Hospital discharge for people experiencing homelessness is a perennial challenge. The Homeless Reduction Act 2017 (HRA) places new responsibilities on hospitals, but it remains unknown whether this has affected discharge practices. This qualitative study explores stakeholders' views on the challenges around hospital discharge for people experiencing homelessness, in the context of a deprived English city. Semi-structured interviews were conducted with 27 stakeholders. Participants were purposively recruited from local authority, third sector and the National Health Service. Interviews were transcribed and thematic analysis conducted. Analysis generated three main themes. First, a need for better planning and communication with the third sector, particularly around medication, prescriptions and information sharing. Second, the need to improve awareness and ‘upskill’ hospital staff to work more effectively with people experiencing homelessness, including understanding their needs, the wider support available and HRA requirements. Third, there were calls for (re)investment in a different approach to better support this population, based on outreach and flexibility. The need for improved partnership working and investment was emphasised. Whilst recognising the challenges faced by hospitals, especially within the context of funding cuts, this study highlights the need to recognise the third sector's contribution in supporting people experiencing homelessness in the community. Developing site-specific checklists for practice before discharge (and as early as possible) may help to ensure appropriate measures are in place. Improving legal literacy in the context of what an appropriate discharge is for people experiencing homelessness may help develop staff confidence to challenge the focus on ‘quick’ discharges.

中文翻译：

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资源有限情况下的无家可归、出院和挑战：对利益相关者关于如何在贫困环境中改善实践的看法的定性研究

让无家可归者出院是一项长期挑战。2017 年减少无家可归者法案 (HRA) 为医院赋予了新的责任，但尚不清楚这是否影响了出院实践。这项定性研究探讨了利益相关者对贫困英国城市中无家可归者出院所面临挑战的看法。对 27 名利益相关者进行了半结构化访谈。参与者是有目的地从地方当局、第三部门和国家卫生服务局招募的。访谈被转录并进行了主题分析。分析产生了三个主要主题。首先，需要与第三部门更好地规划和沟通，特别是在药物、处方和信息共享方面。第二，需要提高认识和“提高”医院工作人员的技能，以便更有效地与无家可归者一起工作，包括了解他们的需求、更广泛的可用支持和 HRA 要求。第三，有人呼吁（重新）投资一种不同的方法，以根据外展和灵活性更好地支持这一人群。强调需要改进伙伴关系工作和投资。虽然认识到医院面临的挑战，尤其是在资金削减的背景下，但这项研究强调需要认识到第三部门在支持社区无家可归者方面的贡献。在出院前（并尽可能早地）制定特定地点的实践检查表可能有助于确保采取适当的措施。