Background Across Britain 227,000 households experience the worst forms of homelessness. The national prognosis for a homeless person is 45 years of age. In Newcastle it is just 42. Marie Curie acknowledges the inadequacies of end of life care outside of those we reach directly, and the team at Marie Curie Newcastle decided to focus on expanding the boundaries of the hospice. As a consequence the team developed an outpatient service to address the needs of this often overlooked population.

Method Individuals identified for inclusion in the service were: homeless adults and those with a relevant past medical history. Homeless persons could also be included if they are considered to have a life expectancy of 6 months or less in the absence of diagnosed conditions. The service narrowed its focus further to those in hostel environments focusing on 7 in Newcastle City Centre.

Results The team enrolled 14 people appropriate to access the service. 3 suffered from cancer or suspected cancer, 9 suffered from other chronic health conditions, 1 had a strong history of sudden cardiac death, and 7 had multiple comorbidities. Service development focused initially on building rapport, and now provides psychological support around historical and current trauma, grief and substance misuse. Practical support included using the hospice outpatient setting for blood tests, ECGs and provision of a home nebuliser machine to reduce hospital admissions. Finally the service has provided the opportunity to engage in ACP discussions as well as to move two people from the hostel to care facilities.

Conclusion The service has faced many barriers in its development, including a lack of trust in institutions, nomadic lifestyles and the taboo of the hospice environment. As a result, at present the service mostly functions by visiting individuals in the community. In the future we hope that the service will be able to reach more people and help to begin to address the health inadequacies in our region.