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PRACTICE COMMENT

'Providing healthcare for the homeless must be a priority'

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Homelessness is one of the biggest public health challenges and nurses are often the ones to take the vital first steps to address it, says Anne Pearson

When public services are cut, it is the disadvantaged who often suffer, including the most vulnerable in our society - people who are homeless. Since last year, according to the Greater London Authority, the number of people sleeping rough in London has increased by 16%. In England over 100,000 people go to their council for help with housing each year.

The Queen’s Nursing Institute believes that homelessness is one of the biggest public health challenges and nurses are often the ones to take the vital first steps to address it. People who are homeless experience significant health challenges compared with the general population: they are over three times more likely to report a mental health issue and nine times more likely to die from suicide. They are eight times more likely to have epilepsy, 34 times more likely to have tuberculosis and 50 times more likely to have hepatitis C.

Nurses working in homeless healthcare formed a collaborative learning network in 2008 to develop and improve practice. Managed by the QNI and currently funded by the Monument Trust, this network has since grown to include more than 1,000 people. Nurses in the network not only work with homeless people but other vulnerable clients such as refugees and asylum seekers, sex workers, gypsy and traveller groups and those affected by substance misuse.

Nurses do not judge people for the situation in which they find themselves; rather they work to improve the health of vulnerable and complex groups, providing care in often challenging environments. They recognise the importance of being flexible in tailoring their service to the client rather than expecting clients with chaotic lifestyles to conform to traditional models of care.

The QNI and network members have designed specialist homeless health assessment guidance, a health check questionnaire and care plans tailored to community nurses and other health professionals working with people who are homeless. These resources include evidence from focus groups and are supported by NICE guidance, Quality and Outcomes Framework indicators, Public Health England outcomes and Pathway commissioning standards. They provide nurses with a comprehensive single health assessment tool for their service users.

The QNI encourages all nurses working with people who are homeless to join the network and take advantage of these resources. Next year, it will launch a new online education resource, Transition to Homeless Health, for nurses who are new to this area. Nurses in this field have shared their expertise to inform this resource; when complete, it will be free to access via the QNI’s website.

Good nursing is about providing compassionate and holistic care at every stage of life. The QNI believes it is vital to support nurses working with the most vulnerable in our society to develop their practice, build trusting relationships with service users and address inequalities in health.

Anne Pearson is director of programmes at the Queen’s Nursing Institute. 

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