Empowering people who are homeless to rebuild their lives and thrive in society

“I remember the first time we met was at University College Hospital in central London where she was recovering. I was so shocked at hearing her stories – what she had to suffer on the street as a woman, how she had to constantly defend herself.”

Dr Michela Tinelli, a health and care economist at LSE’s Care Policy and Evaluation Centre, recalls meeting Jo Coombes, one of the many people with experience of homelessness she has met while researching with King’s College London to improve coordination between services that help homeless people rebuild their lives.

“Her story was so moving and I immediately understood the power of her messaging, the fact that she could communicate something that I couldn’t. She really connected with us, we became friends and eventually, because of our research and our support, she found somewhere to live – and then became a researcher for us.”

Learning from people’s firsthand experiences of homelessness

Ms Coombes, the first full-time peer researcher based at the NIHR (National Institute for Health and Care Research) Health & Social Care Workforce Research Unit at King’s, says: “Working with Michela and getting a job as a peer researcher at King's College London has changed my life.”

This extraordinary story shows how homeless people are very much at the centre of Dr Tinelli’s project, Care Quality Evaluation (CQE), a collaboration with charities such as The People’s Recovery Project, local authorities like Oxfordshire City Council, government bodies and other stakeholders. She has created a digital platform with a continuous flow of information to provide a more joined-up system of informed decision-making for care professionals, such as local authority housing departments, charities and health providers, as well as commissioners locally and nationally.

Dr Tinelli says Ms Coombes’s contribution has been vital in bringing an important perspective to her research and set the scene for the development of the project.

“Jo has been crucial in collecting data because people on the streets don’t want to talk to me because I’m an academic and very distant to them. They are immersed in such a painful situation that it’s difficult for them to open up. But she was able to go straight to them, talk about her experiences, her history, and they could very easily connect with her.

“Individual homeless people are at the core of everything I do and I rely on them at every stage of my research, for ideas, for feedback, for making sure everything works well.”

A powerful voice that draws on real-life experience

Ms Coombes has also helped Dr Tinelli to promote her research to academic colleagues and to organisations that help the homeless.

Dr Tinelli recalls: “I had a conference last year in Belgium and she came on the podium with me to present the research. Having her perspective on things was enormously powerful. And in a meeting with local stakeholders, when she described her situation. Wow! Everybody started listening more to us and to our research.”

Peter Moore, Programme Manager, Oxford City Council Out-of-Hospital Care Team, explains: “Data is crucial. We intend to use the CQE dashboard to enable us to measure systemwide outcomes and to show what impact we're having and really to help us build and commission integrated services.”

In the UK, we are seeing higher than ever numbers of people presenting as homeless. Rising economic hardship is a major factor, with many having lost jobs, suffering relationship breakdowns and poor health. On average, more than 3,000 people are sleeping rough every night, with some repeatedly admitted to hospital and dying premature deaths. There are multiple services involved – police, housing, health, charities – but it is a complex, uncoordinated system which is difficult to access, explains Dr Tinelli.

“Out-of-hospital care systems are disconnected. Everybody’s working in silos and there is limited sharing of information and collaboration between professionals. This means poor patient outcomes and a waste of money. We have terrifying numbers: we estimate that one individual can cost more than £20,000 a year but this can easily escalate to £70,000, so that’s £54 million to £200 million a year. This is what we want to tackle. We want to help service providers provide better services, better support for people.”

Providing the data to guide policy leads, local providers of services and commissioners

Commissioned by the Department of Health and Social Care, Dr Tinelli and her team conducted qualitative interviews with people experiencing homelessness, healthcare professionals and other out-of-hospital care providers. These enabled in-depth exploration of firsthand experiences of and insights into available services. They also conducted quantitative surveys of participants’ experiences and analyses of outcomes, such as rates of readmission to hospital or return to homelessness, and service delivery costs. Other surveys asked participants to choose between two hypothetical situations to work out preferences. This showed, for example, that having their own flat rather than living in a hostel makes people more likely to access health and social care services.

Using the insights gathered, Dr Tinelli is developing a digital platform – Care Quality Evaluation (CQE) - which allows policymakers, local service providers, and commissioners with data to visualise care quality, extract meaningful insights, and explore options for better outcomes and optimise resources.

It enables informed decisions based on present insights, instead of relying on published reports with outdated data. It also allows providers to benchmark themselves against national standards and exchange best practices.

Ed Addison, co-founder of The People’s Recovery Project, a charity which helps people experiencing homelessness and addiction, explains: "By mapping their journeys, analysing their societal costs, and comparing intervention costs over time, we aim to use the CQE dashboard to provide solid data. This evidence will illustrate the impact of timely treatment and support our anecdotal claims, enabling us to present concrete results to the national government.”

Dr Tinelli adds: “We have produced strong evidence in terms of cost-effectiveness, that this can be value for money and improve outcomes for people.”

She is now in conversation with local health and care providers and commissioners to provide the dashboards to out-of-hospital care providers throughout the UK. She is also appealing for more service providers to come forward to contribute data and benefit from the system as a management tool. Additionally, she encourages commissioners and policy leaders across the UK to use it for operational decisions.

She adds: “Our analysis also offers practical guidance for policymakers, informing them where to focus their efforts and resources to align with the preferences of those accessing and implementing these services. It will help to support decision-making for the health and wellbeing of the population at a national level.”

Dr Michela Tinelli was speaking to Joanna Bale, Senior Media Relations Manager at LSE.