Step-down Homeless Medical Care Pathway
Mildmay is the UK's first specialist unit offering pioneering step-down medical care and rehabilitation* for people experiencing homelessness.
Compared to the general population, those who are homeless:
-
visit A&E six times more often
-
are admitted to hospital four times as frequently
-
stay three times longer than the general population.
We bridge the gap in care, giving people time to recover safely and rebuild their lives and, with your support, we help to ease the pressure on NHS hospitals.
Photo by Jutta Kamp on Unsplash
Why this service is urgently needed
Those experiencing homelessness are among the most vulnerable and isolated people in our society, with some of the worst health outcomes.
-
Rough sleeping in London increased by 19% between March 2023 and April 2024.
-
One in 47 Londoners is currently homeless.
-
Across Britain, 1 in every 200 people is homeless or stuck in temporary accommodation such as hostels and B&Bs.
Many people who are homeless live with complex combinations of physical illness, mental illness, substance misuse, and histories of trauma and abuse. Traditional health and care services often struggle to meet these needs.
NHS hospitals can treat acute illnesses and injuries, but they rarely have the space or staff to offer extended recuperation before discharge. Too often, people are discharged back onto the street, with nowhere to go and no chance to recover.
This leads to “revolving door” admissions, damaging people’s health and increasing costs to the NHS.
Mildmay’s unique role
In 2020, Mildmay Hospital launched an innovative step-down service to support the NHS by providing rehabilitative care for people who are homeless or sleeping rough.
Our team of doctors, nurses and therapists work together to help patients:
-
recover from serious illness or injury
-
stabilise complex health conditions
-
begin to address mental health and substance use issues
-
plan for safer, more stable accommodation on discharge
-
This frees up NHS beds, shortens waiting lists, and gives people who are homeless a far better chance of a safe and full recovery.
-
Once discharged from Mildmay, patients are supported by specialist homelessness charities such as Pathway and other partners, helping them move towards safer housing and ongoing care.
-
Step-down care is a UK term for supportive and rehabilitative healthcare given to a patient recuperating from an illness
The situation in London
London has a significant and rising homeless population with highly complex health and care needs.
-
Around 165,220 people in London have no place to call home.
-
In 2022/23, outreach workers saw around 10,053 people sleeping rough in London over the course of the year.
-
The London Borough of Westminster alone has a larger rough-sleeping population than all of Greater Manchester.
-
In 2018, London had the highest rate of deaths among people who are homeless in any English region.
An estimated 800 homeless people died in the 18 months prior to March 2019. The number of people sleeping rough in London continues to rise.
The Greater London Authority’s Combined Homelessness and Information Network (CHAIN) system separately monitors the number of people who sleep rough in London.
Image credit: Young Shih
Why we developed the Homeless Pathway
Much of the charitable work supporting people who are homeless focuses, rightly, on social welfare and housing. But there has been a serious lack of specialist medical respite and rehabilitation following acute hospital care.
In 2012, it was reported that around 70% of homeless patients were being discharged from hospital back onto the street, without their housing or underlying health problems being addressed.
This is where Mildmay comes in.
We provide dedicated inpatient care and rehabilitation for people who are homeless, referred by NHS clinicians. We address complex medical needs and work with partners to plan safer discharges, so people do not simply return to the street.
We have established strong relationships with specialist homeless healthcare providers and experts for clinical sponsorship, governance, training and mentorship, and partner with charities such as Pathway to make a game-changing difference in people’s lives.
Our aims
We exist to make sure that:
-
No rough sleepers die on the street.
-
No one is discharged from a hoåspital to the street.
-
There is fair, equal access to healthcare for people who are homeless.
There is currently no other provision in London like Mildmay Hospital.
No other step-down clinical facility exists for patients who are homeless with such complex and high-level health needs. Traditional intermediate care units often feel unable to cope with the combination of physical illness, mental illness and substance misuse.
A small number of step-down services exist, for example, Gloria House (6 beds) and Olallo House (2-4 beds), but they serve patients with lower health needs. There are also a few floating support services in Westminster and Lambeth.
Mildmay fills a critical gap.
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.
Healthcare challenges of people who are homeless
People who are homeless experience some of the worst health problems in society. The longer someone is without a stable home, especially from young adulthood, the more their health and wellbeing are at risk. It is common for people who are long-term homeless to live with multiple serious conditions at the same time (co-morbidities).
34
50
12
times more likely to have tuberculosis
times more likely to have Hepatitis C
times more likely to have epilepsy
6
5
2.5
times more likely to have heart disease
times more likely to have a stroke
times more likely to have asthma
These are not just statistics – they represent lives cut short and preventable suffering. Mildmay’s step-down care gives people who are homeless the specialist medical support and recovery time they need, so that these conditions can be treated, stabilised and better managed instead of being left to worsen on the streets.
Data courtesy of Pathway
Photo by Milan Cobanov:
Our purpose
Our purpose is two-fold:
-
To deliver better care and health outcomes for homeless patients by providing specialist medical respite, rehabilitation and palliative care tailored to their complex needs.
-
To make more efficient use of NHS resources by freeing up NHS acute beds and reducing costly readmissions, while giving people the time and support they need to recover fully.
Our funding and how you can help
Mildmay is a charity providing specialist services to the NHS. We are not an NHS or private hospital and we do not make a profit.
Around 90% of the cost of caring for patients who are homeless is covered by NHS contracts. The remaining 10%, the difference that turns a bed into a lifeline, depends on donations from people like you.
Your support helps us to:
-
keep this unique step-down service open
-
fund the specialist staff and facilities our patients rely on
-
offer the time, care and dignity that NHS funding alone cannot cover
With your help, we can ensure that people who are homeless are not discharged back onto the street, but given a real chance to recover, rebuild and move towards a safer future.
People who are homeless use far more hospital care than the general population, at much higher cost.
A government study found that single homeless people are more than three times as likely to be admitted to hospital, at an average cost around half as much again as other patients. Taken together, this amounts to tens of millions of pounds in avoidable NHS spending every year – and an enormous amount of preventable suffering.
Our step-down service helps to break this cycle. By giving people who are homeless the time, care and rehabilitation they need after an acute admission, we reduce repeat A&E attendances and emergency readmissions, while improving people’s health and chances of moving on from the street.
Our aim is to make this kind of specialist step-down care available to the most complex homelessness cases across London, so that the people who need it most are not left to fall through the gaps in the system.
Tackling homelessness early could save the government between
£3,000
&
£18,000
for every person helped.
Research by Crisis drawing on large studies on homelessness across Britain
