The Wakefield Housing Support Evaluation (WHoSE) project has published its final project report and economics report reviewing the impact of a pilot service providing Housing Support Coordinators to assist people being discharged from hospital. The reports, produced in collaboration with practitioners, make several recommendations for improving the current service and will be a valuable resource for other providers thinking of implementing similar schemes.
Our housing affects our health and poor housing can have a negative effect on both physical and mental health. Housing providers are now working more closely with health and social care providers, with better collaboration being crucial to deal with rising service demand. Several interventions have been developed across the country to integrate housing and health related services. An example of this is providing help for people being discharged from hospital. Hospital discharge can often be delayed while patients wait for appropriate housing, care packages and home adaptations.
In 2018–21, social housing provider WDH ran a pilot service which provided Housing Support Coordinators to support people leaving hospital and ensure their housing needs were being met. This was done across two hospitals – a mental health hospital and an acute hospital. As a new service, both the NHS and housing partners wanted to understand the impact of the pilot. SPHR researchers at the University of Sheffield were commissioned to evaluate this service and gain a more detailed understanding of its impact on housing outcomes, hospital costs, the discharge process and outcomes for patients.
Overall, 488 people were referred to the service with the majority being male. The ages across the two hospitals varied with patients generally being older from the acute hospital (over 65) and younger from the mental health hospital (under 45). Often service-users led complex lives, experiencing multiple social issues alongside their housing situations. Support from Housing Support Coordinators was needed for a variety of reasons, such as previous accommodation no longer being suitable due to mobility issues, previous disputes with neighbours, issues with payments due to rent arrears, needing home adaptations or wanting to move to be closer to family.
A variety of methods were used to assess the pilot service, these included questionnaires to service-users, data analyses and qualitative interviews with Housing Support Coordinators, housing staff, health care professionals and service users.
Taken collectively, the review found that the pilot had had a positive impact on the hospital discharge system, supporting the reduction of delayed discharges and helping to alleviate pressure on overstretched healthcare staff. For front line staff the service was vital and significantly reduced the time spent supporting people with housing related issues so they could focus on clinical work.
Several challenges to delivery were identified such as organisational differences that affected how the Housing Support Coordinators worked, the availability of suitable housing and managing service-user’s expectations about what housing was available against their needs.
The report makes several recommendations which have now been taken forward by the current service (for more information, see the project report ). In turn, given the push to deliver housing and health services, the report makes several recommendations for those developing similar schemes around the UK:
• The working model should ensure Housing Support Coordinators are placed within a health and care discharge team with access to appropriate medical IT systems.
• Housing Support Coordinators need appropriate managerial support from healthcare managers who understand the role and can help promote it from within the organisation.
• When establishing the Housing Support Coordinator role, significant communication with internal and external stakeholders will be required to ensure the correct people are involved, and that all involved understand each other’s remits, priorities and what the service can provide.
• A clear strength of the service was the Housing Support Coordinators being embedded within the housing association, due to its knowledge and access to other potential support services.
Given the benefits, a recommended model is to base Housing Support Coordinators within an organisation which provides multiple services for onward referral. If this is not possible, time should be invested in learning the availability and remit of different local services to ensure they reflect the complexity of service user needs.
Sarah Roxby, Director for Housing and Health at WDH says:
“Housing has an important role to play in supporting health and social care systems. We are really pleased to have this evaluation for our Housing Support Coordinator service so we can better understand the impact housing can have on hospital discharge services and the wider health system. We will develop a local action plan to ensure all the recommendations made in the evaluation are implemented.”
Ellie Holding, Principal Investigator of the WHoSE project at the University of Sheffield says:
“The importance of housing and health working together has been a focus of recent policy, but little research has looked at the impact of such collaborations on hospital discharge. It has been really valuable to work on this coproduced project to develop recommendations for services wishing to integrate housing and health more closely together. The findings show the importance and benefits housing can bring to heath systems. We hope the findings will be used to help develop other housing services around the country aiming to that improve outcomes for people and help reduce hospital discharge delays”
Researchers have followed up on the project findings and developed an infographic to help others easily engage with the review’s findings
This work highlights how practice and academia can work effectively together to deliver real change, with several of the recommendations being taken forward by the service. It is hoped the collaboration will work together again on future evaluations as similar services are developed around the country.
For questions about this research or if you would like further information, please contact Ellie Holding firstname.lastname@example.org