Published: Friday, 15 September 2023

Oxford City Council has approved a £1.2m investment in a trailblazing project preventing homelessness and hospital readmissions for people at risk of rough sleeping.

On Wednesday (13 September), cabinet agreed to receive £1,213,038 in funding from the NHS Better Care Fund (BCF) to support the Oxfordshire Out of Hospital Care (OOHC) model until March 2024.

This model is a partnership between the NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board, Oxford City Council and Oxfordshire County Council. It provides an integrated approach between housing, health and social care which aims to:

  • prevent discharge to the street and associated readmissions
  • reduce hospital admission and attendance
  • increase support being met in the community
  • prevent rough sleeping and homelessness

How it works

Delayed transfer of care is a particular issue for homeless people on acute mental health wards where they have nowhere to complete their recovery and cannot be discharged.

The experience of homelessness takes a significant toll on people’s health and wellbeing. In a 2019 government survey, four-fifths (82%) of people experiencing rough sleeping reported unmet mental health needs.

This human cost has a wider impact on public services as people find it hard to access and engage with healthcare and other services in the community. People who experience homelessness are 60 times more likely to visit A&E in a year than the general population.

To tackle these issues, the OOHC model uses ‘stepdown’ houses, which provide short-term housing for people who are ready to be discharged. Specialist housing workers help NHS staff unravel complex cases and provide better housing and homelessness prevention support for their patients – for example, in discharge planning and coordinating services.

A preventative team also prevents homelessness and hospital readmission – including use of A&E – by ensuring people receive support in the community, helping them to sustain their tenancies and access services.  

Trailblazing results

There have been more than 200 planned discharges under the OOHC model, with half of these from mental health wards. The use of stepdown housing has resulted in:

  • a 24% reduction in A&E admissions
  • a 56% reduction in A&E presentations
  • a 155% increase in outpatient visits

More than a fifth (22%) of people using stepdown housing were experiencing rough sleeping before they were admitted to hospital. Only one person has returned to rough sleeping and there have been no new cases of people becoming street homeless.

The preventative team has supported 135 people in the community. Of these:

  • 44 people (33%) have stayed out of hospital, breaking the cycle of readmission
  • 59 people (44%) have increased their engagement with healthcare and treatment services
  • 50 people (37%) at acute risk of eviction and homelessness have maintained their accommodation

As well as delivering better outcomes for people, the OOHC model helps reduce pressure on public services. The government estimates the average public cost of someone experiencing rough sleeping at £12,260 a year.

An interim audit of OOHC by King’s College London (KCL) identified around £1.3m in public cost savings over a 10-month period in 2021. A full evaluation of the national BCF programme by KCL is expected later this month.


“The OOHC model is an outstanding example of partnership working. It shows how housing, health and social care can work together to improve housing and mental health outcomes for people who are homeless or at risk of homelessness. 

“Although the vast majority of people experiencing rough sleeping report unmet mental health needs they often can’t access the help they need. OOHC is providing community support that helps people maintain tenancies, move on from rough sleeping and prevent avoidable readmission to hospital. 

“Preventing hospital readmission and tackling the issue of people being stuck on acute wards because they have nowhere to complete their recovery doesn’t just benefit individuals – it helps relieve pressure on the NHS.”

Councillor Linda Smith, Cabinet Member for Housing

“This is a great example of Oxfordshire’s partners working collaboratively to support homeless people in our county. This new round of investment will enable the Oxfordshire Out of Hospital Care programme to support even more vulnerable people to access medical care and offer a safe environment for them to continue their recovery.”

Daniel Leveson, Place Director for Oxfordshire at BOB ICB

Karen Fuller, Interim Director for Adult Social Care at Oxfordshire County Council

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