant, but it is partnerships such as this that demonstrate our resilience. There are many things on which we can and should work together, while recognising each other’s independence. We have no doubt this new relationship will bear significant fruit.”



For further comment please email or call 0207 426 3880.

Notes to editor


Crisis and Pathway will remain two separate charities, operating in a group structure in which Pathway is a subsidiary of Crisis and Crisis is the sole Member of Pathway. In order to adopt this structure, Pathway has made amendments to its governing document which are being submitted to the Charity Commission review and approval. The new legal structure will formally come into place on the later of 1 July 2021, or the Charity Commission’s approval of the revised Pathway articles.

Homelessness data tables

Statutory homelessness: Detailed local authority-level tables 2019-20, Table A4P – Number of households owed a prevention duty by accommodation at time of application England, 2019-20 Financial Year.

About Crisis 

Crisis is the national charity for people who are homeless. We help people directly out of homelessness, and campaign for the social changes needed to solve it altogether. We know that together we can end homelessness.

About Pathway

Pathway is the UK’s leading homeless healthcare charity. We work with the NHS and other partners to create improved models of care for people experiencing homelessness. Our aim is to improve outcomes for homeless patients and help reduce health inequalities.


Hull Pathway Team Reduce Local Rough Sleeping by 77%

Hull city







The Bevan Healthcare Pathway team in Hull has dramatically improved both the health and housing outcomes for homeless patients. The team was commissioned by Hull Clinical Commissioning Group to deliver a local Pathway model of care and advocacy for homeless patients admitted to hospital.

Key achievements include:

  • Reduction of rough sleeping by 77% from 71 of the 235 referred patients to 16.
  • An 88% decrease in very unstable accommodation from 139 patients to 16.
  • 100% increase in stable accommodation to 182 patients from 91.
  • Improved community follow ups – the team have grown to see this as a central part of the support they provide.
  • Improved access to ongoing healthcare aided by updating of patient records (nearly half were found to be out of date or incorrect on admission) and registration of non-registered patients with a GP.
  • The team were also reported to have a positive impact on hospital culture and how staff interact with patients from vulnerable groups.

The Bevan Healthcare ‘Pathway’ team began work at Hull Royal Infirmary and Castle Hill hospitals on 1st October 2019. The team comprises a band 7 nurse, two GPs, two health support workers, a healthcare assistant and an advanced nurse practitioner. Over the course of the first year, 235 patients were referred by hospital staff and community services. Patients were assessed by the team for their physical, mental health, housing, safeguarding and social support needs in order to form a care plan and discharge pathways that prioritise the needs of the patient. The ethos of the team is to deliver this support using a sensitive, compassionate and motivational approach with equal priority given to housing as healthcare outcomes.

A report on the first year of operation demonstrates that in-hospital intervention and advocacy by a dedicated team of healthcare professionals has a positive impact on the lives of people living on the streets or in unstable accommodation. The report describes how such initiatives are a cost-effective way to reduce the cycle of readmission that sees people experiencing homelessness repeatedly in hospital, and so can in turn help to improve hospital capacity.

Pathway has developed an integrated in-hospital care model to address problems of poor morbidity and mortality outcomes and inadequate hospital discharge in people experiencing homelessness, people in prison, Gypsies, travellers and sex workers. The mean average age of death for men in these vulnerable groups is 45, for women it is 43.

The first year of the Hull team has been deemed a significant success and it has been recognised by homeless charity, Emmaus to who gave them an Award for Outstanding Contribution and The Queens Nursing Institute who published a Best practice / Innovation Case Study of the team’s work. As a result, the team have been asked to speak at the upcoming European Federation of National Organisations Working With the Homeless Conference. To read the full report click here.

New street outreach guidelines launched

Pathway and the Faculty for Homeless and Inclusion Health are pleased to endorse new street outreach guidelines launched today.

Street outreach brings health care directly to people who are sleeping rough. Standards published by the Faculty for Homeless and Inclusion Health states that specialist primary care services should provide street outreach. Although many homeless health services around the UK are providing street outreach, until this report, there had been no guidance detailing how to deliver this kind of care.

The aim of the guidelines is to assist services to plan new health related street outreach projects, or to review services’ existing outreach. Homeless health services cover a range of locations, and the demographics of people sleeping rough in these areas may differ widely. This outreach document is designed as a flexible tool for sharing best practice and innovative ideas, allowing services to use them as appropriate to their areas.

The street outreach guidance was led by Rosa Ungpakorn, Advanced Nurse Practitioner and the winner of the Advanced Nursing Practice category in the 2020 RCNi awards.

The guidelines bring together people with lived experience and clinicians, and can be found here: Street Outreach.

Homelessness Training for GP Receptionists

A young woman behind a GP receptionist desk, smiling and looking helpful.

A new homelessness training package for GP receptionists will be launched this week at Homelessness and Health, the annual international symposium of Pathway and the Faculty for Homeless and Inclusion Health.

Over 70% of people who are homeless have physical health problems. Many are wrongly turned away from surgeries at the front desk because they do not have proof of address. People who are homeless attend A&E five times more often than the general population.

Everyone in the UK has a right to register with a GP, and proof of address is not required. The new video and training package is based upon current NHS England Guidance.  It offers simple tips to support patients and shows how important a doctor can be for a person who has lost their home.

Pathway produced the package with Experts by Experience and actors from Cardboard Citizens, on behalf of the NHS Healthy London Partnership.

Click here to view the video and find out more