As the UK’s largest homeless health charity, Pathway carries out a range of research to evidence the impact of our own work, and to explore the relationships between homelessness, health and health services.
Click any of the links below to be taken directly to that report.
- The role of nurses in homeless hospital discharge
- North Central London Homeless Medical Respite Needs Assessment
- How to do a needs assessment for a medical respite service
- Royal Perth Hospital Homeless Team - A Report on the First 18 Months of Operation
- Positive Outcomes for Homeless Patients in UCLH Pathway Programme
- Improving Digital Health Access for Excluded Groups
- End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care
- Digital Health Inclusion for People Who Have Experienced Homelessness – a realistic aspiration?
- Expert by Experience Involvement Handbook
- Piloting a Medical Respite Service for Homeless Patients at University College London Hospitals
- Summary Report: Piloting a Medical Respite Service for Homeless Patients at University College London Hospitals
- Homeless Medical Respite in the UK: A Needs Assessment for South London
- Randomised controlled trial of GP-led in-hospital management of homeless people (‘Pathway’)
- Supporting Employee Driven Innovation in Healthcare
- A Summary of Options for Delivery of Homeless ‘Medical Respite’ Services
- Options for Delivery of Homeless ‘Medical Respite’ Services - A Scoping Paper
- Integrating Health Care For Homeless People: Experiences of the KHP Pathway Homeless Team
- KHP Pathway Homeless Team - first year report, 2014
- North Middlesex University Hospital
- MPATH Homeless Inclusion Pathway Team - The first six months report
- Closing the Gap Through Changing Relationships
- KHP Pathway Homeless Team- Pilot project Jan-Mar 2014
- Kings Health Partners and the Impact of Homelessness
- Integrated Care for Homeless People
- Improving Dental Services for Homeless People: A summary of findings from exploratory research
- Pathway Medical Respite for Homeless People
- Improving Hospital Care for Homeless People
- Homelessness Needs Assessment - Brighton and Sussex University Hospital
- Pathway Needs Assessment for the Royal London Hospital
- Homeless Care at University College London Hospital Trust
- Standards for Commissioners and Service providers
- A report on the first 12 months of service development
- Healthcare for Single Homeless People
- Initial evaluation of the London Pathway at University College Hospital, January 2010
- Editorial on homeless healthcare, Journal of the Royal Society of Medicine, August 2010
- Feasibility study for medical respite centre for homeless patients, June 2012
- Good Practice Guide – Psychologically Informed Services for Homeless People
- Improving hospital admission and discharge for people who are homeless
- Pathway Medical Respite Centre, Feasibility Study, Advisory Panel Response
- Integrated Care
The role of nurses in homeless hospital discharge
Findings from Pathway’s research, courtesy of a 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.
North Central London Homeless Medical Respite Needs Assessment
This needs assessment report highlights the pressing need for intermediate step down care for homeless patients in the North Central London. It highlights the extent of homelessness in this part of London and the extent of A&E attendances and hospital admissions across one mental health Trust all the main acute Trusts. It considers the different ways patients can be supported through medical respite services, with examples from two existing services.
How to do a needs assessment for a medical respite service
Pathway has helped to support a number of medical respite services. This document outlines the process required to carry out a needs assessment for medical respite provision. Pathway can provide consultation and support in this area, details are provided within the document.
Royal Perth Hospital Homeless Team - A Report on the First 18 Months of Operation
The Royal Perth Homeless Team commenced in July 2016, as a collaboration between Royal Perth Hospital and the Homeless Healthcare General Practice. The core aim of the team is to improve outcomes for homeless patients by supporting them through their time in hospital, improving discharge planning and continuity of care and linking them with community-based services to address their underlying health and psychosocial needs.
The Team is modelled on the Pathway model of hospital homeless healthcare, adapted to the Perth homelessness and health sector context. This report examines the baseline health and psychosocial profiles of patients supported by the team, and describes the model of care, patient flow and patterns of contact with community-based support services over the first 18 months of operation.
