Helping to address delayed discharges in South London: the HAWK/SLaM service

Overview

Patients are supported to move on from hospital to either supported living, the private rented sector, council properties or hostel accommodation. They are helped to access funding, legal advice, benefits and other services.

Since launching in February 2017, more than 200 patients in Croydon have been supported with housing, which has allowed them to leave hospital quicker.

The challenge and the context

In early 2017, South London and Maudsley NHS Foundation Trust (SLaM)’s acute inpatient services were experiencing significant pressures to meet the demand for inpatient beds. The number of available acute admission beds had significantly reduced, and the use of overspill beds had increased. Reducing overspill and minimising delays in discharge had become a key trust priority.

Croydon inpatient services were under considerable pressure to meet the demand for inpatient beds due to delays in discharging patients.

A trust-wide audit ¹  revealed that Croydon acute inpatients had the highest mean length of stay, at 60.5 days. Meanwhile, almost one-third of Croydon inpatients experienced lengthy inpatient stays of over 61 days, with many experiencing difficulties with housing or homelessness.

Insecure housing is often cited as reason for patients being admitted to hospital. The Crisp report (2016) found that 16 per cent of patients on acute wards were delayed discharges, and that 49 per cent of these patients could not be discharged due to a lack of suitable housing.

In 2017, Croydon Council’s public health report suggested that from 2014 to 2017, the number of homeless people in Croydon has increased by 22 per cent. By comparison, the London average was 7 per cent during the same timescale.

We know that housing is an essential component of the recovery pathway, and that actively integrating housing into the pathway has been shown to reduce delays. However, accessing housing and negotiating the obstacles to obtain secure housing is complex.

Inevitably, patients need advice and support to navigate the system, yet most mental health professionals would not have the knowledge and expertise to support patients. Incorporating housing expertise within the multi-disciplinary team is one way of addressing these issues.

What the organisation did

In response to this, SLaM commissioned a new specialist service to be based within Bethlem Royal Hospital to work alongside clinicians and the current discharge team.

Launched in February 2017, Look Ahead were commissioned to the deliver the service. It involves Look Ahead housing and advice workers (HAWKs) working with patients with mild to severe mental health needs, who are experiencing housing problems that are leading to delays in discharge.

Patients are supported to move on from the hospital to either supported living, the private rented sector, council properties or hostel accommodation. They are helped to access funding, legal advice, benefits and other services; and once they move into their new accommodation, to sustain their tenancies or placements.

Results and benefits

Since launching in February 2017, more than 200 patients in Croydon have been supported with housing, which has allowed them to leave hospital quicker. In March 2018, the pilot was extended and expanded to include four staff working across hospitals in Southwark, Lambeth and Lewisham – so far they have had more than 60 referrals.

Key to the service’s success are the relationships the HAWK team has built. These include those it has established with the home treatment team (HTT), Croydon Council’s support needs assessment and placement (SNAP) team, clinical consultants, the community mental health team, other housing providers, and hospital wards – all of which facilitate patients’ access to housing.

On average, one in four patients admitted and discharged from the Croydon wards over the period of the pilot had been referred to the HAWK service due to their housing difficulties. Referrals to the HAWK service ranged between 50 per cent and 13 per cent of Croydon inpatient admissions per month, averaging 25 per cent of all Croydon inpatient admissions between February 2017 and March 2018.

The following quotes provide feedback on the HAWK service from a clinical perspective:

• “I cannot overemphasise the value of having a HAWK specialist available to us. Housing issues with mental health are vastly complex and require inter-working between multiple agencies…
• "Expecting clinical staff to do this in addition to our current duties would not only reduce clinical engagement, but put a further strain on resources… [The HAWK service] it’s worth its weight in gold, should be continued and spread to other parts of the trust.” Ward manager.
• “The HAWK team made a big difference in terms of getting patients with housing issues discharged earlier… it’s been a significant part in keeping patient flow going and reducing private overspill.” Consultant psychiatrist.

Overcoming obstacles

As a new service there was inevitability a period of time required to build relationships and engagement with staff. From the outset, the HAWK workers were based in the hospital and had access to IT and other infrastructure necessary to be an integrated part of the team.

Key learning

• There is a joint respect for the role that both parties play in this service. The doctors and nurses appreciate that the HAWK workers help them to do their job.
• Treat the service as an extension of your own service. The HAWK workers are an integral part of the discharge team and attend team meetings, as well as case meetings with patients.
• Recruit specialists. Look Ahead ensured that the HAWK workers recruited had expertise in housing advice and law, welfare benefits, rent arrears, debt management, financial abuse, harassment and domestic abuse.
  
  Additionally, the HAWK workers are expected to have knowledge of mental health issues, substance misuse/harm minimisation, support planning, lone working, health and safety, dealing with challenging behaviour, and adult and child safeguarding.
  
  Look Ahead is responsible for providing relevant training and ensuring the personal development of the HAWK workers throughout the pilot.
• Build trust and work in partnership. The success of HAWK service is down to its ability to work collaboratively with stakeholders. HAWK is very well known within the health and housing professional teams in Croydon.

Takeaway tips

• Appreciate that housing is an area of expertise that NHS staff can have difficulty navigating.
• Engage the service’s stakeholders in the commissioning and design of the service.
• Agree clear outcome measures at the outset in order to enable easier evaluation.
• Evaluation should be both quantitative and qualitative, and include the service’s impact on patients’ length of stay, as well as financial savings.

Want to find out more?

Get in touch with Irmani Smallwood, director of new business and innovation, at irmanismallwood@lookahead.org.uk