Understanding and tackling frailty among homeless and vulnerable people in Lewisham
A new initiative is being developed in Lewisham to improve support for people experiencing homelessness and other vulnerable residents. The project aligns with the neighbourhood health development and recognises the increased risk of frailty within this population.
Led by Pathway, the homeless and inclusion health charity, in partnership with NHS South East London Integrated Care Board and Lewisham Council, the project is funded by the London Homelessness Foundation.
People experiencing homelessness often have health profiles that mirror the priority populations identified within neighbourhood health programmes, including high levels of multi-morbidity, complex health needs and frequent use of healthcare services. However, these challenges are typically experienced at a much younger age and are compounded by barriers to accessing mainstream health and care services.
Working closely with clinicians, commissioners, voluntary and community sector partners, and people with lived experience of homelessness, the project will provide valuable insight into how local frailty services are meeting the needs of this group. Using a bespoke assessment framework designed specifically for people experiencing homelessness, the project will also deliver training for frontline staff working in hostels, temporary accommodation, day centres and other support settings.
The project responds to recent research by Pathway Fellow Jo Dawes at UCL, showing high levels of frailty among people facing homelessness.
Alex Bax, Chief Executive Officer at Pathway said:
“We are delighted to have received this funding from the London Homelessness Foundation to develop a way of responding to frailty among people facing homelessness. Shockingly, 45% of people facing homelessness under the age of 59 are frail. This project aims to show how new neighbourhood health services can address the national priority on frailty while meeting the needs of their most underserved population.
The London Borough of Lewisham and South East London ICB have been ahead of the curve in recognising that responding to frailty in this population can’t wait for old age. Their willingness to test new approaches, and to put their weight behind a partnership that puts inclusion health at the centre of neighbourhood health, is exactly the kind of local leadership we need. We’re proud to be working with them, alongside the local voluntary and community sector.”
A comprehensive system mapping exercise, gap analysis and stakeholder engagement programme will identify opportunities to strengthen local frailty support, particularly for individuals who experience frailty but do not meet the age-based eligibility criteria for existing services.
By taking an in-depth look at both the needs of this population and potential service delivery models, the project could generate wider benefits across the health and care system. For example, learning from this work may help inform support for housed residents living with multiple long-term conditions who also experience significant frailty at a younger age. Applying a homelessness lens offers Lewisham a unique opportunity to test the impact of targeted frailty interventions on outcomes such as A&E attendances, hospital admissions, long-term condition management, and drug and alcohol-related harm.
Jack Howell, Delivery Manager, South East London ICB, said:
“We are excited to be working alongside Pathway and our partners on this important piece of work. People experiencing homelessness often develop frailty much earlier than the general population, yet traditional services are not always designed around their needs. This project gives us an opportunity to test a different approach; one that brings together health, care, housing and community partners to provide more proactive, person-centred support. We hope the learning from Lewisham will help shape future neighbourhood health models, ensuring they are inclusive, equitable and effective for some of our most vulnerable residents.”
Ian Brady, Executive Chair at LHF said:
“We are very proud at LHF to be able to support Pathway. This is an innovative pilot project targeting vulnerable people and bringing together health, social care and local government expertise and resources. We look forward to hearing about the team’s progress and achievements.”