People experiencing homelessness in England face significant healthcare challenges. They have complex needs, a high frequency of visits to hospitals, and require longer inpatient stays. They are also likely to experience street or unsafe discharge, where patients who are medically optimised are released from hospital care without access to a safe and appropriate place to recuperate. This causes poor health outcomes and leads to repeated hospital admissions, with future support provided through unscheduled Accident and Emergency (A&E) visits. Besides creating avoidable strain on the health of patients, unsafe discharge and the associated readmissions also create additional pressure and costs on the NHS.
To address the issue of unsafe discharge and reduce the burden on healthcare services, Pathway has proposed the scaling up of specialist intermediate care facilities across England. These facilities would offer a transitional healthcare solution to bridge the gap between hospital care and stable housing for patients experiencing homelessness, providing temporary medical and social care support.
In this context, Alma Economics was commissioned to conduct a cost-benefit analysis of the proposed initiative, through the estimation of both the financial and societal impact of a nationwide programme for specialist intermediate care. The needs, costs and benefits were estimated through desk-based research, using existing literature and reports, as well as data from existing facilities that provide intermediate care across England.
We considered both the fixed costs related to setting up the facilities, as well as the semi-variable costs (e.g., rent, utilities) and variable costs (e.g., staff costs) associated with operating the facilities. With regards to benefits, we considered four types:
Cost savings associated with reducing street discharges, moving away from unplanned emergency services, and increasing the use of planned outpatient services, which have a lower cost.
Cost savings associated with minimising delayed hospital discharges.
Costs related to other public services such as criminal justice system, housing services, mental health services, and social care.
Non-financial benefits associated with the improved quality of life of patients receiving intermediate care.
Our analysis suggests that over a 10-year horizon, our cost-benefit analysis suggests that an investment of £1.1 billion into the programme will generate cumulative financial benefits of £1.3 billion and societal benefits of £4.7 billion. This indicates a positive return on investment (ROI), with every £1 invested returning £1.20 in financial savings and generating £4.30 in societal value.
The report is available here.
