NHS Fife & Shelter Scotland approach to supporting homeless patients attending hospital

This work outlines evaluation support provided by Healthcare Improvement Scotland’s ihub to Shelter Scotland and the Fife Health and Social Care Partnership (HSCP), conducting both a health economics evaluation and qualitative study of an intervention within Victoria Hospital, Kirkcaldy (NHS Fife). An executive summary is also available.

The intervention

Two full-time Shelter funded staff with a combination of clinical and housing expertise, within an acute hospital setting. The staff liaised with clinical staff to asses, and provide support to patients prior to discharge (and follow up with them post discharge if necessary), and local authority staff to help facilitate the provision of suitable accommodation. There were two hospital settings for the intervention; inpatient discharge via the hospital’s “Discharge Hub” (January 2018 - January 2019), and A&E discharge (November 2019 - February 2020).

The intervention was offered to 91 participants (76 participants from the Discharge Hub setting and 15 from A&E setting).

Resource and cost saving

To help inform decision making and identify impact of the intervention on hospital activity and resource costs, the ihub’s Evidence and Evaluation for Improvement Team (EEvIT) conducted a health economics analysis. 

EEvIT found that following the intervention, people were less likely to be admitted to hospital or stay there long. If these reductions can be attributed to the intervention, then the intervention can be potentially cost-effective, on average saving £2,422 (95% CI: £610 to £3,853) per patient supported. The total observed saving in terms of NHS (acute health services) resource use was calculated to be £376,964.

Impact on housing status

Data collected on self-reported housing status following the intervention provides an indication that the intervention increases the number of people in Council/Registered Social Landlord (RSL) accommodation and temporary accommodation, and reduces the number of people who have no fixed-abode and/or are street homeless.

Data was collected on HL1 applications (the homeless statutory statistical return to the Scottish Government submitted by each Local Authority containing details regarding homelessness applications submitted locally). EEvIT calculated that if applications occurring within one month of the intervention were assumed to be a direct result of the intervention, then 13% of the applications can be regarded as being initiated by the intervention.

Self-reported housing status when admitted to hospital and at discharge

Barchart of self-reported housing status

Read the executive summary or the full health economic evaluation report.

An additional qualitative study was conducted by colleagues from the Place, Home and Housing team. Read the full details and findings from the interviews with service users and staff in the qualitative report.