Homelessness and the Impact on Bed Releases at NHS
One of the greatest pressures on the NHS is the integration of Social and Health Care and ensuring that individuals who have had a need to be in hospital can be released knowing that appropriate care is in place.
This is very evident when it is a homeless individual as how can the individual be cared for whilst living rough on the streets. It is also highly likely that these individuals will be readmitted so the drain on resources is multiplied.
ICRIT Healthcare in Bolton have just launched a service which is designed to work with local hospitals and provide independent living but with care packages in place to support such individuals.
To find out more please visit https://icrithealthcare.co.uk/our-services/hospital-to-housing-support
Here are some of the supporting facts to demonstrat the importance of such a service.
RESEARCH AND BACKGROUND
Research has demonstrated that being homeless can have significant implications for the individual, including increasing the risk of long-term health problems. The Deloitte (2012) study found that up to 70 per cent of people who use homeless services suffer from mental ill health. There were also high levels of alcohol and drug dependency, which tended to exacerbate health problems. Due to a reduced access to normal healthcare services, many homeless people let their conditions deteriorate until a point where emergency care is required.
Research by CRISIS (2011) indicates that the average age of death for a homeless person is 47 years old, 30 years younger than that of the general population. In addition to the impact on individuals, research has started to focus on the cost of homelessness. Research by Homeless Link (2013) estimated that each homeless person represents a cost of £26,000 per year to the public fund. Therefore services that prevent homelessness and help a transition away from this situation will likely result in a saving to the public purse. Deloitte (2012) found that homeless people attend A&E up to six times as often as the general population, are admitted four times as often and once admitted tend to stay three times as long in hospital due to acute health issues and complex needs. Also, one in ten homeless people who do access A&E will do so at least once a month. DoH research in 2010 found that overall the total cost of hospital usage by homeless people is estimated to be £85.6 million per annum. This figure is around four times higher than the cost associated with a similar sized group of non-homeless people. The same DoH (2010) report found that inpatient costs represent the majority of the care provided to this client group, and are approximately eight times higher than for the comparison group, possibly because the homeless have an average length of stay in hospital three times as long as the general population. In total this equates to over £2,100 per person, compared with £525 for the general population (Deloitte, 2012). A joint report by Homeless Link and St Mungo’s in 2012 found that when homeless people finally leave hospital, more than 70 percent will be discharged straight back onto the streets without their housing issues being addressed, which will likely result in readmission due to the conditions being adverse to recuperation.
Despite the circumstances described above, the DoH (2010) report highlighted that in 2010 only 39 percent of Local Authorities indicated that they had specific policies dictating protocol for the admission and discharge of homeless people; furthermore only 27 percent of those who are classed as homeless received help with housing before being discharged. A report by the Centre for Health Service Economics & Organisation (CHSEO) in 2011 showed that projects and models which have been implemented to improve admission and discharge practice have demonstrated cost benefits in two different ways: firstly the average length of stay will change due to a reduction in ‘bed blocking’ as homeless people are more likely to be discharged sooner if their housing and next steps are adequately catered for (however some may stay longer if this is deemed necessary)6; and secondly if patients are discharged at a clinically appropriate time and to suitable accommodation they are in a position to more ably recover from an illness, and thus there are fewer emergency readmissions to hospital within 28 days. Previous interventions have demonstrated these potential cost savings in action.
For example, at the Arrowe Park Hospital in the Wirral, a link worker was hired to ensure that those who were homeless were accounted for in policy and supported during discharge. The DoH study in 2010 found that during the year there was a fall in the number of episodes (26%), admissions (18%) and bed days (26%). The amount of delayed discharges was also reduced, saving an estimated £45,000 in six months
