The Homeless Health Service is a partnership between Brighter Futures and North Staffordshire GP Federation (NHS organisation). The team consists of an advanced nurse practitioner (also project lead) and an assistant practitioner, both NHS employees, a driver, and the Brighter Futures Community Outreach Vehicle (COV). Homeless Health works alongside the Rough Sleeper Team, also led by Brighter Futures in Stoke-on-Trent and Newcastle-under-Lyme.
The COV has been invaluable throughout the COVID pandemic, allowing Homeless Health to be agile and flexible. It provides a safe clean environment, equipped with internet access, a couch for treatments, hand washing facilities, and provision to make hot drinks. When the lockdown was announced, the driver and assistant practitioner were shielding due to underlying health conditions. I was added to the insurance and drove the vehicle throughout the lockdown.
During Everybody In, the timetable was changed to reflect where people were accommodated In the area. I took the COV to hotels and hostels and if someone identified on outreach needed health care, they were signposted to the next time location of the community outreach vehicle (COV) with no appointment required.
The vehicle is usually used by different services, but it was decided that the health team had sole use of the vehicle during the pandemic to minimise the risk of infection. The vehicle has always been cleaned thoroughly between patients, but this was enhanced by deeper cleaning between each clinic.
PPE was available on the COV to ensure safety from infection. We did find though that during lockdown patients became more anxious and their behaviour unpredictable. The COV is equipped with a panic alarm – but to ensure safety the vehicle was either parked where it was easily visible or with someone working with me. Due to limited space, and social distancing, on the COV – the second person stayed outside during a treatment.
We don’t take referrals or appointments for Homeless Health. The only criteria being a homeless adult. If a patient had any symptoms, they were advised to contact NHS 111 and isolate. Support staff from other services were kept informed of any advice or follow up.
Other services were forced to stop face-to-face contact, so I started offering harm reduction initiatives including naloxone kits, needle exchange, and condom provision. I also spent time accessing people who had been verified as rough sleeping and checking their medical records.
One of the groups we put together – the COVID Protect Group – were people with no symptoms but have underlying health risks. This requires a clinical insight to determine the level of risk for the general population and considering their own complex needs. For example, anyone with three or more visits to either a GP or hospital for chest infections were treated as high risk. The average life of someone sleeping rough is just 47 and many of our customers age prematurely. This includes a reduction in their immune system. Therefore, a rough sleeper is usually treated as someone in a higher age group.
I have also been involved with advising accommodation providers and the local authority on other important factors. This includes infection control measures discouraging residents from crowding in communal areas and visiting each other’s rooms, sharing cigarettes, pipes needles, PPE, hand washing and ventilation, etc. I’m currently working with the local authority on exit planning for hotels.
This has been an immensely challenging time for all working in the sector. I have been in clinical practice for 32-years and have needed every year of that experience. I am also very proud to be part of the Rough Sleeper Team who demonstrates huge amounts of passion and commitment to supporting vulnerable people 365 days-a-year.
Advanced Nurse Practitioner Homeless Health
North Staffordshire GP Federation