Outline of the study.

This practical implementation resource accompanies the NICE guideline on integrated health and social care for people experiencing homelessness. It provides real-world examples, case studies, and tools to help practitioners and commissioners deliver coordinated care to address health inequalities faced by people experiencing homelessness.

Findings in brief
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• People experiencing homelessness have far worse health outcomes than the general population, including much lower life expectancy. People experiencing homelessness are more frequent users of acute hospital services and emergency care and often have longer hospital stays, due to multiple unmet needs being identified upon admission
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• Significant barriers prevent people experiencing homelessness from accessing and engaging with services, including: stigma and discrimination, lack of trusting relationships with professionals, fragmented services with strict eligibility criteria, and poor information-sharing between service providers. These also mean that problems are often not addressed until they become severe and complex
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• Targeted approaches and additional resources are essential to ensure that health and social care services for people experiencing homelessness are available, accessible and of good quality, to address health inequalities and poor outcomes
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• Co-design and co-delivery with people with lived experience of homelessness builds trust and self-efficacy and improves service quality ‍
  
  
• Multi-disciplinary approaches are more effective when teams include healthcare professionals, social workers, housing officers, outreach practitioners, voluntary sector professionals, and experts by experience, and offer wraparound support ‍
  
  
• Outreach services on the streets, in hostels and day centres increase flexibility, trusting relationships, early identification of health problems and offer a more efficient way to address these.

Recommendations in brief
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• Build trusting relationships though implementing person-centred, psychologically-informed and trauma-informed care and longer contact times with service users ‍
  
  
• Ensure sufficient resource allocation and establish joint planning and commissioning across health, social care and housing services, including comprehensive local homelessness health and social care needs assessments
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• Develop specialist multidisciplinary teams for people experiencing homelessness, which offer case management, wraparound support and continuity of care across all health and social care needs
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• Expand outreach support, low-threshold and flexible services, such as drop-ins, one-stop shops, self-referral systems, and care navigation support
  
  
• Ensure that people experiencing homelessness can register with a GP without requiring an address
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• Ensure effective transitions between support providers and settings through designated key practitioners, handovers, safe hospital discharge procedures and offering intensive time-limited support
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• Provide comprehensive training for staff working with people experiencing homelessness, including: understanding health needs, trauma-informed care, legal duties and entitlements, equality and diversity issues; offer regular supervision and reflective practice sessions.

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