Positive Outcomes for Homeless Patients in UCLH Pathway Programme
This report, originally published in the British Journal of Healthcare Management details the findings of an audit of homeless patients at University College Hospital London, supported by the Pathway specialist homelessness team. The audit explores whether patients experienced any reduction in A&E presentation, admission or bed days following Pathway care, and the factors that may have contributed to this. Reductions between 38–78% were seen in these parameters, long-distance repatriation, food and clothing donation and accommodation arrangements were likely to have played a role.
Improving Digital Health Access for Excluded Groups
This research, originally published in The British Journal of Healthcare Management reports the findings of a 100 person survey and focus groups on digital access and inclusion, carried out in day centres and hostels. It highlights the wide range of digital experiences and skills that people who are, or who have been, homeless have, with some respondents never having used the internet, and others making use of online services every day. The work goes on to explore the potential and actualised impacts of digital health inclusion for this group, and makes recommendations for future work.
End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care
This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues.
Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.
Digital Health Inclusion for People Who Have Experienced Homelessness – a realistic aspiration?
This small study examines the potential for people experiencing homelessness to engage with digital health applications, and the support required in order for them to do so.
The research, led by a specialist homelessness nurse and a number of Experts by Experience, found that people who are homeless faced issues including not having appropriate devices to access the internet, having insufficient data allowances, being unable to obtain data contracts and issues with access to public wifi.
Expert by Experience Involvement Handbook
Pathway involves people with lived experience of exclusion in every aspect of charity work. This handbook, produced with support from Frontera and Public Health England, sets out a simple guide to Pathway’s approach to including Experts by Experience.
Piloting a Medical Respite Service for Homeless Patients at University College London Hospitals
A report detailing a year-long pilot project run by Pathway and UCLH, implementing homeless medical respite services at one of the UK’s busiest homelessness teams.
‘Pathway2Home’ offered homeless patients needing time to recover after treatment a stay in a medically supported hostel environment.
The service faced a number of practical and financial challenges, but was able to provide incredibly valuable support to patients. This report explores the problems the service faced, including issues around premises, staffing, demonstrating cost effectiveness, off-site methadone prescribing, risk assessment and safety issues.
The report is accompanied by a quick read summary.
Summary Report: Piloting a Medical Respite Service for Homeless Patients at University College London Hospitals
A summary report, detailing the challenges faced by a year-long respite care project for homeless patients at a central London hospital.
Homeless Medical Respite in the UK: A Needs Assessment for South London
This paper (originally published in The British Journal of Healthcare Management 22(8): 405-413) explores the provision of specialist short-stay accommodation for homeless patients who might benefit from additional care following illness or injury. In some cases without this extra care the initial clinical intervention would be wasted and/or the patient won’t have a chance to recover.
This paper considers a range of models of care currently in use across the UK, highlighting their strengths and weaknesses in relation to their possible application in south London, where Pathway KHP, the UK’s largest hospital homelessness team, operates.
Randomised controlled trial of GP-led in-hospital management of homeless people (‘Pathway’)
Homeless people have complex problems, a Pathway model service can help to manage these. In this paper, published by Clinical Medicine, The Journal of the Royal College of Physicians, we performed a randomised, parallel arm trial at two large inner city hospitals. The outcomes demonstrated improved quality of life, reduced street homelessness and a cost effective intervention.
Supporting Employee Driven Innovation in Healthcare
This research briefing from University of Southampton, LLAKES, UCL Institute of Education and the ESRC reviews employee driven innovation within the NHS, citing Pathway and mpath – a Pathway modelled team in Manchester as examples.
A Summary of Options for Delivery of Homeless ‘Medical Respite’ Services
Homeless medical respite services provide ‘step up’ and ‘step down’ bedspaces for homeless patients requiring additional care, potentially reducing bed days and decreasing the risk of readmission.
This Executive Summary offers the headline findings of our scoping paper.
