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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

Purpose

To explore specialist services set up to improve homeless people’s experiences of leaving hospital. It is investigating different types of services; for example, some put patients in touch with a specially trained GP, others might employ a housing support worker to ensure people do not return to living on the streets after hospital discharge. We want to know what homeless people think of specialist 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 will also study hospital discharge arrangements where no specialist support for homeless people is in place.

Timescale

2015 – 2019

Research Team

Michelle Cornes and Jill Manthorpe (SCWRU); 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

This research has two parts. The first is 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 will assess effectiveness and cost effectiveness in a further 14 sites. It will explore how specialist discharge schemes impact on outcomes and patterns of service use across the whole system (e.g. use of unplanned care) and the cost implications of this. This is methodologically innovative in its use of new approaches to data linkage.

BRADFORD CONFERENCE

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

Reports, articles and presentations to different audiences are planned, with two published in 2017. The study will provide practical evidence for commissioners interested in developing hospital discharge schemes for homeless people and the workforces involved.

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.

Contact:

Dr Michelle Cornes.

Chief Investigator

Social Care Workforce Research Unit

King’s College London

Michelle.Cornes@kcl.ac.uk

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