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Deloitte Centre for Health Solutions: Time is ripe to address the healthcare provision for the homeless

2 July 2012

The Health and Social Care Act 2012 presents an opportunity to transform the way in which healthcare for the homeless is commissioned, according to a new report from the Deloitte Centre for Health Solutions.  It could also help create new working models for the commissioning of healthcare services for a wide range of vulnerable or disenfranchised patient groups.

Healthcare for the Homeless’ focuses on addressing the complex health challenges of the single homeless and in identifying practical solutions commissioners and providers might wish to consider.

Karen Taylor, Deloitte UK Centre for Health Solutions research director, explains: “Single homeless people have a significantly higher prevalence of physical and mental ill health and addiction.  Whilst they have a right to access healthcare, they often can’t, won’t or simply don’t.  Many seek help at a much later stage in an illness, at which point it usually involves a visit to the accident and emergency department.  As a result, commissioning healthcare services for the homeless has always been a challenge.

“Providing services for the homeless is multi-faceted and healthcare is just one aspect of those services.  However, evidence shows that addressing their healthcare needs is a vital first step in helping them to tackle some of their other underlying problems.”   

According to a report by  the Department of Health, homeless people attend accident and emergency departments up to six times as often as the general population, they stay in hospital three times as long, with the average cost of hospital services for a single homeless person four times higher (£2,115 versus £525).  The total cost of hospital usage by the homeless is conservatively estimated to be £85 million. A further major challenge is caring for the homeless once they leave hospital. All of which points to the need for an integrated health and social care approach.

Taylor says: “There is not a one size fits all solution.  Commissioners need to identify the scale of the problem and decide which solutions will work best for the local area.  In all likelihood, it will probably be a combination of solutions, not just one that is needed.  Our report presents a number of innovative models of care, such as a specialist care team in hospitals, implemented by London Pathway, that could be successfully adopted more widely, and examples of effective models, such as medical respite centres, that operate in other countries.  However, one common feature is the adoption of an integrated approach across health and social care.

“Addressing the commissioning of healthcare services for the homeless is one of many new areas for which GPs will be taking responsibility.  Ultimately, getting it right for this most complex of patient groups can provide an ideal model to put in place for other disenfranchised and complex groups.”

Professor Aidan Halligan, director of education at University College London Hospitals and chairman of London Pathway, adds: “This timely report highlights what has previously been an invisible and underrepresented dimension of our health service.  It is anomalous that the most vulnerable and dispossessed should be marginalised in our universal comprehensive National Health Service.  Ironically, what we in Pathway have learnt is that a patient centred approach to the care of the homeless offers an excellent model of integrated care that is transferable to unscheduled care demand and long term conditions.”


Notes to editors:
About the Deloitte Centre for Health Solutions
The  Deloitte Centre for Health Solutions generates insights and thought leadership based on the key trends, challenges and opportunities within the healthcare and life sciences industry.  Working closely with other centres in the Deloitte network, including the US centre in Washington, our team of researchers develop ideas, innovations and insights that encourage collaboration across the health value chain, connecting the public and private sectors, health providers and purchasers, and consumers and suppliers.
About Deloitte
In this press release, references to Deloitte are references to Deloitte LLP, which is among the country's leading professional services firms.

Deloitte LLP is the United Kingdom member firm of Deloitte Touche Tohmatsu Limited (“DTTL”), a UK private company limited by guarantee, whose member firms are legally separate and independent entities. Please see for a detailed description of the legal structure of DTTL and its member firms.

The information contained in this press release is correct at the time of going to press.

Member of Deloitte Touche Tohmatsu Limited.

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Celine Gordine-Wright
Deloitte LLP
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