The London Pathway Homeless Team at UCLH Brief Update 2010

The London Pathway and Innovation  First hospital based nurse specialising in homeless health care  First GP led ward rounds for homeless patients (or any patient group) in a hospital setting  First regular hospital based multiagency meetings to develop care plans for homeless patients  First regular inclusion of voluntary sector hostel support, street outreach, drug and alcohol inreach, mental health services, social services, housing options and hospital staff in multi-agency care planning

The London Pathway and Outcomes  Average duration of unscheduled admissions for homeless patients at University College Hospital reduced by 3.2 days per patient  Projected annual net savings of £300,000 for the health community following application of the London Pathway at UCH  Appropriate durations of stay increased with double the number of homeless patients staying 6-10 days  Savings mainly generated by reducing the number of homeless patients staying longer than 30 days from 14% to 3%  Weekly multi-agency care planning meetings for complex homeless patients implemented  Total proportion of homeless patients discharged with multi-agency care plans increased tenfold from 3.5% to 35%  Care planning extended to include homeless frequent attenders at A&E and homeless patients referred for routine surgery  Where liaison psychiatric assessments carried out, proportion summarised in discharge letter increased from 33% to 75%

The London Pathway and Replication  Simple care plan defined, aim to encourage other Acute Trusts to adopt this approach  Objective 1 - Think Homelessness!  Check housing status for all patients on admission. If homeless or temporary housing refer to the Homeless Health Practitioner  Objective 2 - Homeless Team Coordinate Care  Patient seen by Homeless Health Practitioner, visited by the Homeless Ward Round, needs assessed and Homeless Care Plan started.  Objective 3 Care Plan Meeting  Complex needs cases referred to weekly Homeless Paper Ward Round for multi-agency Care Plan and Sanctuary assessment.  Objective 4 Community Support  HHP refers to Care Navigator Team & assesses need for Sanctuary Placement (ongoing medical needs and complex case).

The London Pathway & Next Steps  Care Navigator team, move from pilot to full service  People with an experience of homelessness offering mentoring, befriending and on-going support after discharge  Joining the ward round with status of Hospital Volunteers  Supported by a Care Navigator coordinator  Recruited and paid as 6 month apprentices by Street League  Funding needed to develop the role of care navigator coordinator