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Effectiveness and cost-effectiveness of 'Usual Care' versus 'Specialist Integrated Care'

Graphic showing concentric circles

A comparative study of hospital discharge arrangements for homeless people in England


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.


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)


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


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.


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.


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

9 October 2023: 'A national framework for NHS – action on inclusion health' from NHS England cites this study (specifically the economic analysis by Michela Tinelli et al., 2022) under the sub-head, Benefits of improved pathways.

See also

Evaluation of the Out-of-Hospital Care Models programme for people experiencing homelessness (2021-2023)

Project status: Completed