Homeless people experience a higher rate of
serious health problems, and have greater problems accessing
healthcare than the general population. With this in mind, a
project offering integrated care for homeless people was piloted
with the aim of reducing mortality and morbidity, and reducing
acute secondary healthcare usage among its clients.
The pilot took place during 2009 at the 120-bed St Mungo's
Cedars Road hostel in Clapham, London, supported by a £20,000
grant. Due to its success, the project was mainstreamed by
community services in 2011. From early 2012 the scheme will be
relocated to Thames Reach's Graham House in Vauxhall.
This project reflects the Charity's commitment to supporting new
ways of delivering healthcare that meets the needs of local
populations. It also demonstrates commitment to robust evaluation
in order to evidence the efficacy of these new models of care, so
that they can be adopted in other parts of the country.
Within the project, a full-time Band 7 nurse and health support
worker are based on site, with a weekly in-house session provided
by the project GP. The service aims to improve residents'
healthcare, and access to treatment. The project team currently
manages a caseload of 10-12 clients: those assessed to be most at
risk of death or disability at any one time.
A main target has been to ensure clients are engaged with all
the specialist services they should be accessing, through help such
as transport provision and reminders of appointments. Common new
referrals for clients have included HIV services, chest clinics,
neurology, psychology, counselling, and dentistry.
As a result, deaths among those involved have fallen
significantly. Residents are also now admitted into A&E less
with 52 per cent lower admissions than pre-project, and hospital
admissions have fallen by 77 per cent. The scheme has also proved
cost effective, due to the reduction in secondary care usage.
"The project has shown that it is possible to offer intermediate
care to homeless hostel residents and improve health outcomes and
secondary care usage as a result," says Samantha Dorney-Smith,
joint service lead, Homeless, Blood Born Virus Health Care and
Refugee Health Teams. "It has provided equal access to intermediate
care services for this disenfranchised group based on clinical need
and demonstrated that tackling the health inequality experienced by
the homeless can be done cost effectively."