'You have to eradicate the term 'failure' from your vocabulary'

A sign in Southampton’s Two Saints homeless day shelter tells staff: “Don’t look down on people, unless you are helping them up.” It is a mantra that homelessness nurse Pamela Campbell certainly lives by. She is in charge of a practice based in a day shelter that, as well as subsidised food, showers, education and a safe place to rest, offers a full range of primary care services.

Nurses from the Homeless Healthcare Team regularly visit local hostels to provide healthcare and see people on the street to encourage them to come along. So while many nurses find it tough to ensure their patients follow their healthcare regimen, for Ms Campbell it’s even more challenging. But she is devoted to her work. And it is her belief in its validity that motivates her.

“Access to good healthcare is not a level playing field. It’s dictated by where you live and your socioeconomic status. There is a lack of tolerance of people who are ‘other’, and I want to right that wrong.”

After training as a nurse in the 1970s and earning a psychology degree, Ms Campbell worked in Latin America offering primary care services in impoverished societies. Returning to the UK in 1991 she took a job in Southampton as a practice nurse in the fledgling version of the service where she now works. Then it was a pilot with just four staff and three GP sessions a week. But after three years it “utterly established” the need for itself, according to Ms Campbell. Now it has 12 members of staff and five GP sessions a week.

Still nurse-led with Ms Campbell as the manager, the service’s work has extended to provide alcohol and other substance misuse care, including blood-borne virus screening, counselling, mental health care, sexual healthcare and all primary care services.

The Homeless Healthcare Team has some 500 registered patients at any one time and, while it operates as a standard registered practice, there are special considerations to bear in mind. “Forty per cent of our client group have a mental health issue,” says Ms Campbell. “The risk of suicide by overdose or self-harm is high. We have to think about this if we are prescribing to someone who is, say, in need of epilepsy medication.”

Another challenge is that many clients exhibit difficult behaviour because of their lifestyles or mental states. Ms Campbell says homeless people need a much more rounded approach - recently talk therapies have been secured, which have proved useful for clients with depression and anxiety.

A key aspect of healthcare for homeless people is working with partner agencies to ensure their most basic needs are met. The nurses spend considerable time ensuring their clients have appropriate care from other parts of the health service, such as negotiating with other health professionals for an acute hospital bed or a further outpatient appointment.

One difficulty is the migratory nature of the client group. Ms Campbell says it is hard to predict seasonal patterns but often service users can leave suddenly and without a trace, sometimes reappearing months or even years later.

That lack of continuity of care is not the only frustration, but Ms Campbell does not let it get her down. “You have to eradicate the term ‘failure’ from your vocabulary,” she says. “If someone does a seven-day detox and then is dry until day 10, is that a success or not? It is not my place to set expectations, but rather the client’s. I tell our service users never to be upset about letting me down, I am not their judge. We will always advocate for them to receive an equitable service, be it a hostel bed or a place on a programme.”

And she means it. “Some patients we see have suffered terrible things in their lives and are dealing with these every waking moment. Somewhere the essence of their personality shines through but risk of self-neglect, self-harm or suicide is never far away. Working with an individual to help them achieve their own goals makes it worthwhile.

“Seeing someone come back for their fifth or sixth detox doesn’t depress me. It inspires me, like Robert the Bruce’s spider - they just keep at it. I couldn’t conceive of having such strength.”

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