The UK is currently facing a hospital bed crisis, with the NHS struggling to meet the growing demand for care.
As hospitals across the country near full capacity, rising rates of flu, COVID-19, and other seasonal illnesses are pushing healthcare services to their limit. At the heart of this problem is the inability to discharge patients who are ready to leave hospital but have no safe place to go, particularly those who are homeless. This is where Mildmay Hospital, a charity providing its services solely to the NHS under contract, can play a unique and vital role in providing a solution.
Mildmay was the first unit in England to offer step-down medical care for people experiencing homelessness, a service that is urgently needed to address the cycle of homelessness, hospital admissions, and unsafe discharges. Our specialised inpatient care for people who are homeless or at risk of homelessness is designed to provide a crucial bridge between acute hospital treatment and recovery in the community.
The Revolving Door of Homelessness and Hospitalisation
Too often, homeless patients find themselves caught in a revolving door of hospital admissions and discharges, only to end up back on the streets without the medical and social support they need. The situation is dire: more than 32,600 homeless patients in England could benefit from step-down care each year, according to a recent report commissioned by the charity Pathway. These patients are often discharged prematurely, with nowhere safe to recuperate, leading to poor health outcomes and a high likelihood of re-admission to the NHS.
Pathway’s research highlights the clear need for intermediate care facilities where patients can recover in a safe environment after being discharged from hospital. Such services can help break the cycle of homelessness and ill-health while delivering significant cost savings to the NHS—an estimated £5,200 per patient.
The Impact on the NHS
The NHS is facing immense pressure. According to recent reports, 95% of hospital beds were occupied at the start of December 2024, a figure normally seen only in the depths of winter. Hospitals are full, and ambulance handover delays are at critical levels, with two-thirds of patients facing prolonged waits to be transferred from ambulances to A&E. These delays are a symptom of the deeper crisis: hospitals cannot discharge patients who are ready to leave because there is nowhere for them to go. For homeless patients, this often means being discharged back onto the streets, worsening their health and increasing the likelihood of re-admission.
Patients who are homeless are six times more likely to use A&E services, four times as likely to be admitted to hospital, and will stay twice as long as those with stable housing. These figures underscore the need for a new approach to care for homeless patients, one that prioritises recovery in a safe and supportive environment.
Mildmay’s Unique Role in Step-Down Care
Mildmay Hospital offers a proven solution to this problem. Since 2020, we have been providing ground-breaking step-down medical care, stabilisation, and rehabilitation for homeless patients transitioning from acute medical treatment. Our services help ease the strain on NHS hospitals by freeing up beds, shortening waiting lists, and allowing hospitals to focus on the most urgent cases.
Our multidisciplinary team of doctors, nurses, and therapists work together to deliver compassionate, specialised care for patients who have no home to return to. This care is tailored to the complex needs of homeless individuals, who often face a combination of mental health issues, physical illness, and substance misuse. Mildmay provides a safe place for recovery, giving patients the time and support they need to heal before transitioning to more permanent housing solutions with the help of partner organisations such as Pathway.
A Cost-Effective Solution with High Returns
The benefits of providing step-down care extend beyond improving patient outcomes. The Alma Economics report commissioned by Pathway found that an investment in intermediate care facilities could save the NHS millions of pounds in unnecessary re-admissions and prolonged hospital stays. The report estimates that every £1 invested in this type of care returns £1.20 in financial savings and £4.30 in societal value. This is not only a moral imperative but also an economically sound solution to the current healthcare crisis.
Mildmay’s step-down care programme is already making a difference. By addressing the unmet medical needs of homeless patients and preventing unsafe discharges, we are helping to reduce the burden on the NHS while giving vulnerable individuals a much-needed chance at recovery and stability.
Conclusion: A Call to Action
The NHS is facing an unprecedented crisis, with hospitals stretched to their limits and thousands of patients in desperate need of care. Mildmay Hospital is uniquely positioned to help alleviate this pressure by providing essential step-down medical care for homeless patients. Our services not only improve patient outcomes but also deliver significant cost savings to the NHS, making it a win-win solution for healthcare providers and society at large.
As the government continues to develop its homelessness strategy, we urge policymakers to recognise the critical importance of step-down care in addressing both the healthcare and housing needs of homeless patients. Mildmay has shown that with the right support, we can help break the cycle of homelessness and hospitalisation, offering a path to recovery for some of the most vulnerable people in our society.
By investing in step-down care, we can create a more efficient and compassionate healthcare system, one that ensures no one is left behind when they need help the most.
Mildmay’s vital work supporting homeless patients is only possible through the generosity of our donors. Together, we can make a lasting impact on the lives of vulnerable individuals and help ease the strain on the NHS.
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