Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes. Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group).Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0).  The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600).  The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512).Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.

Cases of holoprosencephaly which occurred in the west ofScotland over the past 20 years were ascertained from genetics, paediatric, and pathology department records. Fifty cases were identified of which 17 had an underlying cytogenetic abnormality. Of the remaining 33 cases, 26 were delivered after 28 weeks' gestation giving a birth prevalence of 1 in 26 730. Twenty-one babies were liveborn and nine children are currently alive. All survivors are profoundly mentally retarded and most have seizures. Twenty-eight patients with non-chromosomal holoprosencephaly had a total of 23 sibs and three families were identified where there was either recurrence of holoprosencephaly (one family), a related cerebral malformation (one family), or mental handicap (one family) giving an overall recurrence risk for serious neurological disability of 12% (standard error 7%). We conclude that holoprosencephaly does not necessarily breed true and this observation should be taken into account when giving genetic counselling and attempting ultrasound prenatal diagnosis after the birth of an affected child (JMed Genet 1996;33:578-584)

Most of these originated in the UK or the USA and fell within the realist quality rating of "thick description". The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements.First, that "psychologically informed" approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not "handed over" at the point at which the intermediate care episodeends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis-à-vis the prevention of readmission to hospital. schemes and empirical research on these is emerging. | INTRODUCTIONThe paper begins with an overview of these recent developments in intermediate care for people who are homeless. We then outline the search strategy and the methods used to synthesise the literature on homelessness, before discussing how this additional evidence "speaks" to the conceptual framework for intermediate care proposed by Pearson et al. (2013Pearson et al. ( , 2015. In the final section, we draw out the implications for service development and future research, and also make recommendations about possible refinements to the original conceptual framework. This review is reported in accordance with the RAMESES publication standards for realist reviews (Wong, Greenhalgh, Westhorp, Buckingham, & Pawson, 2013). Long-term homelessness is characterised by "tri-morbidity", the combination of mental ill-health, physical ill-health, and drug and alcohol misuse (Hewett, Halligan, & Boyce, 2012). People who are home- | INTERMEDIATE CARE AND HOMELESSNESS What is known about this topic• Long-term homelessness is characterised by "tri-morbidity" (the combination of mental ill-health, physical illhealth, and drug and alcohol misuse).• Hospital discharge is often problematic for people who are homeless with high rates of readmission.• Much is known about the design and delivery of intermediate care services for older people, but less is known about how to meet the transitional care needs of people who are homeless. • A reconceptualisation of the intermediate care concept which is designed to prevent these short-term services from becoming "blocked". What this paper adds | e347CORNES Et al. housing legislation and local housing options. Staffing roles include addressing broader health and well-being outcomes by means of advocating for and supporting people who are homeless to engage with the full range of local primary care, mental health, drug and alcohol and social care services. Clinically led Schemes:These are...

This article sets out to critically explore the expanding and contested vocabulary of ‘responsible citizenship’ as it relates to homeless people in a small market town in rural Dorset. Taking as its reference point the controversial decision to introduce a payment system for hot food at a day-centre for rough sleepers, I offer a concrete illustration of how the desire to cultivate ‘active’ and ‘responsible’ citizens is experienced and perceived by people who are affected by homelessness and other dimensions of ‘deep’ social exclusion. My concern here is to show that the logic of ‘responsibilisation’, which I suggest aims to ensure that difficult and troublesome individuals are made to accept prevailing social norms, draws its sustenance from a more fundamental concern with refashioning the meaning of contemporary citizenship. In so doing, I focus on the particular problems with this approach, using an alternative approach that argues that the problems and vulnerabilities associated with entrenched and chronic homelessness remain a significant obstacle to social inclusion and meaningful participation in community life.

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