Options for Delivery of Homeless ‘Medical Respite’ Services - A Scoping Paper
Homeless medical respite services provide ‘step up’ and ‘step down’ bedspaces for homeless patients requiring additional care, potentially reducing bed days and decreasing the risk of readmission.
This scoping paper reviews a number of models of respite care currently in operation across England, considers their relative merits and recounts views of service providers and formerly homeless people (Experts by Experience) in the provision of respite care.
Integrating Health Care For Homeless People: Experiences of the KHP Pathway Homeless Team
Kings’s Health Partners Pathway Team operates across 4 sites, supporting over 1000 patients per year. This article (which originally appeared in The British Journal of Healthcare Management 22(4): 215–224) examines the staffing mechanisms of the team, the practicalities of integrated work, implementation of a frequent attenders forum, the use of peer advocacy and improved patient outcomes.
KHP Pathway Homeless Team - first year report, 2014
We are delighted to publish the Pathway Kings Health Partners team’s first full year report, covering the year 2014. The Kings Health Partner’s team is the largest Pathway team in the country. This report presents a wide range of material about their first full year’s work. It includes some very powerful case studies that illustrate the complex challenges faced by specialist homelessness hospital teams and their patients. It also shows just how many different partner agencies a Pathway team needs to work with in order to improve outcomes for some of the NHS’s most vulnerable and needy patients.
Pathway believes that St Thomas’ hospital is the leading provider in the country of unscheduled care to homeless patients in the UK (and possibly in Europe) and this report presents lots of learning for colleagues working in other NHS Trusts across right across the UK.
North Middlesex University Hospital
A small Pathway team conducted 6 months of action research at North Middlesex Hospital to investigate the best way of improving health care for homeless people in the hospital. Their findings are helping to refine a definition of a range of services which might be recommended as appropriate to different levels of local need.
MPATH Homeless Inclusion Pathway Team - The first six months report
MPath is a Pathway hospital service based in Manchester with strong links to local inclusion health Primary Care services. This report documents a 6 month pilot of the service in a hospital setting.
Closing the Gap Through Changing Relationships
The Health Foundation has published the final independent evaluation report of their ‘Closing the Gap through Changing Relationships’ programme. The development of Pathway’s first team in UCH benefitted hugely from participating in this two year Health Foundation from 2011-13. This substantial report re-emphasises just how important good quality relationships are to the business of improving the quality of patient care.
KHP Pathway Homeless Team- Pilot project Jan-Mar 2014
A multi-disciplinary team conducted a 3 month care coordination pilot encompassing 2 trusts and 4 sites in South London. This report reviews the pilot and makes recommendations for the development of the service.
Kings Health Partners and the Impact of Homelessness
This comprehensive needs assessment of homeless people’s secondary care usage across Guy’s and St Thomas’, Kings College and South London and the Maudsley NHS Trusts was finalised in autumn 2013. Written by Dr Nigel Hewett and Nurse Practitioner Samantha Dorney-Smith it includes data on homeless admissions and A&E attendances. It also contains data from other hospitals Pathway has worked with, and detailed proposals for the design of an integrated Pathway team to serve homeless patients in the three hospitals.
Integrated Care for Homeless People
An editorial in the British Journal of Hospital Medicine, written by Pathway’s medical director Dr Nigel Hewett, Chairman, Professor Aidan Halligan, and Chief Executive, Alex Bax.
The editorial suggests that the care of homeless people in hospital is an ‘acid test’ for the whole system. Homeless patients often have multiple health problems that challenge clinical boundaries, and almost by definition they will bring a whole collection of social problems with them to hospital. Pathway’s model of dedicated homeless teams based in hospitals brings integration to secondary care.
Improving Dental Services for Homeless People: A summary of findings from exploratory research
This EbE led field research reviews the dental experiences of more than 150 homeless, former homeless and vulnerably housed people and highlights barriers to access to dental care. This work was carried out in conjunction with Eastman Dental Hospital.
Pathway Medical Respite for Homeless People
This report describes specialist medical respite provision for homeless patients. It sets out the standards such service should meet, and how patient flows from hospitals should be managed. It should be read alongside the Faculty for Homeless Health’s general service standards document and Pathway’s ‘prospectus’ for medical respite published in May 2012.
