This blog is based on an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Eleanor Holding is a Research Fellow in the Sheffield Centre for Health and Related Research (ScHARR), at the University of Sheffield. She specialises in qualitative research and the evaluation of complex interventions that seek to reduce health inequalities and target the social determinants of health.
She has a particular interest in housing research and how local authorities, housing and health services can work together to improve health. Her current research aims to understand how local authorities can support children, young people and families who are experiencing housing insecurity.
Delayed discharge from hospital increases hospitals' costs and is a challenge for healthcare services globally. A common reason for delays among people who are medically well is a lack of appropriate housing or social care. People may be homeless, have serious mental health issues, or need accessible housing due to mobility issues. Previous studies show that 30 – 70% of homeless people are discharged from hospital on to the street.
The NHS and local authorities have trialled new support services to aid discharge for people with housing needs. New services include employing housing support coordinators, who help service users with housing applications, provide wellbeing support, and refer them to other services as necessary (social care and debt advice, for instance) while they are in hospital. The aim is to stop housing issues from escalating, in the hope of preventing the “revolving door” of hospital readmissions.
We assessed whether having these housing experts in hospitals aids hospital discharge and improves the health and wellbeing of service users. Our study was based on two experienced housing support coordinators from Wakefield District Housing (WDH). One was embedded at a mental health hospital, the other at a general hospital in Wakefield. Health professionals identified patients with potential housing issues while in hospital and referred them to the service. We analysed data from 488 people who received support from the service between April 2018 and June 2021. We also interviewed 5 service users, and 11 health professionals and housing staff from the mental health hospital and the housing association.
What did the study find?
Most services users (67%) were male. Those at the mental health hospital were more likely to be homeless (39%); while those at the acute hospital more likely to have homes that no longer met their physical needs (17%). Service users often had multiple social issues alongside their housing situations, such as drug misuse, debt, and abuse or violence at home, which also impacted on their housing.
Housing support coordinators provided patient-centred support to a variety of people, such as those who had physical health issues or who were behind on rent. They helped people bid for accommodation, arrange occupational therapist visits, and apply for rehousing because of their health. Most service users received help for less than one month. Early referrals to coordinators helped them get everything in place for discharge; when referrals were late, it was a scramble to get everything ready in time.
Both hospital staff and service users benefitted from housing support coordinators, especially those with insecure housing. Service users felt comforted by the support they received. One person said, “If I didn’t have that offer and that service, I wouldn’t have had a clue. . .where to start and where I’d be, I’d still be bottom of the list.”
Hospital staff said housing support coordinators made discharge faster and easier, which reduced their stress and workloads. Staff spent less time supporting people with housing issues, which allowed them to focus on clinical work. One healthcare professional said, “…. I think everybody is saying it’s really beneficial to have someone who specialises in housing. I wouldn’t know where to start if someone told me that they were homeless… it takes the stress off both staff and service users.”
Barriers faced by housing support coordinators included the availability of appropriate housing (particularly supported housing for people with mental health needs) and follow-up support after discharge.
Our study was carried out during the pandemic, which posed several challenges. We wanted to interview people before and after they used the service, but various COVID-related issues made this too difficult. We also could not recruit as many people to the study as we wanted, particularly service users.
Implementing housing support in hospitals
Our results demonstrate the value of integrating housing support within hospitals for staff and service users. After the study, our findings were used to improve housing support in local hospitals, and helped secure funding to continue the roles. Our housing partners also used the research to develop other housing support roles.
We hope our key learnings could help other hospitals to setup their own service. We found that housing support coordinators were most effective when they were:
- embedded within discharge teams, part of multidisciplinary team meetings, and given access to appropriate IT systems
- supported by healthcare managers who understand their role and promote it within the hospital
- supported by internal and external communications, so that everyone understands each other’s responsibilities and what the service can provide
- familiar with, and had access to housing associations and other relevant support services to help support onward referral.
Our economic model suggested that the service had the potential to save more money than it cost but we were unable to thoroughly investigate this due to missing data. Further research could investigate the value for money housing support coordinators offer.
You may be interested to read
This is a summary of: Holding E, and others. Exploring the Impact of a Housing Support Service on Hospital Discharge: A Mixed-Methods Process Evaluation in Two UK Hospital Trusts. Health and Social Care in the Community 2023. DOI: 10.1155/2023/4027277.
A policy briefing about the implications of the study.
A press release about the study from the NIHR School for Public Health Research.
Guidance on discharge and community support from the Department for Health and Social Care.
Advice from Shelter on housing rights for people with mental health needs.
Funding: This study was funded by the NIHR School for Public Health Research.
Conflicts of Interest: None declared.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
