New Roles at the Health, Housing and Social Care Interface – The Homeless Health Team Leader

The DHSC’s Out-of-Hospital Care Models Programme provided £16m of funding to 17 test sites across England to improve discharge arrangements for people experiencing homelessness. The programme affords opportunities to develop new services and workforce roles that aim to integrate health, housing and social care at key transition points. In this blog, Shevon Simon describes her work as a ‘Homeless Health Team Leader’ at the Princess Royal University Hospital in South East London. 

What is your job role?

In my new role as Homeless Health Team Leader, I am assigned to PRUH (Princess Royal University Hospital) in South East London to support the hospital with facilitating the discharge of homeless patients – primarily the discharge of single homeless people with complex needs. I am also responsible for developing discharge pathways and upskilling Discharge Teams to understand key homelessness legislation.

Can you tell us about why your role is needed?

My background is in local authority homelessness assessments and 14 years ago people rarely presented as homeless with more than one medical condition.

Today, many people have more than one condition – so they are multi-symptomatic and this in itself creates complexities around health management and means that they are sicker than in earlier times. In addition, chronic homelessness usually features at least three multiple long-term conditions – meaning people are more likely to suffer mental health problems, physical health problems and substance misuse and are not accessing the health services they need. COVID–19 and multiple lockdowns have not helped with healthcare accessibility, with many services not being as accessible as they were prior to the first lockdown in March 2020. Two years on and most local authority housing departments are still closed for face-to-face/office appointments, requiring patients to complete lengthy online forms or telephone assessments. As you can imagine, this is a huge barrier for someone who is homeless.

What does your role involve on a day-to-day basis?

Homelessness is something that we all need to be aware of.  A key part of my role is to raise awareness among hospital staff about the importance of identifying homeless patients on the ward as soon as possible.  The earlier that we know that there are housing issues, the quicker referrals can be made to our service which will reduce the length of time people stay over their estimated discharge date. Under homelessness legislation all emergency departments, urgent treatment centres and hospitals in their function of providing inpatient care have a duty to notify a local authority’s housing department that they have someone who is homeless in their hospital. This came into effect in April 2018 under the Homelessness Reduction Act.  Under the Duty to Refer – hospitals in England also have a duty to let a local authority know that someone is threatened with homelessness within 56 days and so it is not just those that are actually homeless that we are asked to be active with, but also those who are at risk of homelessness. For example, that patient who says that their landlord has served them with a notice and they don’t know what to do – or one who has not paid rent and the landlord may be taking them to court. When ward staff know someone is homeless or is threatened with homelessness, they can refer the patient to me and I can then action the Duty to Refer and support the subsequent plan. This saves ward staff a lot time. Currently, I am spending time teaching staff about the Act and the internal processes we have wrapped around it here at PRUH.

Supporting the wider out-of-hospital care team

Since the COVID-19 pandemic the expectation is that key assessments will occur outside of the hospital setting as a way to free up beds and improve patient flow within hospitals. This now incorporates the Discharge to Assess Model. In order for assessments in the community to be successful people need support as outlined above – with form-filling and a wide range of other issues. A very innovative aspect of the model that we are delivering in the South East London Out-of-Hospital project includes Service Co-ordinators from the British Red Cross who provide up to 6 weeks “settle in” support in the community to patients following discharge. My role is to link patients in with this new service and help coordinate the discharge plan.  While Red Cross have a long history of working with older people, this new out of hospital care service is vital to help homeless patients recover in the period shortly after discharge.

What do you enjoy most about your role?

What I enjoy most is that the role gives me a wide scope to be able to deliver what is needed under that umbrella of ‘supporting the hospital with facilitating the safe timely discharge of homeless patients.’ Partnership working is at the heart of the role and it is incredible what we can achieve when we work together.

King’s College London, London School of Economics and Expert Focus are evaluating the DHSC’s Out-of-Hospital Care Models Programme: Project page.