Pathway welcomes ‘game-changing’ NICE guideline on care for people experiencing homelessness


Immediate release

16th March 2022 

 
Pathway welcomes the National Institute for Health and Care Excellence’s (NICE) first ever guideline on integrated health and social care for people experiencing homelessness. Pathway has long advocated for multi-disciplinary responses to the complex health needs of people experiencing homelessness, who are at the sharp end of our nation’s health inequalities 

 

Pathway has a significant track record in implementing expert multi-disciplinary support in hospital settings for patients experiencing homelessness, and we are pleased to see NICE’s support for this approach.  
 

This new guideline comes at a crucial time in health and social care reform. The Government’s emphasis on health inequalities shows the importance of improving the health of those who have been least well served. This guideline will support the implementation of the Core20PLUS5 principles in Integrated Care Systems, giving clinicians and commissioners a clear, practical guide to meeting the needs of people experiencing homelessness.  
  

The new NICE guideline recognises the value in addressing the social determinants of health and multi-morbidity through poverty/trauma informed care, multi-disciplinary working, building cultural competences, and the requirement of services to always consider safeguarding risks and individuals’ mental capacity. Also, significant, and in alignment with Pathway’s view, is the acknowledgment that much more needs to be done to meet the palliative care needs of those experiencing homelessness who are reaching the end of their lives. The proposal of wraparound health and social care support that sensitively responds to patients’ palliative care and wider long-term support needs is vital. 

 

Pathway Chief Executive Alex Bax said: 

This new guidance should be a game-changer in the lives of homeless patients. We are delighted that NICE recognises that more effort and targeted health and care provision is needed for those experiencing homeless and social exclusion, across primary and secondary care; over the short and long term; taking into account addictions, mental health and palliative care support; and working within NHS structures as well as through outreach teams. This acknowledges the multiple and complex needs of people experiencing homelessness and the range of integrated services needed to support the most vulnerable in our society. 

 

Pathway’s model of creating specialist multi-disciplinary teams to support people experiencing homelessness in hospital is fully aligned with the new guidance (i)We were pleased that the NICE Committee accepted the evidence we submitted (ii) and the fact that our model is highlighted in the NHS Long Term Plan (iii)Through our national Partnership Programme, we will continue to work with NHS partners, doing all that we can to support them to comply with the new guidance issued today and improve health and care outcomes for those who need us most.” 
 

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

We first published our set of inclusion health standards in 2011 with the primary aim of reaffirming the fundamental rights of all people to be treated with dignity, compassion and respect. At the sharp end of health inequalities, homelessness and other expressions of social exclusion are associated with extremely high healthcare costs coupled with appalling outcomes – we must and can to do better than this. These NICE guidelines have the potential to bring the whole NHS into alignment with the values and standards of the Faculty for Homeless and Inclusion Health and deliver better health outcomes for those in most need. 

 

NICE’s guideline is published as clinicians and practitioners from across the inclusion health community meet this week at Pathway’s 10th annual symposium. The conference includes keynote addresses from the Mayor of Greater Manchester Andy Burnhamhealth and government advisor Professor Dame Carol Black, and social policy advocate Dame Julia Unwin. 

 

ENDS 

____________________ 

 
Notes to editors 

For more information contact: Eva Morrison, Pathway Communications Lead, on eva.morrison@pathway.org.uk 

 

Pathway’s 10th annual symposium on inclusion health PATHWAYS FROM HOMELESSNESS 2022 takes place in Manchester, on Wednesday 16 March, at King’s House Conference Centre, 49-51 Sidney St, Manchester M1 7HB; and in London, on Thursday 17 March, at the Royal National Hotel, Bedford Row, 38-51 Bedford Way, London WC1H 0DG. 

 

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. 

 

The Faculty for Homeless and Inclusion Health is an inclusive membership organisation for people involved in healthcare for excluded groups. Membership is open to nurses, doctors, allied medical professionals, social workers, public health experts, health advocates and support workers, commissioners, researchers and people with a lived experience of exclusion. Our aim is to improve the quality of healthcare for people experiencing homelessness and other excluded groups. The Faculty is hosted by Pathway. 

 

Pathway Partnership Programme offers a defined, not-for-profit method to replicate and scale proven interventions, partnering with NHS organisations to deliver health care to quality standards. Pathway’s Partnership approach aims to increase the adoption of the Pathway hospital team model nationally by making it as easy as possible for local NHS service providers to adopt the model. It also ensures Pathway’s growing body of knowledge and expertise can be made available across the NHS. 

