North West London integrated approach to homeless health

NWL has the largest homeless population in London, and the borough with the largest homeless population, Westminster. There are stark health inequalities for those who are homeless; a combination of multiple, long term, often under-treated health needs, experiences of trauma and discrimination mean that this sub-set of our population often do not get the care they need.

In 2021, NHS North West London was awarded funds from DHSC’s Shared Outcomes Fund to develop an Out of Hospital Care Model (OOHCM) for people experiencing, or at risk of, homelessness. This formed part of a nationwide programme of 18 sites, aiming to:
• Prevent discharges to street and associated readmissions;
• Avoid hospital attendance and admissions (where health, care and support needs can be better met in the community);
• Support an improvement in an individual’s health and wellbeing; and
• Prevent rough sleeping and homelessness.

Following the success of the first year of operation, NWL ICB has recognised the significant impact this model of care can have and approved a business case for a further 3 years of funding to deliver an integrated, multidisciplinary model of care for people experiencing homelessness, both when they are inpatients in acute trusts, and in the community.

The ‘inclusion health teams’ are multi-disciplinary teams who work with homeless patients in hospital to maximise the benefit of their time there, providing specific health interventions, social care, housing, advocacy and practical input so that patients are discharged in an improved situation, reducing hospital re-admittance and homelessness. Part of the model includes specialist community homeless health nursing teams, and all parts of the model work in close collaboration with mental health and primary care for ongoing case management. The NWL model as a whole will consist of GPs, nurses, AHP and housing workers, and see approximately 1200 patients per year.

The scheme has already proved successful and in its initial months of operation has delivered a 54% decrease in rough sleeping and a 200% increase in people moving in to temporary accommodation. The team have supported patients with their wider health needs, registering with a GP and making significant progress in meeting their housing and social care needs. A recent study with the London School of Economics has also demonstrated that the scheme costs the system a whole (including health, housing, social care, mental health, criminal justice, etc) 64% less, and care is more community based, preventative and recovery focused, improving patients wellbeing.

In order to make sustained, positive change for a person experiencing homelessness it requires extensive and flexible input by trained and dedicated resources, however, it is also our aspiration that this model of care becomes part of 'business as usual' and sets the standard for how we treat people experiencing homelesness.

The model of care is part of a wider, coordinated and integrated approach across NW London for people experiencing homelessness in the Integrated Care System, which includes other programme workstreams (e.g. primary care, vaccinations) as well as support for local place based plans for homeless health. Integrated governance is provided via a pan NWL Homeless Health Steering Group including NHS acute, community and mental health providers, ICB, voluntary sector, local authority, public health and more.