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The economic case for hospital discharge services for people experiencing homelessness in England: An in-depth analysis with different service configurations providing specialist care

Research output: Contribution to journalArticlepeer-review

Michela Tinelli, Raphael Wittenberg, Michelle Cornes, Robert W Aldridge, Michael Clark, Richard Byng, Graham Foster, James Fuller, Andrew Hayward, Nigel Hewett, Alan Kilmister, Jill Manthorpe, Joanne Neale, Elizabeth Biswell, Martin Whiteford

Original languageEnglish
Pages (from-to)e6194-e6205
Number of pages12
JournalHealth and Social Care in the Community
Issue number6
Early online date7 Oct 2022
Accepted/In press12 Sep 2022
E-pub ahead of print7 Oct 2022
Published15 Dec 2022

Bibliographical note

Funding Information: About 4800 people are sleeping rough any night in England. Local authority funding to support single people experiencing homelessness has fallen substantially in recent years in England; many of the schemes originally funded by the Homeless Hospital Discharge Fund are now reduced in scale or have closed. Compared to people who are not homeless, those experiencing homelessness are likely to be discharged back onto the street (70%), attend Accident and Emergency (A&E) departments six times more frequently, be admitted three times more frequently, stay in hospital three times longer and have unscheduled hospital care eight times more frequently. Publisher Copyright: © 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.

King's Authors


There are long-standing concerns that people experiencing homelessness may not recover well if left unsupported after a hospital stay. This study reports on a study investigating the cost-effectiveness of three different ‘in patient care coordination and discharge planning’ configurations for adults experiencing homelessness who are discharged from hospitals in England. The first configuration provided a clinical and housing in-reach service during acute care and discharge coordination but with no ‘step-down’ care. The second configuration provided clinical and housing in-reach, discharge coordination and ‘step-down’ intermediate care. The third configuration consisted of housing support workers providing in-reach and discharge coordination as well as step-down care. These three configurations were each compared with ‘standard care’ (control, defined as one visit by the homelessness health nurse before discharge during which patients received an information leaflet on local services). Multiple sources of data and multi-outcome measures were adopted to assess the cost utility of hospital discharge service delivery for the NHS and broader public perspective. Details of 354 participants were collated on service delivery costs (salary, on-costs, capital, overheads and ‘hotel’ costs, advertising and other indirect costs), the economic consequences for different public services (e.g. NHS, social care, criminal justice, housing, etc.) and health utilities (quality-adjusted-life-years, QALYs). Findings were complex across the configurations, but, on the whole, there was promising evidence suggesting that, with delivery costs similar to those reported for bed-based intermediate care, step-down care secured better health outcomes and improved cost-effectiveness (compared with usual care) within NICE cost-effectiveness recommendations.

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