Embedded housing workers in hospitals

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The context

We know some people present to housing options too late for their homelessness to be prevented. But often, those people have interacted with, or even resided care of, other statutory bodies shortly beforehand. During consultation for the Oxfordshire Homelessness Trailblazer (2017-19), both professionals and people with lived experience of homelessness repeatedly put forward the concept of on-hand housing expertise in non-housing settings as a solution to this systemic problem.

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The intervention

Embedded housing specialists were employed by Oxford charity, Connection Support, and based in other public services (health, criminal justice and children and families social work). Two housing workers were located in general and mental health hospital wards. Their remit was to operate as an onsite housing expert, directly engaging with and trying to resolve the housing issues of patients. But it was also to educate and upskill other staff to detect and act on housing problems, build relationships across systems and establish in-house housing expertise in hospital discharge and social work teams.

Housing workers were initially allocated to help patients whose housing situation was preventing them leaving hospital. They discovered the housing issues had only come to the fore at the point a patient was medically fit for discharge. The housing workers started attending ward rounds with social workers and medical staff, finding opportunities within routine enquiries for the right questions to be asked about potential housing problems and flagged earlier. They also built relationships with specific wards and attended discharge meetings.

Housing workers noted staff in hospital settings had limited understanding of housing and homelessness law, especially tenants’ rights. For example, they might accept a patient’s own understanding – or a landlord’s suggestion – that a tenancy could not be returned to, when, in fact, the person had a right to do so. Workers upskilled health and social care staff on systems, services and legislation, attending routine meetings to ask key housing questions, and creating step-by-step guides and resources.

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The outcome

Over 17 months, embedded housing workers received 422 referrals. Whilst the Trailblazer’s purpose was ‘upstream’ prevention, 50% of referrals concerned patients who were already homeless. A third of patients were threatened with homelessness in two months, with 17% at risk of homelessness beyond two months. Overall, workers achieved positive housing outcomes for 51% of referrals, with more success in the ‘prevention’ group: almost half were helped to secure alternative housing before discharge, and a smaller number to retain their previous housing - all avoiding homelessness.

From a hospital perspective, workers reduced delayed discharge by 38% in one NHS Trust and by 66% in another. In the mental health hospital, the project had a substantial positive impact, with individuals under section no longer placed out of area – which had been a large problem beforehand. The embedded housing worker led to ‘quick wins’ for both housing and health systems. Connection Support received continuation funding, partially from the NHS, for housing workers. From 2021, the service was commissioned on a long-term basis.

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Key insights

• whilst workers successfully put housing on the radar of hospital staff, high pressure and staff turnover/capacity in hospital settings points to an ongoing need for a housing expert on site
• operating as an embedded worker can be hard until the host team sees its value in practice - for example, a positive outcome for a patient, or saving staff time unpicking housing queries
• to break down barriers and forge relationships, embedding requires a face-to-face presence

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Find out more…

Mel Thompson, Team Manager: Embedded Housing Workers, Connection Support
melthompson@connectionsupport.org.uk