Earlier this week Public Health Minister Anna Soubry announced £10 million of new funding for projects aimed at improving the care that homeless people receive on discharge from hospital.1 It is estimated that currently, 70% of homeless people are discharged from hospital back onto the street without their health and housing problems being properly addressed. The Department of Health has finally got the message that by investing in some preventive to deal with this problem, it might actually save money by reducing further A&E attendances and revolving door readmissions.
The Homeless Hospital Discharge Fund is offering a mixture of capital and revenue funding. This is targeted principally at two kinds of project. The first is the approach that has been pioneered by Pathway in their work in a number of hospitals in London and beyond.2 This is to make sure that all patients who are homeless or at risk of homelessness are identified as soon as possible on admission. A hospital-based Homelessness Team then works with the patient and a wider multidisciplinary team (involving agencies such as housing, drug and alcohol services, mental health and social services) to get a clear plan is in place to meet the patient’s housing needs and needs for on-going health and social support on discharge.
The second is to encourage the development of Intermediate Care facilities for homeless patients who no longer need the intensive support of a hospital, but who are not yet ready to be discharged to a hostel or to live alone. Examples might be an elderly homeless man recovering from a severe pneumonia or someone with newly diagnosed TB who needs an extra week to get properly established on therapy.
Both types of work have clear need for GP involvement. GPs along with CCGs will have a vital role in the development and planning of these new services. And GP clinical input will be essential once services are set up, either doing hospital in-reach sessions with homeless patients, or providing clinical leadership and hands-on care for patients in new Intermediate care facilities.
How then can GPs get themselves involved?
1. Team up with the voluntary sector
A crucial thing to note is that this Fund is open only to applications from voluntary sector organisations (including charities and social enterprises) which work principally with homeless people or from voluntary sector-led partnerships. So for example a specialist GP practice for homeless people run as a community interest company could apply directly for funding. However, in more usual circumstances interested GPs, CCGs and their local hospitals would need to work in close partnership with a local homelessness charity or other organisation to develop a bid for funding. This voluntary sector organisation would then lead the application to the fund and administer the grant if successful.
2. Establish local need
It is important to be able to demonstrate a clear local need for any proposed new services. This would involve looking for example at numbers of homeless admissions and readmissions, homeless A&E attendances. This process in itself can often be problematic, as many homeless people attending hospital are not recorded as such.
Any application must show how high standards of clinical practice, including service user involvement, will be maintained.
3. Demonstrate sustainability
The third key element of any proposal is sustainability – how will new services continue to be funded from 2014? This is where CCG and commissioner input to any proposals will be essential for their success.
4. Move quickly
Finally, the closing date for applications is July 8th. That gives less than two months to get a lot of work done on producing a business case. Developing this kind of service could make big savings on hospital spending as well as making a huge impact on health inequality. So if you are thinking about making an application to this fund, you will need to get networking fast.
Dr Les Goldman is chair and acting medical director at Bevan Healthcare CIC and a GP in Bradford
1 Details of how to apply to the 2013-14 Homeless Hospital Discharge Fund are available at https://www.gov.uk/government/publications/homeless-hospital-discharge-fund-2013-to-2014
2 Details of Pathway’s work with homeless people can be found on their website www.pathway.org.uk