Working with the Most Vulnerable in Croydon

He is a keen advocate of developing nursing roles beyond the traditional remit to improve access to diagnosis and treatment for difficult-to-reach groups.

Paul has completed a Dip HE in nursing, BSc in Health Care and an MSc in Advanced Practice. He works with a number of stakeholders, including NHS England, Public Health England, Crisis, Freedom from Torture, Migrant Helpline, Mobile X-Ray Unit, Terence Higgins Trust, Salvation Army, Croydon Reach, and the Home Office to endeavour to deliver improvements in care and access to health care for vulnerable groups in Croydon.

Paul teaches in a variety of settings, such as lecturing Midwifery students at Kingston and St George’s Faculty of Health and Social Care on the complex health needs of homeless and asylum-seeking clients. His team won the Nursing Times Community Student Placement of the Year Award in 2015.

Homeless Health Services in Croydon

 Every nurse should have the opportunity to work in an extraordinary and diverse place like Croydon. Like many London boroughs, it has its challenges, with wealthy areas and pockets of significant deprivation.

Based at the Rainbow Health Centre, the Homeless Health Team provides a designated nurse-led service for the homeless and asylum seekers in Croydon. This includes rough sleepers, those accommodated in hostels, bed and breakfast accommodation, sofa surfers and asylum seekers in Initial Accommodation.

Our team offers a specialised holistic service tailored to meet the specific health needs of this group. The team comprises a Consultant Nurse (me), four other nurses, a part-time GP, a midwife, a health visitor, a senior healthcare assistant, a service administrator and two receptionists.

In 2014, I successfully bid for extra funding for a designated midwife for vulnerable and marginalised women. We saw significant numbers of late-gestation asylum-seeking women who often have had no care prior to contact with our service, and require extra resources. I was delighted when we won the Nursing Times Community Student Placement of the Year Award in 2015 and our midwife Memuna Sowe won Midwife of Year award in 2018 from the British Journal of Midwifery.

 Our Clinical Services

We offer a new patient check, screening for TB symptoms and immunisations, an opt-out basic HIV test and other blood-borne infection screening. The team also offers health promotion, including sexual health screening, free condoms for those under 24 years of age and smoking cessation service.

All members of staff work as a team with shared responsibilities. Nurses work independently but consult widely when necessary. I am proud to be part of the team and my role in supporting its development, and it is very rewarding to hear service users compliment us for our work.

The team has built up substantial knowledge around housing, welfare benefits, specialised services, the voluntary sector and many other local and national resources. This enables us to support our client group and meet the access agenda. We also work closely with other stakeholders, including the TB Mobile X-Ray Screening Unit and organisations such as the Department of Health and Social Care, NHS England, the London Homeless Nurses Network, the Helen Bamber Foundation and Freedom from Torture.

Outreach Services

Outreach activities in collaboration with voluntary organisations enable us to provide specific services at sites attended by both rough sleepers and asylum seekers. This includes walk-in clinics every Monday at the Salvation Army where lunch, showers and a change of clothes are provided; at Crisis Skylight every Tuesday and Thursday, which provides showers and laundry facilities and a range of specialist drop-ins. In addition, they provide 1-1 advice and guidance on education, training and housing, support to find work and accommodation and help and support linking in with physical and mental health services. Crisis also provides a range of short and long courses in the creative arts, employability and practical subjects like painting and decorating.

The Student Nurse Experience

All of the team work together to create a supportive learning environment for our student nurses, which can be challenging when considering how complex and vulnerable our client group is. We provide debriefing to student nurses who have heard a client recount a traumatic experience. This might be torture, such as waterboarding, being hung upside-down for days and flogged, burned and cut, or women been raped in front of their husband and children. Although this can be harrowing for students to hear, it can also provide learning opportunities, skills and practice development that they are unlikely to receive elsewhere.

Students are actively encouraged to reflect on learning experiences and allowed to foster learning by incorporating exposure, participation, identification and internalisation. Transformational learning is frequently observed by the mentors in the team. This represents a shift to flexible and reflective perspective on some of the very traumatic experiences that the students will hear about, such as rape, torture and, increasingly, human trafficking into prostitution or modern-day slavery.

My team are aware that most learning in the clinical environment is achieved informally through role modelling and we all endeavour to exhibit high standards of care, advanced communication skills and compassion to all our clients. We work closely with our students to support learning that is personal and individual, and encourage them to be active in achieving their learning objectives. Students have the opportunity to work with interpreters, both face-to-face and over the telephone, which exposes them to the complexity of working with non-English speaking clients. Our students gain clinical experience in a variety of care settings where they have to work autonomously and adapt to the environment to meet the clients’ needs.

It is a privilege to work with such a unique and diverse client group and know we are making a difference to the lives of such a vulnerable and underrepresented yet increasing section of the population. Our work is rooted in the core NHS values of respect for and promotion of our clients’ dignity and human rights. Likewise, we are committed to a wider social duty to promote equality in society where improvements in health and life expectancy are increasingly uneven. Finally, we believe that our service not only makes an excellent contribution to the healthcare of vulnerable people in Croydon, but it is also committed to the improvement of population health, now and in the future.

Paul Coleman

Consultant Nurse Homeless Health Services

Notes:

In 2018, Paul led an innovation project focused on improving skin conditions and respiratory health of rough sleepers and asylum seekers, funded by the QNI and Oak Foundation. Read the final report here.