The Queen’s Nursing Institute has announced that 10 new local nurse-led projects are set to benefit from a year long programme of financial and professional support.
The 12-month projects will all benefit people who are experiencing homelessness or who are living in vulnerable or temporary housing. Such groups included recent migrants, street homeless, people in custody, and Gypsy, Roma and Traveller populations, noted community nursing charity the QNI.
“These projects represent the vital role that community nurses have to play in supporting some of the most vulnerable groups”
It is the first time that the QNI’s Fund for Innovation and Leadership has focused specifically on projects that work with the homeless population.
The theme results from the fact that the QNI is currently working in partnership with funder, Oak Foundation, which is supporting its Homeless Health Programme for three years.
The 10 projects are all led by community nurses working in different parts of England, with projects taking place in London and the South East, Birmingham, the North West and the South West (see box below).
Project leaders benefit from six days of training sessions with the QNI professional team and ongoing support throughout the year. There is funding of up to £5,000 for each project.
New homeless health nursing projects to receive funding
David Parker-Radford, the QNI’s homeless health programme manager, said: “These projects represent the vital role that community nurses have to play in supporting some of the most vulnerable groups in society, by engaging with them on the streets through outreach and treatment work, where more traditional models of care are not effective.
“The health and social problems related to homelessness are acute and the number of people who are street homeless has increased substantially in recent years in recent years,” he said.
“Community nurses are at the forefront of delivering compassionate and effective healthcare to people who may otherwise simply be invisible to the system, with terrible costs to them as individuals and to society as a whole,” he added.
The QNI said it hoped that by supporting innovation in the field and measuring outcomes, positive benefits to patient care and service delivery will be identified.
Following project completion and reporting, any new learning would be shared with other practitioners, it said.
Latent TB screening and TB awareness at HMP Birmingham
HMP Birmingham is the largest prison in the West Midlands. It has a huge turnover with 5,500 admissions annually.
TB is a bacterial infection which infects 10 million people each year worldwide. Four million of these will receive no care. There are approximately three million deaths each year.
Two billion (almost a third) of the world’s population have latent TB infection. TB rates in England are among highest in Western Europe, ranking in the top three.
Underserved populations are more at risk, including drug users, prisoners:
- 2x more likely to have infectious TB
- 2x more likely to die from TB
In Birmingham, if someone is new to the country the GP will offer a latent TB blood test. However, those new to the country and in prison do not get tested.
The project aims to share innovation to improve the health of vulnerable populations. The project will:
- Provide education sessions and symptom awareness to prisoners, staff, nurses etc.
- Testing under-65 year olds with a history of homelessness, substance misuse, or new to the country in the past five years.
- Positive result means a patient will be assessed and treated for latent TB in a nurse led clinic run within the prison. Treatments will be for three months. Patients who do test positive can be isolated in a ward, as someone can remain infectious even eight weeks after starting treatment.
- Entry into the prison. Overcoming this by being made a ‘key-holder’.
- Accessing medical records as prison in managed by a different trust.
- Encouraging people to have blood tests.
- Information getting to prisoners. If people are released sometimes they have nowhere to live. Information needs to follow the patient.
- Prison staff can be anxious. Cases where they refuse to look after a patient, request protective clothing, etc.
Five Ways to Wellbeing
The project seeks to improve the emotional and mental wellbeing of homeless people in Bristol who access the service. Bristol has an increasing homeless population and anecdotally there are more females at present.
According to the charity HomelessLink
- 80% of homeless people have experienced poor mental health (2014)
- 88% have difficulty in accessing mental health services (2016)
‘Five ways to wellbeing’ is a document provided by New Economics Forum. The five ways include:
- Be active.
- Keep learning.
- Give to others.
- Take notice.
How will the project work?
The project will run five courses through the year. Each course will contain sessions which links to one of the five actions documented in the ‘five ways to wellbeing’.Sessions will follow the structure of activity, discussion, reflection and one-to-one support.
Challenges the project may face are: clients failing to attend all five sessions.
The service users, manager, nurse will meet twice in between each of the courses to assess feedback and make appropriate changes to the course.
The project will measure outcomes by:
- Using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS).
- Emoji cards.
- Qualitative feedback
- Provide people opportunities to use ideas developed through courses as part of everyday life.
- Give people the confidence to continue the skills learnt throughout their life.
- Empower people to take control of their physical health.
Community outreach self-harm awareness group (Weston-super-Mare)
- Acute mental health services lack of low level mental health support and first aid.
- No set wound clinic/support group for self-harmers.
- Limited knowledge on self-care for self-harmers.
The project will:
- Provide a support group to cater for emotional wellbeing, physical health and psychological effects.
- Provide education on first aid, harm reduction, personal safety plans, distraction techniques; personal safety plans will be uploaded to EMIS so other health professionals can see records.
- Reduce presentation at A&E, wound care, reduce skin infection etc.
The group is aimed at:
- Over 18’s.
- Those with a history of self-harm.
Healthcare will be provided in a soup kitchen, as this is what clients are used to: a one-stop-shop, a familiar place known to the client group etc. The existing group is mostly comprised of men who use the soup kitchen and self-harm. The project will use ‘hooks’ to get clients in. For example, a new sleeping bag, food, clean bedding etc.
Approximately 80% of the homeless population in Weston-super-Mare are male. There has been a recent increase in self harm in current group. Lots of rehabs in Weston-super-Mare means there are high levels of homelessness, sofa surfing etc. There is a lack of support in North Somerset.
