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People experiencing homelessness often have multiple health and other support needs, requiring complex, coordinated support. Admission to hospital is potentially an opportunity to address these needs and begin integrating care, but so often it is a missed one. Our purpose in this research was to evaluate an ongoing, roll-out programme that offered government funding to 17 “test sites” across England to develop integrated care as part of post-discharge “step-down” support. In this paper, we examine senior stakeholder experiences of seeking to implement integrated care as part of specialist step-down care.

In this paper, we focus on data collected in interviews with key stakeholders (N = 10) who managed the mobilisation of local out of hospital care models for people experiencing homelessness. Interviews were conducted and analysed from a relational perspective, that is focusing on relationships between interactants, through which, for example, identities, understanding and integrating practice emerge.

A relational perspective on the data provides insights to better understand the complexity of integrating care at the point of hospital discharge for people experiencing homelessness.

Although in depth, the data were limited to certain perspectives on the issues. Other perspectives and data collection from in-depth study of case sites would be invaluable in developing the empirical evidence base for a relational understanding of integrating care.

A relational perspective highlights the emergent and ongoing nature of integrating care in this context of support for people experiencing homelessness. The need for different system agents to work to be constantly enacting the desired support is crucial to understanding future system changes for integrating care.

This is the first paper developing a relational analysis of integrating care. It highlights a different theoretical perspective on the issues and important insights.

This article reports the results of a randomized field experiment that tested the effects of a new business intervention among managers of small- and medium-sized enterprises (SMEs) in England.

Individual managers (learners) were randomly assigned in clusters (companies) to either an intervention group (265 learners; 40 SMEs) receiving a novel virtual, blended training program designed to stimulate a change in management behavior or a no-intervention group (118 learners; 22 SMEs).

The results show that the primary objective of changing management behavior to use more of an Operational Coaching™ style of management has been achieved (to a statistically significant level), and this is against the backdrop of the devastating COVID-19 pandemic. Positive trends in SME productivity metrics were also observed in the intervention group companies.

These important results could be indicative of the economic and productivity impact that a change in management behavior could have, and they warrant serious further investigation.

People experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.

The paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.

Supporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.

The data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.

Integration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.

Addressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.

This paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.