Award-winning homelessness project keeps on showing the way forward

The Lewisham division of HPLAS is a collaboration with three different hospitals: University Hospital Lewisham, South London and Maudsley Hospital, and Queen Elizabeth Hospital in Greenwich.

HPLAS is a Health Justice Partnership and takes a holistic legal approach, meaning it is set up to resolve legal problems which cluster. A typical HPLAS client has immigration, housing and welfare benefits problems that are interlinked.

When you break it down it’s easy to see why: lack of valid immigration status might mean no access to work or state support. This might mean no income and no access to housing. The person is trapped. They might have an underlying health condition, or their circumstances now cause one; they end up in hospital.

Hospitals have a duty of care to patients; they cannot discharge them to street homelessness. The problem this results in is ‘bed blocking’—taking up valuable NHS inpatient resources (those for patients staying in hospital overnight) when the person would be better treated as an outpatient. Inpatient services are typically much more expensive than outpatient services—in 2020, it was estimated that one night on a general ward costs over £500. HPLAS works to build a stable future for patients who are stuck in these situations. Its effectiveness has been proven in Southwark, and now in Lewisham:

• All patients referred to the project were discharged into accommodation—none were discharged to street homelessness.

• In year 1 of the project, 90% of patients (19) had been admitted to University Hospital Lewisham (as inpatients) in the 6 months prior to referral, staying a combined length of 532 days. Following referral to the project, only 2 patients were admitted.

The project has therefore contributed to a shift from the use of high-cost hospital resources to low-cost hospital resources, all while securing better outcomes for patients. Take the case of HPLAS client, Bayo:

Bayo’s case provides an insight into the complex situations facing HPLAS clients, which can take a long time to resolve. Some people in the health system need more help than others, and not all of it is medical.

HPLAS has stopped being an experiment and is starting to be recognised as a service model to deliver on the NHS's overarching aim of reducing health inequalities. To build a stronger NHS and a healthier society, it is imperative that Health Justice Partnerships form a part of normal service delivery.

Georgina O'Reilly, Immigration Solicitor at Southwark Law Centre, said:

"I firmly believe the patients who were assisted would not have received legal advice without the existence of this project, and this may have impacted on their ability to access treatment, housing, financial support, social care, and prevent exploitation from others."

Read the full evaluation report.

For media enquiries, please contact media@lawcentres.org.uk.

Lewisham University Hospital (Gilo1969, CC BY-SA 3.0, via Wikimedia Commons)