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Nurses break boundaries to improve support for migrant TB patients

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Specialist tuberculosis (TB) nurses in Leeds have developed a new care pathway to ensure some of their most vulnerable patients get the all-round support they need, including help to find housing and work.

The initiative has seen nurses from Leeds Community TB Service – part of Leeds Community Healthcare Trust – work with a wide range of different professionals and organisations in a bid to prevent delayed discharge in the most complex cases.

“While this is going on patients were left in hospital because they had nowhere to go”

Jayne Burnett

Previously nurses were spending huge amounts of time trying to identify sources of support for patients with TB who “have no recourse to public funds” as a result of their immigration status, meaning they are not eligible to claim most benefits, tax credits or housing assistance paid by the state.

Often people in this situation would end up staying in hospital far longer than necessary because they had nowhere else to go, explained lead TB nurse Jayne Burnett.

“The logistics of trying to get them out of hospital and into a property were just a nightmare,” she said. “You’d have endless teleconferences and Skype meetings about who is going to fund what and it just took hours and hours to get it sorted.

“While this is going on patients were left in hospital because they had nowhere to go,” Ms Burnett told Nursing Times.

Although the service generally only dealt with two or three such cases a year, they could take up a disproportionate amount of time and energy, she explained.

However, the hope is the new care pathway developed with Leeds City Council’s public health team, social services department and housing service means support can be put in place much faster.

Under the new system people are first assessed by social services and if they have no social care need they are then referred to the Leeds Housing Options service, who carry out an assessment for accommodation and a subsistence payment.

The first patient to benefit from this new way of working was a man who had been a victim of modern day slavery for 13 years, explained Ms Burnett.

Originally from Slovakia he was trafficked to the UK in 2005 and forced to work for no pay often going without food for days.

He had a history of TB and having escaped his traffickers and ended up in Leeds was admitted to hospital where he was diagnosed with miliary TB.

He was in hospital for so long that he lost his place at a refuge and with “no recourse to public funds” would struggle to find alternative housing.

However, the new care pathway meant the team was able to secure him a property and small weekly allowance.

“It took a bit longer to pull it all together then we had anticipated so it was still a delayed discharge but not as long as it could have been,” said Ms Burnett.

As well as carrying out DOTs (directly observed treatments), members of the community TB team – including Ms Burnett and trainee nursing associate Alison Wright – worked with other professionals to ensure the man got the support he needed to live independently.

“He had lost all his life skills because he was so institutionalised”

Jayne Burnett

This included liaising with community nursing teams to ensure the patient got medication, ensuring he got psychological support and working with occupational therapists to help him regain all-important life skills such as cooking and washing.

“He had lost all his life skills because he was so institutionalised,” explained Ms Burnett. “So we got the OTs to take him out to the local shopping area and show him the ropes, helping him to fit back into society.”

The team supported the man to register with a GP, start looking for work and sign up with employment agencies, and access English classes.

Ms Burnett also helped him get support from the charity Citizens UK, which provided advice on applying for benefits and arranged a meeting with specialist lawyers to help him continue living in the UK.

He was now “doing really well”, she said.

The initiative has led to further partnership work with Citizens UK and the development of a new referral pathway for patients with a range of problems.

“Anybody with problems – if they can’t work because of their TB or they have housing issues – we can now refer straight on to Citizens UK who will assess them and help sort their problems out,” said Ms Burnett.

The partnership will see a keyworker from the charity get specific training and shadow the team to boost their understanding of the wider challenges facing TB patients and the staff that work with them.

Ms Burnett said this and the new care pathways represented a move away from simply signposting people to support services to “a more integrated working”.

“We have got really good relationships with these services and can work together for a better outcome for the patient,” she said.

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