Health

Effectiveness and cost-effectiveness of 'Usual Care' versus 'Specialist Integrated Care': A comparative study of hospital discharge arrangements for homeless people in England

Purpose

To explore different types of specialist services for homeless people leaving hospital; for example, some put patients in touch with a specialist GP, others employ a housing support worker to ensure people do not return to the streets after discharge. We have explored what homeless people think of different services, how they help them tackle the range of problems they may have, and if this support prevents them returning to hospital. To compare effectiveness and costs we have also studied hospital discharge arrangements where no specialist support for homeless people is in place.

Timescale

2015 – 2019

Research Team

Michelle Cornes and Jill Manthorpe (HSCWRU); Martin Whiteford (University of Liverpool); Andrew Hayward, Rob Aldridge, Fatima Wurie (University College London); Michela Tinelli and Mike Clark (LSE); Graham Foster (Queen Mary’s); Jo Neale (King’s College London’s Institute of Psychiatry, Psychology & Neuroscience); Nigel Hewett (Pathway); James Fuller and Alan Kilmister (Peer Researchers)

Funding

National Institute for Health Research (NIHR) Health Services and Delivery Research

Methods

The first part of this research was a realist evaluation designed to generate six case studies exploring the differences between sites with access to specialist discharge schemes and those without. The second part assessed effectiveness and cost effectiveness in a further 14 sites. It explored how specialist discharge schemes impact on outcomes and patterns of service use across the system and the cost implications. This project has been methodologically innovative in its approaches to data linkage.

Findings

The study found evidence that specialist approaches to homeless hospital discharge are more effective and cost effective than standard care, and yet people are still being discharged from hospital to the streets.

See the #NIHRMakingADifference story: 'Specialist support for people who are homeless reduces emergency hospital readmissions' (16 January 2023)

Project team

Michael Clark

Associate Professorial Research Fellow, London School of Economics

Michelle Cornes

Visiting Professor

Jill Manthorpe

Professor of Social Work

Michela Tinelli

Assistant Professorial Research Fellow, London School of Economics

Publications

End-of-project report

October 2021: Cornes M, Aldridge RW, Biswell E, Byng R, Clark M, Foster G, et al. Improving care transfers for homeless patients after hospital discharge: a realist evaluation. Health Serv Deliv Res 2021;9(17).

June 2021: 'First Look' summary of final report.

Articles

Tinelli, M., Wittenberg, R., Cornes, M., Aldridge, R. W., Clark, M., Byng, R., Foster, G., Fuller, J., Hayward, A., Hewett, N., Kilmister, A., Manthorpe, J., Neale, J., Biswell, E., & Whiteford, M. (2022). The economic case for hospital discharge services for people experiencing homelessness in England: An in-depth analysis with different service configurations providing specialist care. Health & Social Care in the Community. https://doi.org/10.1111/hsc.14057

Aldridge, R. W., Menezes, D., Lewer, D., Cornes, M., Evans, H., Blackburn, R. M., Byng, R., Clark, M., Denaxas, S., Fuller, J., Hewett, N., Kilmister, A., Luchenski, S., Manthorpe, J., McKee, M., Neale, J., Story, A., Tinelli, M., Whiteford, M., ... Hayward, A. (2019). Causes of death among homeless people: A population-based cross-sectional study of linked hospitalisation and mortality data in england. [version 1; peer review: 2 approved]. Wellcome Open Research, 4(0), [49]. https://doi.org/10.12688/wellcomeopenres.15151.1

Cornes, M., Whiteford, M., Manthorpe, J., Neale, J., Byng, R., Hewett, N., Clark, M., Alan, K., J, F., Robert, A., & Michela, T. (2017) Improving Hospital Discharge Arrangements for People who are Homeless: A Realist Synthesis of the Intermediate Care Literature. Health and Social Care in the Community. https://doi.org/10.1111/hsc.12474

Earlier outputs

This project has produced a Support Tool with accompanying Briefing Notes: Transforming out-of-hospital care for people who are homeless.

Presentations

Michelle Cornes 28 February 2020 Presentation on homelessness and out of hospital care

Conferences

Strengthening Pathways Out of Hospital for People who are Homeless

Researchers worked with Pathway, the leading charity in this field, and colleagues from the Department of Health and Social Care (DHSC), Ministry of Housing, Communities and Local Government (MHCLG), NHS England, Public Health England, Local Government Association (LGA) and the Greater London Authority (GLA) to develop and deliver a range of national and regional impact activities. All involved ‘experts by experience’ and are co-produced with project partner Stan Burridge.

Events were held in early 2020 in Bristol, London, Newcastle and Birmingham. This programme was funded by King’s College London ESRC IAA Social Science Impact Fund.

London Champions

Principal Investigator Michelle Cornes secured Research England funding to use the learning from this project to support the development of step-down services across London. Events were held in the capital in January, February and March 2020.

Key project partners supporting this London Champions work alongside King’s are: Emma De Zoete (Public Health Consultant to the Greater London Authority); Jemma Gilbert, Director of Transformation at Healthy London Partnership; Gill Leng (Homeless Health Advisor to DHSC and MHCLG); Alex Bax, Chief Executive at Pathway, Stan Burridge, Director of Expert Focus and a group of Experts by Experience.