Improving Hospital Care for Homeless People
A general practitioner and nurse led approach to improving hospital care for homeless people. Paper by Aidan Halligan, Nigel Hewett and Trudy Boyce, published in the BMJ.
Homelessness Needs Assessment - Brighton and Sussex University Hospital
The document presents the results of a review of data relating to numbers of admissions of homeless patients to the hospital, and recommendations for the establishment of a Pathway homeless team in the hospital.
Pathway Needs Assessment for the Royal London Hospital
This report investigates a homelessness needs assessment at the Royal London Hospital. It reviews the number of homeless people attending the hospital and makes recommendations for how a better care co-ordination approach could be implemented. This study was funded by Barts and the London NHS Trust and the work was made possible by a grant to Pathway from the Health Foundation. The study would not have been possible without the participation and support of staff across the hospital and in the London Borough of Tower Hamlets.
Homeless Care at University College London Hospital Trust
Porter, M. & Shand, S. University of London College Hospital Trust: Homeless Care; Harvard Business School/UCL Partners ‘case’ paper presented at ‘Value in Healthcare Delivery’, London, June 2011.
Standards for Commissioners and Service providers
This is the first comprehensive set of standards for health services for homeless people. London Pathway is publishing this document in partnership with the Faculty for Homeless Health. This is version one of a document we expect to expand and be amended over time. Comments on the document are welcome. For help and support implementing the Standards please contact us via the email address under the ‘Contact Us’ button above.
A report on the first 12 months of service development
This report presents a review of the first twelve months of the developing London Pathway service running in University College Hospital, London. It includes individual case histories, new data on the costs of treating homeless patients, and presents the London Pathway’s model of health services for homeless people.
Healthcare for Single Homeless People
This report (from the Office of the Chief Analyst at the Department of Health) presents an analysis of the health needs and relative healthcare costs associated with people who are homeless or living in certain types of insecure or short term accommodation. It is a very useful overall summary. This report supported the development of Pathway.
Initial evaluation of the London Pathway at University College Hospital, January 2010
The development and evaluation of this service for homeless patients at University College Hospital was funded by UCLH Charity, NHS Camden and NHS Westminster.
Editorial on homeless healthcare, Journal of the Royal Society of Medicine, August 2010
Chronic homelessness is a red flag symptom, marking a significantly increased risk of ill-health and premature death. For too long the NHS has dismissed homelessness as simply an issue of housing and social care, but there is a growing body of evidence that long-term homelessness is fundamentally an issue of health.
Feasibility study for medical respite centre for homeless patients, June 2012
Produced by Pathway in partnership with UCL/Bartlett School of Architecture and the Built Environment and Earth Regeneneration.
Good Practice Guide – Psychologically Informed Services for Homeless People
Pathway, CQC, College of Medicine, Homeless Healthcare CIC, Department of Communities and Local Government.
A comprehensive introduction to the concept of Psychologically Informed Environments, and good practice guidance, produced by a range of leading homeless and health agencies.
Improving hospital admission and discharge for people who are homeless
May 2012, St Mungo’s and Homeless Link. This reports assesses current good practice and makes recommendations for improvements to NHS services. It identifies the Pathway service as particular example of good practice.
Pathway Medical Respite Centre, Feasibility Study, Advisory Panel Response
We are pleased to publish this short report by Stan Burridge presenting the results of six weeks research with people who have current and former experience of homelessness. We set two objectives for this project. First, we wanted to find out what homeless people thought of the idea of specialist homeless medical respite centres, what homeless people thought they should be like, and to gather some initial views on how they should run. And second, we asked Stan to use the research process to identify and if possible convene a core group of people with personal experience of homelessness who might be interested in helping us shape the development of the first respite centre: to become an initial homeless advisory board for the project. This report fully meets the two objectives we set. It makes eleven clear recommendations about how to continue to involve homeless people in the project.