Putting the NICE guideline on homelessness to work

We are often told it can take 17 years for evidence from empirical medical research to translate into clinical practice. This is an average figure, of course. And the gap or time lag between generating high quality scientific evidence and incorporating it into routine patient care spans many complexities.

The principle holds, however. Progress can be slow, however strong the evidence, and is seldom linear. And this principle can extend beyond primary research. 

Translating insights from robust research trials into frontline practice and system design is central to the purpose of the Centre for Homelessness Impact: our mission is to to accelerate an end to homelessness by acting as a catalyst to encourage better use of evidence and data.

We were pleased to work in partnership with the National Institute for Health and Care Excellence (NICE) to co-produce its first guideline on integrated health and social care for people experiencing homelessness, published in 2022. Our role included sharing knowledge from the current research base on health and homelessness, through our Evidence and Gap Maps, and providing prompts and constructive challenge including by encouraging a greater focus in the guideline on mental health.

We think it’s an excellent guideline with many important recommendations: it encourages a person-centred engagement approach with people affected by homelessness, delivery in an empathetic non-judgmental manner and communicated in a way that suits the individual. It says services should consider giving people experiencing homelessness longer appointments and priority on waiting lists and says care professionals should recognise that an individual’s behaviour and engagement with services may be influenced by past trauma, poverty and previous bad experiences with authority.

And yet, we now face a different problem. Some clinicians and people who design and deliver care are doing great work to put the guideline’s recommendations into practice. But around 1.4 million people work in the National Health Service in England and another 1.6 million in social care. And it appears that many care professionals just don’t yet know we have a guideline of best practice, supported by evidence, for care for people impacted by homelessness.  

Very limited knowledge of the guideline was found in a consultation with 49 local authorities in England last year by the Office for Health Improvement and Disparities, part of the Department of Health and Social Care.

We didn’t want a repeat of the ‘17 year rule’ with this ground-breaking guideline: an unacceptably long time lag between evidence-based recommendations to improve care being published and put into practice. We want to see it put to work.

So in January 2023 we published an implementation manual to support practitioners to use the guideline in their work, with step-by-step advice and check lists on how to follow key recommendations in different disciplines, case studies of good practice and links to resources.

Peer influencing

Now we’ve done more. We are sharing a series of short films to raise awareness of the guideline and how it can support care professionals in their work and deliver better access and outcomes for patients. We have used the principle of peer influencing: evidence shows we tend to listen to people who do similar things to us and understand our challenges. So in the films, care professionals talk at their places of work about how they use the guideline.

We targeted four discrete audiences, and made a separate film aimed at each. 

One is front line workers and clinicians in mainstream services, such as accident & emergency departments and GPs’ surgeries. A second is front line professionals in adult social care such as social workers with multidisciplinary experience, day care centre teams and local authority housing staff.

A third audience is commissioners of services, especially those combining health and housing and including mental health services. And a fourth is strategic senior leaders, who take a whole-system view of health and social care in their services and may have less experience of homelessness and inclusion health, such as chief executive of health trusts and care providers and directors of public health.

And in each film we embedded the patient voice: testimonies from people with personal experience of homelessness who describe what it is like to have poor care or to navigate systems that can feel hostile, or at least unwelcoming.  

We found professionals who work in each audience group to take part and filmed them while on shift. Making the films took us to a busy accident and emergency department at a general hospital in Gloucester; to a mental health assessment team in south London; to a specialist GP service in Bristol; to a large community health trust based in Doncaster; to a homelessness drop-in service in Windsor; and to a local authority in inner London. We are grateful to all of them, and to many others who offered to take part.

We encourage people working in health and social care, and in homelessness services, to watch these films and to raise awareness of the NICE guideline by sharing the films with professional networks. You can find them on our YouTube channel.

If this happens, there is every chance that we won’t need to wait 17 years for people impacted by homelessness to access and benefit from high quality, personalised health and care when they need it.

* Greg Hurst is Director of Communications and Public Engagement at the Centre for Homelessness Impact‍