Finding pathways through the wilderness

Photo provided by Pathway

People experiencing homelessness are more likely to suffer from multiple health conditions such as physical or mental illness, substance misuse problems, and psychological trauma. As a result, those experiencing homelessness end up in hospitals on a more frequent basis. However, without a special focus on patients experiencing homelessness, hospitals can struggle to respond to their complex needs. These patients can end up discharged into environments that are unsuitable for recovery, leading them to be re-admitted to hospitals later on, with the whole cycle repeating.

Pathway, a UK-based homeless healthcare charity understands the complexity of providing healthcare to people experiencing homelessness, and works with National Health Service (NHS) hospitals to help them provide better care. Professor Aidan Halligan, Pathway’s founding chairman, explains why and how the London Pathway service was introduced in this video. Aidan used to meet weekly with people who were experiencing homelessness, and he quickly realised that the NHS was not providing adequately for their unique needs. Aidan described a man he had befriended who was experiencing homelessness. “He was actually so dispossessed in many ways that he couldn’t have a voice to feed in as an equal, as a patient,” he says. “So it was about that time that I thought, we should really do something about this.”

“It’s not simply about inequality, it’s about equity, it’s about living in a just society in which healthcare provision is proportionate to people’s needs,” says Dr Nigel Hewlett, medical director of Pathway. “So I kept a passionate wish to ensure that the NHS, of which we are all so proud, keeps that concept of equity at the heart of everything it does.”

Pathway strives to help the NHS improve care for people experiencing homelessness, by working with the NHS to create specialist homeless teams in hospitals, made up of general practitioners, nurses, allied health professionals, housing experts and those who have experienced homelessness themselves. Pathway staff build trusting relationships with patients experiencing homelessness while they are in hospital, and strives to better meet their needs by helping coordinate across health, housing and social services. Since it began in 2009, Pathway has grown to support a network of 12 NHS teams across the UK who help more than 4,000 patients each year.  

Pathway also seeks to tackle the root causes of health inequalities faced by people experiencing homelessness. It provides education in homelessness to hospital staff, uses research and evidence to influence the NHS to deliver better healthcare for the homeless, and works to improve medical and nursing education on inclusion health[1]. The networks and services Pathway has helped to create played a key role in the Covid-19 response. When the Covid-19 crisis first hit, Pathway knew that many individuals experiencing homelessness were at greater risk of having severe disease from contracting the virus. Leading inclusion health clinicians presented a Covid-19 homeless sector response plan at Pathway’s annual conference two weeks before the first UK national lockdown in April 2020[2]. The plan engaged the Government, helped raise emergency funding, and, that, alongside the efforts of frontline practitioners and the collaboration of services across health, housing and the charity sector, resulted in 37,000 people being moved from the streets into safe, self-contained accommodation.

“You’ve done more for me in a 48-hour period than other organisations have done for me in the last 23 years,” said one patient speaking about her experience of a Pathway team.

This grant falls under our Housing and Homelessness Programme (HHP), which works to tackle the structural causes of homelessness. HHP’s partners are working to build a fairer society by creating opportunities, as well as strong communities where everyone can thrive and live dignified lives. Read about other work being done within the HHP programme here. Find out more about Pathway here. To give insight into the lives of people who experienced homelessness for a while, watch this video.

[1] Inclusion Health is a field which seeks to prevent and address the health and social inequalities experienced by groups of people at risk of or living with extremely poor health as a result of poverty, marginalisation, multi-morbidity and social exclusion.

[2] Professor Andrew Hayward and Al Story’s presentations to the March 2020 Faculty for Homeless and Inclusion Health conference are here https://vimeo.com/484018510