In England, 70% of people who were homeless on admission to hospital were discharged back to the street without having their care and support needs addressed (Department of Health, 2013). Furthermore they experienced high hospital readmission rates and often resorted to inappropriate use of the Emergency Department. Following these data, Government funding was provided to enable hospitals to work with local partners to develop specialist integrated homeless hospital discharge schemes, including intermediate or step-up/step-down care. In this paper we report preliminary findings from a realist evaluation which explored the effectiveness of the different schemes established. Schemes took many different formats, and tended to be either uniprofessional, comprising housing workers, or multi-professional, comprising: GPs; occupational therapists; nurses; social workers; housing workers; and peer navigators