Homelessness, hospital discharge and challenges in the context of limited resources: A qualitative study of stakeholders' views on how to improve practice in a deprived setting

Abstract

Hospital discharge for people experiencing homelessness is a perennial challenge. The Homeless Reduction Act 2017 (HRA) places new responsibilities on hospitals, but it remains unknown whether this has affected discharge practices. This qualitative study explores stakeholders' views on the challenges around hospital discharge for people experiencing homelessness, in the context of a deprived English city. Semi‐structured interviews were conducted with 27 stakeholders. Participants were purposively recruited from local authority, third sector and the National Health Service. Interviews were transcribed and thematic analysis conducted. Analysis generated three main themes. First, a need for better planning and communication with the third sector, particularly around medication, prescriptions and information sharing. Second, the need to improve awareness and ‘upskill’ hospital staff to work more effectively with people experiencing homelessness, including understanding their needs, the wider support available and HRA requirements. Third, there were calls for (re)investment in a different approach to better support this population, based on outreach and flexibility. The need for improved partnership working and investment was emphasised. Whilst recognising the challenges faced by hospitals, especially within the context of funding cuts, this study highlights the need to recognise the third sector's contribution in supporting people experiencing homelessness in the community. Developing site‐specific checklists for practice before discharge (and as early as possible) may help to ensure appropriate measures are in place. Improving legal literacy in the context of what an appropriate discharge is for people experiencing homelessness may help develop staff confidence to challenge the focus on ‘quick’ discharges.

Hospitalization and Housing: A Qualitative Study Exploring the Perspectives of Hospitalized Patients Experiencing Housing Insecurity

“…PEHs are often entangled in cycles of poor health, substance use, and hospitalization, and vulnerably housed patients are at risk of hospital-generated housing insecurity. Hospital systems should ensure adequate staffing of critical inpatient social work teams and consider investing in specialty social work teams with enhanced capabilities to navigate local housing resources [ 29 ]. Furthermore, healthcare systems should actively partner with community organizations to address local housing capacity and resources [ 30 ].…”

Applying situational analysis to examine the impact of VOICES on people experiencing multiple disadvantage

“…According to the evidence considered in situational analysis, support services more aligned with equality were mostly those of the public sector. This is perhaps not surprising as the common delivery focus is citywide and based on population needs, rather than being targeted or tailored to those with the most extreme disadvantage and needs (McCormack et al ., 2019). However, in this situation, it appears to have led to failure demand, exacerbating social and health inequities between the local general population and those with multiple disadvantage (Wilson et al , 2016).…”

“…Stigma and marginalisation among some personnel in public sector support services emerged as a fundamental barrier to people with multiple disadvantage accessing services (Figure 2). Described by one stakeholder, as “the elephant in the room” (McCormack et al ., 2019), when discussing hospital discharge processes for people experiencing homelessness, it was recognised that stigma can vary with the needs/situation of the individual (e.g. substance misuse vs homeless vs offending history).…”

“…Independent Evaluation Report www.issuu.com/voicesofstoke Stoke-on-Trent Safe City partnership (2021) Multi-agency Resolution Group Stoke-on-Trent: Working Together for Your Community Gidlow, C., McCormack, F., Riley, V. and Spyropoulos, K. (2021a) Multi-agency Resolution Group (MaRG): Evaluation report www.chadresearch.co.uk/wp-content/uploads/2022/01/MarG-report-final-version.pdf CFE Research, University of Sheffield, Systems Change Action Network (2020) Improving access to mental health support for people experiencing multiple disadvantage Evaluation of Fulfilling Lives: Supporting people with multiple needs www.issuu.com/voicesofstoke Rice B. (2019) The VOICES Model of using Personal Budgets in Service Coordination www.issuu.com/voicesofstoke Wilson B., Astley P. (2016) Gatekeepers: Access to Primary Care for those with Multiple Needs www.issuu.com/voicesofstoke McCormack, F., Parry, S. and Gidlow, C. (2019) Hospital Discharge and Homelessness: Local stakeholder perspectives www.issuu.com/voicesofstoke Sharman Sharon (2020) An Improbable Journey: Exploring a prison release plan - Case Study www.issuu.com/voicesofstoke McCormack, F., Massie, R., Machin, R., Vincent, P., Kurth, J,. Morton, J. and Gidlow, C. (2016) City Centre Rough Sleeping and Street Activity: Project Report www.issuu.com/voicesofstoke Ornelas, B., Bateman, F., Meakin, A., Cornes, M., Pritchard-Jones, L. (2020).…”

“…McCormack, F., Parry, S. and Gidlow, C. (2019) Hospital Discharge and Homelessness: Local stakeholder perspectives www.issuu.com/voicesofstoke…”