Following on from a successful pilot project in January 2020, NHS Southend Clinical Commissioning Group (CCG), working as part of a multi-agency team put in place a dedicated integrated healthcare service for people experiencing homelessness in Southend-on-Sea.
The project, known as SIHH (Southend Integrated Healthcare for the Homeless), was launched in January this year after a funding bid was approved by NHS England in September 2020.
The project bid was led by Dr Haroon Siddique, building on the previous work done by him and his team based at Southend Medical Centre. This involved providing health reviews for people experiencing homelessness who had been housed in bed and breakfast accommodation during the first Covid lock down. A full time Advanced Nurse Practitioner (ANP) and a part time administrator were appointed in October to the project to work alongside Dr Siddique to help consolidate outreach clinics and also assist in the rollout of the COVID vaccine programme for people experiencing homelessness.
The service is based at Southend Medical Centre, which already looks after a large population of people experiencing homelessness in Southend, with 93 people currently registered. Advanced Nurse Practitioner Edel Spruce took on the new role of Rough Sleeper Nurse in Southend in 2020. Starting in December, Edel runs:
- Two weekly clinics at Harp, Southend’s homelessness charity – Harp currently houses 220 temporary residents in its projects, ranging from those with multiple complex medical and social needs, to those closer to realising independent living.
- Two evening clinics are provided at the local soup kitchens, One Love and St Vincent de Paul.
- Targeted outreach to people on the streets where this is needed – Harp also run the street outreach services locally, enabling a whole systems approach. Outreach staff who have health concerns about people they have seen on the street encourage them to attend these clinics, and additionally Edel is able to go with the outreach team to do targeted outreach.
A MDT has been set up by Edel that brings together a drug and alcohol support worker, a mental health nurse and occupational therapist from the rough sleepers initiative, together with Harp and a housing representative, to enable a holistic approach. Edel has also started work to link in with the hospital discharge team. She has reported that recruitment is underway for a staff member from STARS (the drug and alcohol service) to provide hospital in-reach, so Edel is hoping to liaise with them in the future to improve care.
In terms of data and sharing information, Edel is working with the council to formulate a proforma that GPs can populate with information relevant to housing needs. This homeless specific form will also have key worker input to give real time data where social support needs are considered relevant.
Vaccination campaign (with Hep C screening and BP checks)
Edel started Covid-19 vaccinations with Dr Siddique and a team of volunteers in March. She describes her experience:
‘We had a very successful day last Thursday (04/03/2021). We vaccinated 109 people in total mostly at the HARP Bradbury Day Centre. This included 12 people at one of the soup kitchen sessions. with what we had left over. We are planning another session next month and have been told we can give the second dose after 28 days.
‘We also managed to arrange for a Hepatitis C nurse Rachael Bates from Addenbrookes to screen as many as would consent at the vaccination session, and she managed to screen 60 people. There were many positive results, which she is now following up with my help. She will also return in one month. Everyone had their BP checked as well with many requiring follow up.
‘Many people came who we thought might not attend. Prior to the vaccination day, key workers talked to clients and prepared a list of consenting individuals who were resident in any of the Harp properties/complex needs hostels in Southend to come to the day centre. They were also asked to distribute the Groundswell leaflets prior to vaccination to help make informed choices.
‘In the future, further evenings will be spent at the two soup kitchens for those we have missed or who are not known to Harp. We have about 200 residents dotted in various temporary accommodation throughout Harp, so we are making plans to continue clinics to connect with the rest. We have the Harp van to use to connect with those unwilling to travel and the key workers will ensure they are notified in advance and try to ensure they are in.’
Future plans for this new service include a more universal patient access system to enable people experiencing homelessness to get the right treatment quicker, by further engaging with primary care services such as GP practices, and improved appropriate contact with secondary care with swifter discharge pathways. It is also planned to improve health screening, including cervical screening and bowel screening. Future educational work with other GP practices in the local area will be undertaken to support staff to provide appropriate care for people experiencing homelessness.
For more information about the project contact:
Edel Spruce – Advanced Nurse Practitioner firstname.lastname@example.org
Dr Haroon Siddique MRCGP – GP email@example.com
Key reflections on the project locally:
Local GP and project lead, Dr Haroon Siddique, said, ‘We know the homeless have an increased rate of mortality and morbidity and the access they have to health care services has often been fragmented. With this pilot we have an excellent opportunity to put the health of the homeless at the centre of a wrap-around service which integrates all the other excellent services for the homeless we are lucky to have locally including the voluntary sector. In providing support to our colleagues in primary care we also hope to help break down some of the barriers the homeless have in accessing health care. This is an exciting opportunity, and we look forward to seeing the positive results at the end of this project.’
Tricia D’Orsi, Alliance Director for NHS Castle Point & Rochford and NHS Southend Clinical Commissioning Group (CCG), said, ‘While the NHS cannot solve homelessness on its own, it is working hard with partner organisations to ensure rough sleepers and homeless people have easy access to services that are built and designed around their needs – putting an end to the revolving door of care. This is an excellent example of collaborative work across all sectors involved in looking after the needs of the homeless. Many rough sleepers and homeless people have been through incredibly traumatic experiences which can cause mental ill health or exacerbate problems, often impacting on the type of support they need. This initiative will prevent our most vulnerable people slipping through the net.’
Cllr Ian Gilbert, Leader of the Council with a responsibility for housing, said, ‘Every person who is sleeping rough has a unique story to tell and addressing health challenges is essential to helping those we work with to get off the streets and stay off the streets. Being on the streets can negatively impact mental as well as physical health. It can make the symptoms of existing conditions worse or expose the vulnerable to viruses, such as flu or COVID. The funding of this initiative, collaborative working and assistance from the voluntary sector locally, will further help us to ensure that homeless people and rough sleepers can get the right support they need to break this vicious circle.’
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