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Step-Down Homeless Medical Care Pathway


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Mildmay Hospital is the first specialist unit to provide step-down medical care for the homeless population of London and other regions, addressing a huge unmet need for specialised medical care following treatment in an NHS hospital/acute centre.

This service provides rehabilitative healthcare for people who are homeless or rough-sleeping and recuperating from illness or injury.

It employs the medical leadership and personalised treatment and care provided by our multidisciplinary team to alleviate the burden on NHS hospitals.

Beds are available for homeless patients, with funding on a spot purchase basis, being referred by NHS hospitals/acute centres providing services and care in a ‘psychologically informed’ environment with a dual focus on convalescence and recovery and client-centred, coordinated planning for move-on.


"Hey Team,


I just wanted to pass on some feedback from two patients today.


  1. Patient has said they are grateful, finally feels safe and appreciates the warm and friendly welcome to your hospital.

  2. Patient said the team were great, and they loved their time spent at the hospital (they didn't want to leave!)"


Homeless Health Lead Nurse

Out of hospital care

Central London Community Healthcare

Homeless Pathway admission criteria

  • The service is intended for single homeless people, including rough sleepers, hostel-dwellers and those with no recourse to public funds, for whom discharge would be otherwise delayed because adequate care cannot be provided in their previous environment.

  • Funding is on a spot purchase basis

  • These are planned admissions, and patients are admitted Monday to Friday

  • When admitted, these patients access a wide range of therapies according to their needs, in addition to medical and nursing care.

  • Pathway teams are normally involved in all step-down referrals, although this may change in the future

  • Patients will be sufficiently recovered to no longer need high-cost acute medical or surgical hospital care but may still need medical and nursing care

  • Patients still need a further period of isolation and/ or convalescence and community care planning before a safe hospital discharge can be achieved

  • Once a planned discharge from Mildmay is arranged, patients will be further supported by specialist homelessness and social care charities such as Pathway.


To discuss or make a referral, please contact our Admissions Manager by telephone at 020 7613 6347 or by email:

Use the referral page to download forms for:
  • HIV Medical Referral

  • HIV Nursing

  • Homeless Medical Care Pathway

  • REBUILD Pathway

  • Social Care Questions for Admission


Service benefits

Our medical respite/rehabilitation services help to prevent serious illness and unplanned hospital admissions, making Mildmay more cost-effective than standard care.

Specialist medical and nursing care aims to meet the needs of people who are homeless with tri-morbidity, i.e. physical ill-health or injury complicated by a history of mental illness and problems related to substance misuse and possibly COVID-19.

We free up NHS beds and help homeless patients improve their health and likelihood of reintegrating into the community.

Goals and outcomes

Mildmay's aims are that:


  1. No rough sleepers die on the street

  2. No one is discharged from a hospital to the street

  3. There is equal and fair access to healthcare for those who are homeless.

Inpatient facilities

  • Twenty-eight ensuite single rooms (including two anti-ligature rooms)

  • Two wards, each with a communal lounge and fitted kitchens for patient use

  • A well-equipped physical rehabilitation centre

  • Occupational therapy assessment centre

  • Specialist therapeutic equipment

  • Laundry facilities

  • Tranquil courtyard garden

  • Digital Inclusion Room

  • Chapel

Mildmay’s Multi-Disciplinary Team

  • Medical Director

  • Art Therapist

  • Chaplain

  • Clinical Lead Nurse and a nursing team of Registered General Nurses and Healthcare Support Workers

  • Dietitian​

  • Housing Officer

  • Junior Doctors

  • Liaison Psychiatrist

  • Occupational Therapist

  • Physiotherapists

  • Psychologist

  • Social Worker and Counsellor

  • Speech and Language Therapist

  • Substance Misuse Recovery Worker

  • Volunteers

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Our purpose is two-fold:

1. To deliver better care and health outcomes for homeless patients

2. To make more efficient use of all available health resources by freeing up NHS acute beds and providing medical respite/rehabilitation for this vulnerable cohort, improving the likelihood of a safe and full recovery.

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