Cornwall Homeless Hospital Discharge Project

“Since January 2014, the project has received 216 referrals, with 169 receiving a safe and timely discharge. The remainder either have a home but no longer suitable due to their health or poor quality that contributed to their health problems. Savings to the NHS of nearly £70,000 a year”

Homeless Discharge Partnership

Inclusion Cornwall, with St Petrocs, Shelter, Cornwall Council, Cornwall Housing, NHS, Health for Homeless and Coastline Housing are partners in the Cornwall Homeless Hospital Discharge project.

The project seeks to reduce the number of repeat hospital admissions and delayed discharge from hospital by single homeless people who were medically fit to leave hospital but had no home to go.

The project started in January 2014, with a dedicated Homeless Patient Advisor (hosted by Shelter), taking referrals for any patients in hospitals in Cornwall (including Treliske, mental health and community hospitals).

Inclusion Cornwall manage the Homeless Hospital Discharge Enabling Fund to facilitate (where agencies are unable to) safe discharges that improve outcomes for homeless patients.

Since January 2014, the project has received over 216 referrals, with some 169 receiving a safe and timely discharge. The remainder either have a home but no longer suitable due to their health or poor quality that contributed to their health problems. St Petrocs manage temporary housing for the project.

Most are known to local services and are discussed with partner agencies at the Rough Sleepers Operational Group, where people look at individual cases of people who have become entrenched rough sleepers, share information and discuss possible solutions.

Please contact Colette Jolly, Homeless Patient Advisor, Shelter – Cornwall. 07969 801 807

Case Study highlights the complex nature of homelessness (feel free to edit/amend)

CASE STUDY 1: Entrenched rough sleeper

Number of admissions prior to referral 0
Number of bed days prior to admission 0
Bed days 54 (36 in acute bed & 18 in community bed) = £31,500
Number of admissions since 0
Number of bed days 0
Admissions within 30 days 0
Referral made June 2014
Background -Mr J was admitted to hospital in May 2014 after collapsing at the local breakfast club, he suffered with COPD but due to months of self-neglect his general health was very poor. He did not respond to the nurses, he would close his eyes when they came to his bedside and Depravation of Liberty under the Mental Capacity Act was undertaken and considered that he would not have been allowed to leave hospital if he should try to against medical advice.
How we assistedHe was referred to the project by the homeless link worker for Cornwall Housing, however the nursing staff felt that he would not be able to live independently and was likely to be placed in residential care.After several weeks he became more active, getting up, talking to other patients and nurses, until eventually he was well enough to be discharged. He was in hospital for over two months.He was referred again when he was moved into a local community hospital for rehab treatment.He was placed into the hospital discharge accommodation.We arranged for him to be collected from the hospital and driven to the accommodation, which was fully furnished and a food parcel was provided whilst he waited for his benefit payments.

He was visited at least twice weekly by support workers and assistance was provided to complete benefits claim, register with a GP and access required services.

He was referred to long term supported accommodation for people with complex needs.

Outcome: He was offered a place with the supported housing and has settled in well.He visits the support office every evening when the day shift ends and night one starts and has a coffee and catch up with the staff.He participates with the Sunday lunch club and socialises much more.He is hoping to secure a social housing tenancy through the housing register, and he is being assisted by the support workers to complete the application.He has had no further admissions to hospital and his general health is much improved.