A year-long, nurse-led intermediate care pilot project was undertaken at a 120-bed homeless hostel in south London to improve healthcare outcomes among the clients involved, and to reduce emergency department (ED) attendance, ambulance call outs and use of acute care services. By the end of the year, the number of ED and hospital admissions had dropped significantly. The project was recognised by the Department of Health in 2010 as an example of innovative practice in work with 'at-risk' groups, and was awarded the 2011 Nursing Standard Community Nursing Award. This article considers reasons for the success of the project and the lessons that can be learned from it.