Using an outreach vehicle to provide agile homeless healthcare
The Homeless Health Service is a partnership between Stoke-on-Trent City Council and the NHS North Staffordshire GP Federation hosted by Brighter Futures. 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), funded by Stoke-on-Trent City Council. Homeless Health works alongside the Rough Sleeper Team (funded by both Stoke-on-Trent City Council and Newcastle-under-Lyme Borough Council), also led by Brighter Futures in Stoke-on-Trent and Newcastle-under-Lyme.
The Community Outreach Vehicle has been invaluable throughout the COVID-19 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, and I stepped in to drive the vehicle throughout the period.
During ‘Everybody In’, the vehicle’s timetable was changed to reflect where people experiencing homelessness were accommodated in the area. I took the COV to hotels and hostels, and if someone identified on outreach required healthcare, they were signposted to the scheduled time of the next location of the COV, with no appointment required.
The vehicle is usually used by different services, but it was decided that the health team should have sole use 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. Personal protective equipment (PPE) was available 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 I had someone working with me. Due to limited space and social distancing, 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 COVID-19 symptoms, they were advised to contact NHS 111 and isolate following government guidance. Support staff from other services were kept informed of any advice or follow up.
Our other services were forced to stop face-to-face contact, so we adapted and I started offering harm reduction initiatives including naloxone kits, needle exchange, and condom provision from the vehicle. I also spent time accessing people who had been verified as rough sleeping and checking their medical records.
One of the groups we supported – the COVID Protect Group – were people with no symptoms but underlying health risks. This requires a clinical insight to determine the level of risk for the general population, as well as considering the individuals’ complex needs. For example, anyone who had made three or more visits to either a GP or hospital for chest infections were treated as high risk. The average life expectancy of someone sleeping rough is just 47, and many of our customers age prematurely, which includes a reduction in their immune system, therefore they are usually treated as someone in a higher age group.
I have also been involved with advising accommodation providers and the local authority on infection control measures, such as discouraging residents from crowding in communal areas and visiting each other’s rooms, sharing cigarettes, pipes and needles, PPE, hand washing and ventilation, etc. I’m currently working with the local authority on exit planning for hotels.
The Community Outreach Vehicle is essential – and without it our service cannot operate as normal. It provides a unique model of taking services directly to people without a referral through its ability to be flexible.
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 demonstrate huge amounts of passion and commitment to supporting vulnerable people 365 days-a-year.
Our #EveryoneInForGood Member Blog Series highlights the positive innovation and practice of frontline homelessness services during the COVID-19 pandemic, and the resulting successful outcomes for the people they support. It advocates for the important role of Homeless Link’s members in the next phase of the response, while inspiring and motivating others.
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Advanced Nurse Practitioner, Homeless Health, North Staffordshire GP Federation
Jane Morton is a Advanced Nurse Practitioner, Homeless Health, North Staffordshire GP Federation