Photo by 'Carol' on Flickr
Compared to the general population, those who are homeless:
visit A&E six times more often
are admitted to hospital four times as frequently and stay three times longer.
We aim to bridge the gap in care and provide a pathway to recovery and stability.
This frees up beds - shortening waiting lists, and provides respite for this vulnerable cohort, with a far better chance of a safe and full recovery.
Once discharged from Mildmay, the aim is that people will be supported by specialist homelessness charities such as Pathway.
*Step-down care is a term used primarily in the UK for supportive and rehabilitative healthcare given to a patient recuperating from an illness or intervention, who is regaining the ability to function independently.
With homelessness in London and other major cities across the UK increasing, there is urgent need for the highly focused, specialist care of the sort Mildmay provides. The number of rough sleepers in London has more than doubled in the last 10 years. 8,855 People were seen sleeping rough in London in 2018/2019.
These record levels of homelessness in London are putting NHS hospitals under increased pressure.
To address this, Mildmay has introduced the Step-Down Homeless Medical Care Pathway to help ease the burden on NHS hospitals and provide the care that these patients need.
Many people who are homeless or rough-sleeping have complex combinations of physical illness, mental illness and substance misuse problems, and histories of trauma and abuse. They are some of the most vulnerable people in society. Traditional systems of health and care often struggle to meet their needs.
Most charitable work supporting people who are rough sleeping or homeless, centres on social welfare, so a step-down service from acute hospital care for respite, recovery and palliative care is much-needed.
In 2012, it was reported that 70% of homeless patients were being discharged from hospital back onto the street, without housing or underlying health problems being addressed.
This is further damaging their health and increasing costs to the NHS through ‘revolving door’ admissions.
It has the highest levels of homelessness, with almost 165,220 people, without a place to call home. Rough sleeping is at the extreme end of homelessness. The Greater London Authority’s Combined Homelessness and Information Network (CHAIN) system separately monitors the number of people who sleep rough in London.
In 2022/23 around 10,053 people were seen sleeping rough in London by outreach workers over the course of that year.
An estimated 800 homeless people died in the 18 months prior to March 2019 and the data shows that there is an increasing trend in the number of people sleeping rough in London.
Image credit: Young Shih on Unsplash
Only a small number of step-down services, such as Gloria House (6 beds) and Olallo House (2-4 beds), which take patients with lower health needs, and there are a small number of floating support services in Westminster and Lambeth.
Mildmay has developed partnerships with several homeless charities, such as Pathway, which is already doing excellent work across London. We are working with them to make a truly game-changing difference in the lives of London's homeless people.
We have established relationships with homeless healthcare providers and experts for clinical sponsorship, governance, training and mentorship:
NHS Trusts and Commissioning Groups and other statutory bodies
Local Authority housing and adult social care agencies in Tower Hamlets, Hackney, Newham, Westminster, etc
Sector charities such as Pathway
This implies a gross cost of £76.2 million per year, rising to £85.6 million when outpatient usage and accident and emergency attendances are added, equivalent to annual costs ranging from £24,000 to £30,000 (gross) per person.
This service is in line with the London Vision and with a view to providing these services for the most complex cases London-wide.
Research by Crisis drawing on large studies on homelessness across Britain
People who are homeless experience some of the worst health problems in society. The longer a person experiences homelessness, particularly from young adulthood, the more likely their health and wellbeing will be at risk. Co-morbidity (two or more diseases or disorders occurring in the same person) among the longer-term homeless population is common.
34
times more likely to have tuberculosis
50
times more likely to have Hepatitis C
12
times more likely to have epilepsy
6
times more likely to have heart disease
5
times more likely to have a stroke
2.5
times more likely to have asthma
Data courtesy of Pathway
Mildmay is a charity providing specialist services to the NHS, not an NHS or private hospital. We don't make a profit and all donations are invested in our patients, staff, services and facilities.
Help us secure the future of our UK hospital by developing our services for people who are homeless, so we can ensure equal and fair access to healthcare for all.