The project will evaluate its outcomes by being client focused:
- How many self-harm packs are given out?
- How many packs a single individual will receive?
- Who comes to the groups?
- How long someone attends the groups?
Primary care services for homeless asylum seekers (The Rainbow Centre, Croydon)
The project seeks to improve skin conditions and respiratory health for rough sleepers and asylum seekers.
The service was part of the PCT but has now merged with the acute trust. As a result funding has been lost but through funding bids, commissioning has been achieved on a five-year basis. The Rainbow Centre is nurse-led. Nurses hold the budget and therefore “hold the power”. A GP is employed for 15 hours by the service and the CCG employs the GP for a further 8 hours. They work collaboratively with voluntary organisations like Turning Point, Crisis and the Salvation Army.
The project hopes to:
- Develop pathway for clients with scabies that allows speedy treatment.
- Develop pathway for clients with respiratory illness.
- Give access to new clothing following treatment for both conditions.
Drop in and NHS health check outreach clinic (Wirral Ark)
The project seeks to address serious and life threatening obstacles to health services that homeless people face in getting appropriate health care.
Homeless people don’t tend to attend GP appointments, meaning there is no follow-up for conditions. There are difficulties in communicating with the health sector and homeless patients are frequent attendees at A&E. Often personal behaviour is unacceptable.
The Wirral is the 66th (of 326) most deprived authorities in England. There are high levels of health inequality.
The project estimates that they will reach approximately 180-250 people each year. This includes all Wirral Ark residents aged 40-75 who receive NHS health check and non-residents who will access service. Aim to reduce attendance at A&E, walk-in centres, GP surgeries.
Leap Ahead Project (The James Street Project, Darwen)
The project seeks to reduce inequalities and improve access to general practice for homeless individuals.
The project will:
- Be proactive not reactive
- Reduce barriers in GP service registration
- Increase vaccination uptake in infectious disease
The project focuses on:
In 2015-16 366 households in Blackburn with Darwen were accepted as homeless. The James Street Project is a £3.5m supported housing scheme for single homeless people, with low to moderate support needs, aged 16-65. It aims to reach vulnerable groups could improve health outcomes for local population.
The project will reach clients who can be hard to reach by:
- Providing healthcare clinics in own environment.
- Trial group consultation around health promotion.
- Communication book checked weekly.
- Remove stigma. Create comfortable environment.
- Act as an advocate and provide a voice to reduce barriers.
- Providing one session every week.
Outcomes of the project will be:
- Improve immunisation rate.
- Provide respiratory education.
- Lifestyle education.
- Training for hostel staff in health to ensure care is provided at the right time in the right place to the right person to reduce health complications and prevent health admissions.
HIT plus targeted street outreach for rough sleepers in Southwark
The purpose of the project is to:
- Target rough sleepers not accessing primary health care services.
- Signpost rough sleepers to day centres and primary health care services.
- Reduced burden on A&E and secondary care.
- Provide health education, promotion, assessment.
The Project is an extension of the existing service. The project works in conjunction with Southwark’s Street Population Outreach Team (charity) and Melbourne Grove practice in East Dulwich to provide GP services.
Rough sleepers visit A&E 7x as often as general population and are admitted to hospital more frequently. Rough sleepers in Southwark who are injecting drugs aren’t allowed to use certain day centres.
The service runs once a month, but clinics can be cancelled due to staff shortages. Data collection will generate information to secure funding to commission a post.
Touch Base - collaborative service to improve testing and treatment of Hepatitis C (HCV) (Brighton and Hove)
Improve testing for HCV at homeless day centre by frontline staff and giving staff and volunteers education and training on liver disease, HCV and testing.
Between 2010 and 2017 the number of rough sleepers rose by 134%. Mortality in homeless population is 4x higher than general population.
The average age of death for homeless person is 47. There has been a 25% increase in the number of homeless people with addiction.
HCV increase four-fold in homeless population. In Brighton only 44% of homeless people have been tested for HCV. HCV an lead to liver fibrosis, cirrhosis, liver failure and cancer.
Outcomes of the project:
- Increase testing
- Increase frontline staff awareness
- Improve collaborative working
Health Champions for the Homeless (Newham, East London)
One in 27 people in Newham are homeless. This is the second highest in the country.
The project will establish peer support group for the homeless by recruiting 10-12 health champions. To participate they must be 18-65 years old and be able to speak English as the service does not have capacity to offer translation services.
The service will provide education and awareness sessions on diabetes, mental health, and respiratory conditions for health champions who take this information back to soup kitchens. The service will accept anyone.
The Health Bus (Surrey)
The project will concentrate on health promotion, screening for diabetes/heart disease and signposting with the Gypsy, Roma and Traveller (GRT) population.
Trusted relationships: face-to-face contact is what counts. Important to understand culture context which does not often fit with the culture of the health service, for example communicating via letters. Building on existing relationships and practice.
Barriers to health care in travelling community include:
The service will use visual aids to overcome barriers of literacy and will use terms that are used within the GRT community, for example ‘bad nerves’ to refer to mental health or related issues.
Outcomes of the project:
- More contact
- Increased GP referrals
- Increased hospital dental appointment
- More agencies receiving referrals/contacts
- Identifying issues through screening
- Improved awareness of health services