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Integrated care key to improving health of homeless

Numbers rising amid widespread cuts to homelessness services

Caroline White

Monday, 02 July 2012

Integrated care will be key to improving the health outcomes of the homeless, numbers of whom have been rising since 2009 after several years of decline, says a new report published today by the Deloitte Centre for Health Solutions.

Half of homeless services have experienced funding cuts, and there are an estimated 2000 rough sleepers and nearly 50,000 people living in hostels, says the report.

Healthcare for the Homeless points out that the health problems of the homeless are often complex, and frequently underserved because this group don’t or can’t access health services and frequently have chaotic lifestyles.

They are six times as likely to seek emergency care as the general population and their hospital stays are likely to be three times as long, with the average cost of hospital services for a single homeless person four times higher (£2,115 vs £525).

The total cost of hospital use by the homeless is conservatively estimated to be £85 million. A further major challenge is caring for the homeless once they leave hospital. All of which points to the need for an integrated health and social care approach, says the report.

It emphasises that under the terms of Health and Social Care Act, there will be a statutory duty of care for Clinical Commissioning Groups to narrow health inequalities and to commission services for all those within their geographical area, regardless of whether they are registered or not.

The report outlines good practice from several charitable organisations, including the London Pathway, Queen’s Nursing Institute and St Mungo’s, which have attempted to address the complex health challenges of the single homeless, and attempts to identify practical solutions healthcare commissioners and providers might wish to consider. 

The report calls on the nascent NHS Commissioning Board to issue guidance for CCGs on commissioning for this vulnerable and disenfranchised group, and it urges CCGs to work with housing and voluntary sector services to commission appropriate services.

It recommends the establishment of formal networks of all the relevant stakeholders to provide integrated care, and suggests that CCGs should adopt a standardised flag system.

Statutory and voluntary healthcare providers should collect solid and timely data on activity, cost, and outcomes to inform CCGs decision making, it says.

Without an integrated approach, emergency admissions and repeated hospital admissions will rise among the homeless, the report warns.

Karen Taylor, Deloitte UK Centre for Health Solutions research director, explains: “Whilst [the single homeless] have a right to access healthcare, they often can’t, won’t or simply don’t. Many seek help at a much later stage in an illness, at which point it usually involves a visit to the accident and emergency department. As a result, commissioning healthcare services for the homeless has always been a challenge.

She adds: “There is not a one size fits all solution. Commissioners need to identify the scale of the problem and decide which solutions will work best for the local area. In all likelihood, it will probably be a combination of solutions, not just one that is needed.

Ultimately, getting it right for this most complex of patient groups can provide an ideal model to put in place for other disenfranchised and complex groups.”

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