Cornwall Homeless Hospital Discharge Service
Supporting Homeless People with Safe and Timely Discharge from Hospital
The project seeks to reduce the number of repeat hospital admissions and delayed discharge from hospital by single homeless people who are medically fit to leave hospital but have no home to go.
Inclusion Cornwall, with St Petrocs, Shelter, Cornwall Council, Cornwall Housing, NHS trusts, Health for Homeless and Coastline Housing are partners in the Cornwall Homeless Hospital Discharge project.
The Homeless Hospital Discharge Service operating for Royal Cornwall Hospitals Trust and Cornwall Foundation Trust is responsible for:
- Supporting wards that have patients that will be homeless on discharge or were homeless on admission
- Providing advice and guidance to patients who may need assistance with housing, ensuring they are referred to the appropriate accommodation providers
- The development of clinical guidelines, relating to the multiagency response to those who are homeless in hospital and ensuring that these guidelines are followed
- Ensuring that the Trust meets its duty, under the Homelessness Reduction Act 2017, to refer anyone who they believe to be homeless or at risk of becoming homeless if they have attended the emergency department or admitted as an inpatient
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 manages the Homeless Hospital Discharge Enabling Fund to facilitate (where agencies are unable to) safe discharges that improve outcomes for homeless patients.
In 2020, an increase in funding has made it possible to recruit for an additional part time member of staff to supplement the existing full time person, and support a further 6 discharge beds provided by Harbour housing, including outreach support for those being discharged into other homeless accommodation.
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.
Case Study
Mr J, entrenched rough sleeper, with 54 bed days (36 in acute ward, 18 in community ward), cost to NHS £31,500. 2014.
Situation
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 Deprivation 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 assisted
Mr J 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 to the project when he was moved into a local community hospital for rehab treatment, and was placed into the hospital discharge accommodation. We arranged the transfer for him from hospital to the accommodation, which was fully furnished with a food parcel whilst he waited for his benefit payments.
He was visited at least twice weekly by support workers and assistance was provided to complete a benefits claim, register with a GP and access required services.
He was referred to long term supported accommodation for people with complex needs.
Outcome
Mr J was offered a place with the supported housing provider 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 is being assisted by the support workers to complete the application. Mr J has had no further admissions to hospital and his general health is much improved.