About the study

The Joint Principal Investigators of this project are Michelle Cornes (NIHR Policy Research Unit in Health and Social Care Workforce at King's) and Michela Tinelli (LSE).

In the photo above: members of the research team at the first project meeting, 21 October 2021, at the Virginia Woolf Building, King's College London. From left: Michela Tinelli, Jo Coombes, Michelle Cornes, Lizzie Biswell, Stan Burridge.

Aims

1. The overall aim of the evaluation is to capture the learning from test sites from the OOHCM programme and to evidence the outcomes that are being achieved.
2. Provide an understanding of the most effective way of implementing(scaling) out-of-hospital care across a wider range of areas – including how to shift to this position and the conditions needed to maximise the effectiveness and sustainability of the services.
3. Describe how models are being integrated into the evolving health, housing and social care system, supporting D2A (the new NHS hospital discharge operating model), the NHS Long-Term Plan and Covid Care/recovery.
4. Identify the challenges that remain to systems and service delivery that require changes outside the direct control of organisations in the locality.
5. Further test the key components of effective and cost-effective models especially where they have not previously been brought together into a single system.

Background

Research suggests that out-of-hospital care is effective and cost effective in supporting safe, timely transfers of care for patients who are homeless (Cornes et al., 2019 & 2021). At present, access to out-of-hospital care is limited or non-existent for people experiencing homelessness. In 2020, the Department of Health and Social Care, Ministry of Housing, Communities & Local Government and Ministry of Justice allocated £16 million through the shared outcomes fund to “roll-out” and robustly evaluate the Out-of-Hospital Care Model (OOHCM) for people who are homeless. In the same year, a new hospital discharge operating model Discharge to Assess (D2A) was implemented across England to meet the demands of the pandemic and increase in hospitalisations. A key objective of the OOHCM programme is aimed at exploring how support for homeless patients can be integrated as part of the new D2A operating model.

Methods

A mixed methods approach comprising four work packages:

• WP1: Basic Audit
• WP2: Study of Positive Practice
• WP3: Full Economic Evaluation
• WP4: Discrete Choice Experiment User Preference

People with lived experience will be actively involved in all aspects of the evaluation as specialist advisors and peer researchers.

Funding

Department of Health and Social Care

Timescale

September 2021 – August 2023

Further reading

Read the guidance published by the King's Team and partners for the LGA and ADASS on Home First: Discharge to Assess and Homelessness (March 2023).

Our research has been cited (p. 26) in the NHS England guidance: Intermediate care framework for rehabilitation, reablement and recovery following hospital discharge (September 2023).

And see: National framework for NHS – action on inclusion health (October 2023).

Further information

The page for this project on the LSE website carries much more information and access to the beta dashboards. And see this blog by Michela Tinelli on the NIHR School for Social Care Research website (14 Dec 2023) and the news item about Michela's webinar (14 Dec 2023) for the King's Homelessness series, a recording of which is available.

See also our earlier project

Effectiveness and cost-effectiveness of 'Usual Care' versus 'Specialist Integrated Care': A comparative study of hospital discharge arrangements for homeless people in England (2015-2019)