Exploring the impact of a housing support service on hospital discharge: a mixed-methods process evaluation in two UK hospital trusts

Delayed discharge from hospital is a global healthcare problem with negative impacts on patient outcomes and the wider health system. Delays to discharge can arise when a patient remains in hospital even when they are medically fit due to nonmedical reasons such as a lack of appropriate housing or social care. However, whilst several nonmedical interventions have been developed to facilitate timely hospital discharge, there remains a lack of evidence on their impact. This study reports on findings from a mixed-methods process evaluation of a newly integrated housing and health service in two United Kingdom- (UK-) based hospitals (one mental health hospital and one general hospital). The service involved housing support coordinators (HSCs) being based within hospitals and supporting inpatients with their housing-related needs. We employed qualitative interviews with service users and hospital/housing staff (N = 16) and routine data analysis (n = 488) to understand the impact of the service and any challenges to service delivery. Service users faced different housing barriers, for example: 28.3% experienced homelessness (n = 136) whilst 80 (16.4%) faced challenges with their accommodation no longer meeting their physical needs. Service users received support for a variety of issues such as assistance with medical priority applications, support to apply for social housing, and referral to other support services. Healthcare professionals at all levels credit the service for improving hospital discharge processes and reducing stress on clinical staff, enabling them to concentrate more effectively on clinical tasks. Key to success is experienced housing staff providing patient-centred support, being integrated within a multidisciplinary team with management and oversight from the health service, and the availability of appropriate housing stock and wider services to support people after discharge. Our findings indicate that other hospitals may benefit from implementing similar housing and health integrated services

Thresholds for adding degraded tropical forest to the conservation estate

Logged and disturbed forests are often viewed as degraded and depauperate environments compared with primary forest. However, they are dynamic ecosystems1 that provide refugia for large amounts of biodiversity2,3, so we cannot afford to underestimate their conservation value4. Here we present empirically defined thresholds for categorizing the conservation value of logged forests, using one of the most comprehensive assessments of taxon responses to habitat degradation in any tropical forest environment. We analysed the impact of logging intensity on the individual occurrence patterns of 1,681 taxa belonging to 86 taxonomic orders and 126 functional groups in Sabah, Malaysia. Our results demonstrate the existence of two conservation-relevant thresholds. First, lightly logged forests (68%) of their biomass removed, and these are likely to require more expensive measures to recover their biodiversity value. Overall, our data confirm that primary forests are irreplaceable5, but they also reinforce the message that logged forests retain considerable conservation value that should not be overlooked

Thresholds for adding degraded tropical forest to the conservation estate

Logged and disturbed forests are often viewed as degraded and depauperate environments compared with primary forest. However, they are dynamic ecosystems1 that provide refugia for large amounts of biodiversity2,3, so we cannot afford to underestimate their conservation value4. Here we present empirically defined thresholds for categorizing the conservation value of logged forests, using one of the most comprehensive assessments of taxon responses to habitat degradation in any tropical forest environment. We analysed the impact of logging intensity on the individual occurrence patterns of 1,681 taxa belonging to 86 taxonomic orders and 126 functional groups in Sabah, Malaysia. Our results demonstrate the existence of two conservation-relevant thresholds. First, lightly logged forests (68%) of their biomass removed, and these are likely to require more expensive measures to recover their biodiversity value. Overall, our data confirm that primary forests are irreplaceable5, but they also reinforce the message that logged forests retain considerable conservation value that should not be overlooked

Thresholds for adding degraded tropical forest to the conservation estate.

Acknowledgements: This study was supported by funding to the Stability of Altered Forest Ecosystems Project by the Sime Darby Foundation. Research permission and site access were provided by the Maliau Basin Management Committee, the Sabah Foundation, Benta Wawasan, Sabah Softwoods, the Innoprise Foundation, the Sabah Forestry Department and the Sabah Biodiversity Centre. R.M.E. is supported by the NOMIS Foundation. Data collection was financed by Australian Research Council grant DP140101541; Bat Conservation International; the British Council Newton-Ungku Omar Fund 216433953; British Ecological Society grant 3256/4035; the Cambridge Trust; the Cambridge University Commonwealth Fund; the Czech Science Foundation (14-32302S); the European Research Council (281986); the European Social Fund and the Czech Republic (CZ.1.07/2.3.00/20.0064); the Fundamental Research Grant Scheme (FRG0302-STWN-1/ 2011), Ministry of Higher Education, Malaysia; FFWS CZU (IGA number A_26_22); the Jardine Foundation; Malaysia Industry Group for High Technology (216433953); the Ministry of Education, Youth and Sports of the Czech Republic (INTER-TRANSFER LTT19018); the Panton Trust; the Primate Society of Great Britain; ProForest; Royal Society of London grant RG130793; the Sime Darby Foundation; the S. T. Lee Fund; the Sir Philip Reckitt Educational Trust; the Tim Whitmore Fund; the Universiti Malaysia Sabah; the University of East Anglia; the University of Kent; the University of Florida Institute of Food and Agricultural Sciences; UK Research and Innovation Natural Environment Research Council grants NE/H011307/1, NE/K016253/1, NE/K016407/1, NE/K016148/1, NE/K0106261/1, NE/K015377/1, NE/L002515/1, NE/L002582/1 and NE/P00363X/1 and studentship 1122589; the Varley Gradwell Travelling Fellowship; and the World Wildlife Fund for Nature. Data collection was supported by R. Adzhar, A. Afendy, N. Arumugam, S. Benedick, V. Bignet, S. Butler, K. Graves, H. E. Hah, H. Heroin, A. Kendall, H. H. Mahsol, D. Mann, J. Miller, S. Milne, J. Mumford, D. Norman, H. Rossleykho, D. Shapiro, K. Sieving, J. Sugau, B. Udell, B. E. Yahya and M. A. Zakaria.Logged and disturbed forests are often viewed as degraded and depauperate environments compared with primary forest. However, they are dynamic ecosystems1 that provide refugia for large amounts of biodiversity2,3, so we cannot afford to underestimate their conservation value4. Here we present empirically defined thresholds for categorizing the conservation value of logged forests, using one of the most comprehensive assessments of taxon responses to habitat degradation in any tropical forest environment. We analysed the impact of logging intensity on the individual occurrence patterns of 1,681 taxa belonging to 86 taxonomic orders and 126 functional groups in Sabah, Malaysia. Our results demonstrate the existence of two conservation-relevant thresholds. First, lightly logged forests (68%) of their biomass removed, and these are likely to require more expensive measures to recover their biodiversity value. Overall, our data confirm that primary forests are irreplaceable5, but they also reinforce the message that logged forests retain considerable conservation value that should not be overlooked