 

NICE is the National Institute for Health and Care Excellence. NICE’s role is to improve outcomes for people using the NHS and other public health and social care services by: Producing evidence-based guidance and advice for health, public health and social care practitioners; Developing quality standards and performance metrics for those providing and commissioning health, public health and social care services; Providing a range of information services for commissioners, practitioners and managers across health and social care. 

Further reading 

  1. Hewett 2016 

  2. Khan 2020 

  3. p42 NHS Long Term Plan 2019 

 

 

Pathway model case study 

Inclusion Health: outreach, in-reach, and community support 

The Pathway charity works with the NHS to help spread and develop its successful model of enhanced care coordination for people who are homeless and other excluded groups. 

Pathway developed the Pathway Partnership Programme to systematically partner with more providers to deliver high quality care to the people who need it most. 

Pathway’s work in Bradford, Brighton and at the Royal London, illustrate the ideal package of support across primary and secondary care for the most vulnerable patients. In these locations the Pathway team in the hospital consists of a GP, Nurse, OT/Social Worker, Housing Worker and Peer support. 

The Pathway team is based in the hospital, and can accept referrals directly via outreach and community services as well as hospital departments. Patients are then assessed in hospital for their healthcare needs by the Pathway team. Whilst in hospital, the patient is then registered with local a GP, and any addiction or mental health challenges are also addressed and their housing needs supported. The Pathway team hold weekly multi-disciplinary team meetings to discuss each patient with all partner organisations. On discharge from hospital, the Pathway team continue patient follow-up with community liaison – be that respite care if needed or straight into housing/GP support. 

Pathway is commissioned and works in partnership with the NHS, other health and social care organisations, and local authorities to help deliver quality care to marginalised patients. In Bradford Pathway also works with Bevan Healthcare and Horton Housing; in Brighton Pathway works with Arch Healthcare and Juslife; and, at the Royal London, Pathway works with Health E1, Providence Row, Thames Reach and the Peabody Trust. 

 

 

Pathway patient case study 

Adam is in his 30s. He has been known to the local Housing and mental health team over the last five years and had experienced homelessness due to his excessive alcohol use in an attempt to numb child and adulthood traumas.  

When the Inclusion Pathways team met Adam, he had presented in A&E after spending some time out of area. He had disengaged from services, stopped his medications and was involved in a relationship which he described as toxic.  

Adam presented tearful, unkempt and covered in bruises, he stated he was “desperate for help” and that his drinking was “ruining his life.” “I had to leave the flat I was living in and was told I could not be housed as I had no local connection, I used the last of my money to get a train to visit my sister. I knew I could not stay with her for long because of her children, it would not be fair – I needed to stop drinking but I was scared.”  

Adam told the team he had children who he had lost contact with and had increased his drinking to roughly 1L of spirits a day since leaving the army, 4 years ago. He wanted to detox but had had a seizure the last time he tried. He agreed to accept support from the Pathway team upon discharge but did not have a phone; he consented to the team making contact with his sister and providing her with a phone for him.  

The team advocated for Adam with hospital staff and encouraged him to stay in A&E to be assessed. After spending some time on the hospital Medical Emergency Unit, he was transferred to a Rapid Access Detox Acute Referral bed at a local detox unit. The aim of the Service is to provide quick access for patients from acute hospitals presenting with alcohol dependence or acute alcohol withdrawals who would otherwise require admission to an acute hospital bed.  

In the meantime, the team contacted the local Housing team to make an application for accommodation. Adam was able to return to his property that he occupied before leaving the area and was linked back up with his supported tenancies worker who specialises in supporting veterans.  

From the Detox unit, Adam made contact with the team to check in and organise support upon discharge, he was registered with the Inclusion GP service to promote wrap around care, and during the weekly MDT he was discussed with the local Drugs and Alcohol Community team who agreed to provide Outreach support upon discharge. Weekly reviews allowed the team to monitor Adam’s progress and support as and when needed.  

Adam finds working with the Community Drugs and Alcohol team difficult and he is also finding it hard to budget to meet his basic day-to day needs but the team are on call to provide regular support to help him maintain the progress made. He has abstained from alcohol since his detox. During the team’s last call, he shared that he had accepted a full-time job which he is looking forward to starting to keep him busy. His long-term plan is to reconnect with his children once he is more settled; he said he feels like to he is on the road to a good place.