Understanding the Missing Links: Integrated Health and Social Care for People Experiencing Homelessness

Homelessness (including street homelessness, temporary accommodation and sofa surfing) is a persistent and growing problem. Homelessness is associated with much greater morbidity and is associated with a thirty-year reduction in average life expectancy compared to the general population in the UK. Despite high levels of need, people experiencing homelessness face substantial barriers to accessing health and social care including stigma, discrimination, lack of trust and fragmented care. Barriers to accessing community services result in medical emergencies with high inpatient costs. Recent NICE guidance concluded that there is good evidence on effectiveness and cost-effectiveness of housing-related interventions with wraparound support for health and social care. However, there is lack of evidence on: how this wraparound support is delivered; strategies for improved integration; the experiences of those receiving new models of provision; and impacts on costs, health and wellbeing. Our research addresses these evidence gaps. Research questions: How do structural and system factors help or hinder commissioning of health and social care that is integrated with housing and what are stakeholders experiences of integrated care? What is the value for money of length of health and social care contact on service use, costs, and health related outcomes for people experiencing homelessness? To explore structural and system factors, and experiences of integrated care, we will use a qualitative case study approach in North West England, North East England and London. Sampling will ensure diversity and inclusion to reflect varied contexts for people experiencing homelessness. We will conduct interviews and observation to explore how multidisciplinary health and social care services work together, system level barriers and variation across sites. We will conduct interviews to explore the experiences of new models of integrated service for stakeholders (e.g. service managers, commissioners) and people experiencing homelessness. We will explore the impacts of length of health and social care contacts on service use, costs, outcomes related to health and SMD for people experiencing homelessness. This will begin with a rapid review of evidence on effectiveness and cost-effectiveness of longer contacts. We will combine findings with information of people experiencing homelessness from large routine data gathered from GP records to conduct a care pathway analysis – allowing us to compare current care with longer contact alternatives. We will develop a decision-analytic model, from a public sector perspective, to project long-term costs and effects associated with changes in short-term outcomes We will work closely with people experiencing homelessness and stakeholders across the health and care system to co-produce recommendations to strengthen wraparound integrated care, and improve experience and outcomes for people experiencing homelessness. We will use workshops and an adapted Nominal Group Technique (NGT) to develop recommendations. We will work throughout with our public advisory group and peer researchers with experience of homelessness to ensure our research is co-produced. We will produce a range of outputs (such as policy briefings, blogs, presentations) aiming to influence policy and commissioning. We will also use creative methods (e.g. visual minutes, podcasts) to share key messages with wider audiences.