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Effectiveness and Cost-effectiveness of 'Usual Care' versus 'Specialist Integrated Care': A Comparative Study of Hospital Discharge Arrangements for Homeless People in England

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 evaluationHealth Serv Deliv Res 2021;9(17).

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

Earlier outputs:

This project has produced a Support Tool with accompanying Briefing Notes: Transforming out-of-hospital care for people who are homeless. See also one page summary sheet with a focus on safeguarding. 

Strengthening Pathways

A follow-on initiative comprising five regional events in early 2020 aims to accelerate the impact and reach of this study's findings. All presentations from these events are on the project page.

London Champions

Principal Investigator Michelle Cornes also secured Research England funding to use the learning from this research to support the development of step-down services across London

‘Duty to refer’ in hospitals: working with experts by experience

Michelle Cornes and Jess Harris, working with Stan Burridge, Expert by Experience and Director of Expert Voice, have been awarded National Lottery funding to take the messages from the Unit’s Homeless Hospital Discharge study out to hospital staff, working with a group of people with lived experiences of homelessness who will talk about their experiences of being discharged to the street.

Related work

Dr Michelle Cornes has recently begun a new project examining the topic of self-neglect and people who are homeless. In autumn 2019, Michelle  co-authored a report analysing Safeguarding Adults Reviews where homelessness was a factor.


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 be discharged from hospital to the streets.


Improving Hospital Discharge for People who are Homeless. Findings from NIHR Research & Practice

Slides, including emerging findings from this study, were presented at the end of award event held in Bradford, 25 September 2019. The meeting was chaired by Gill Leng (Health Advisor, MHCLG & DHSC)

Delivering Safe, Timely Transfers of Care for All Patients – Victoria Bennett (National Programme Manager for Delayed Transfers of Care, NHS England & Improvement)

How Sick are Homeless Patients? Rob Aldridge & Dee Menezes (University College London) 

Discharged to the Street - Jo Coombes and Darren O’Shea (Experts by Experience) with Elizabeth Biswell (Research Nurse, Northamptonshire NHS Foundation Trust) 

What Works? Key Messages for Policy Makers and Commissioners - Michelle Cornes (King's College London), Michela Tinelli (London School of Economics) & Rob Aldridge (University College London)

The Bradford Out of Hospital Care System: Integrating Pathway Teams and Specialist Intermediate Care – Gina Rowlands (Bevan Healthcare), Helen Phelan (Bradford Pathway Team) and Sue Atkinson (Horton Services Director)

Palliative Care in Intermediate Care – Sarah Holmes (Medical Director, Marie Curie Hospice Bradford)

Outputs and Impact

The Support Tool and accompanying Briefing Notes were launched at a national conference in Bradford in September 2019 and the full project report will be published 2020. A series of presentations to different policy and practitioner audiences are underway. The project has already been instrumental in shaping national policy and generating interest in and the commissioning of homeless hospital discharge schemes.

Cornes, M., Aldridge, R., Tinelli, M., Whiteford, M., Hewett, N., Clark, M., ... O'Shea, D. (2019). Transforming out-of-hospital care for people who are homeless. Support Tool & Briefing Notes: complementing the High Impact Change Model for transfers between hospital and home. London: NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King's College London. 

Whiteford, M. et al. (2016) Caring in hard times: A critical appraisal of the role of hospital discharge arrangements in preventing homelessness in England, European Network for Housing Research, Belfast, 28th June – 1st July

Cornes, M. et al. (2016) Effectiveness and Cost-effectiveness of ‘Usual Care’ versus ‘Specialist Integrated Care’: A Comparative Study of Hospital Discharge Arrangements for Homeless People in England. Regional Events: London 18th & 20th January 2016; Liverpool 11th January 2016; Crewe 10th February 2016; Cumbria (GP Forum) 23rd February.


Dr Michelle Cornes.

Chief Investigator

Social Care Workforce Research Unit

King’s College London

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