In 2013 St. Luke’s (Cheshire) Hospice opened its doors wider to capturing people experiencing homelessness because it was unwarranted to ignore this ailing vulnerable group. Tobin et al., (2021. BMJ Support Palliat Care.) suggested hospices were not fully inclusive, supported by Hospice UK (2021), although they cited St. Luke’s as a ‘trailblazer’ for its homelessness service.

Homelessness exceeds its socio-economic or political problem as it impacts health and access to healthcare for an already marginalized group. The gaps within health and social care are easy for people experiencing homelessness to slip through, little recognition is given to individuals with competing priorities such as addiction. There is poor understanding around how unwell people experiencing homelessness are and how this is experienced at a much younger age.

Rogans-Watson et al. study (2021. Housing, Care and Support. 23: 77 ), in a UK hostel, found that the average age of a 55year old person experiencing homelessness was comparative to an 89 year old within the average population. Their findings also highlighted premature frailty, multiple morbidities and geriatric conditions. Homeless Link (2014) suggest these conditions can lead to premature death with heavy symptom burden at end of life.

The aim of St. Luke’s homelessness work is to increase access for palliative homeless individuals into services supporting them to live and die well. Methods used include case work by the homelessness lead, multi-agency meetings across Cheshire, teaching and training hostel staff, supporting hostel staff to manage someone very unwell, access to the 24 hour dedicated helplines at the hospices for the hostel staff, visits by hospice clinicians into the hostels and patient advocacy.

St Luke’s (Cheshire) Hospice commissioned an external evaluation between 2016 and 2019 reporting the success of the service. The homelessness lead seeks feedback in multi-agency meetings across the county, all training is evaluated and quarterly reports are prepared for external funders. The service has now grown and encompasses East Cheshire Hospice and Hospice of the Good Shepherd (Chester) thus spreading itself across the whole of Cheshire. The lead remains flexible, seeking to ensure services fit patients rather than contrarily.