UCH Homeless Response

March 2009 Update

Background

 

D

uring 2008, Professor Aidan Halligan, Director of Education at University College London Hospitals, became aware of problems surrounding the treatment of homeless patients at UCLH. Until recently, secondary care has largely been blind to the problem of homelessness, the essential failure of understanding is to consider chronic homeless as a diagnosis rather than as a symptom. If homelessness is seen as the final diagnosis then the treatment is housing which is not the responsibility of secondary care. But if chronic homelessness is recognised as a “red flag” symptom of tri-morbidity, then there is an obligation to investigate the full extent of physical ill health with mental ill health and substance misuse, which often contribute to chronic homelessness, and to provide an appropriate response to all of these conditions.

The Response

Three themes are being developed: Care Navigators with an experience of homelessness, a regular ward round in UCLH focusing on the needs of homeless people, and developing an intermediate care “super-hostel” in the community Significant progress has been made against these themes, but in the course of the development of these ideas, the potential scope of the project has widened considerably with the need to integrate a clinical model, with a social care model and a financial model.

The Future

It is increasingly acknowledged that current approaches to the health care of homeless people result in considerable secondary care expenditure (in the UK 7-8 times the costs of housed patients) with no apparent impact on an average age of death of 41.

UCLH is planning to pioneer a perfect partner organisation to the NHS (modelled on Macmillan cancer care), that would provide intensive medical support to chronic homeless patients in the hospital, in the hostels and on the streets by making better use of funding currently expended on prolonged and repeated hospital admissions.

People with an experience of homelessness will be involved at all levels of delivery from the Board to the front line.

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