Arch Health CIC hospital inreach service, “Pathway”: case study

Arch Health CIC hospital inreach service, “Pathway”: case study

Homelessness is a healthcare problem: a period of homelessness can be devastating for a person’s health. Conversely, good healthcare can empower people, and give them a base of stability and strength, to address challenges they may be facing in their lives.

Pathway is a national model that uses the opportunity of hospital admittance, to identify people experiencing homelessness, and by providing extra, tailored care, coupled with housing support, help these patients to benefit from their hospital treatment and recover properly, during and beyond their hospital stay.

Enabling people to stick with their treatment and stay in hospital as long as they need, will ensure they’re not leaving whilst still ill, and thus at risk for readmittance within a short time.

Supporting people to move on to somewhere appropriate after their hospital stay, will ensure that people have the chance to recover properly, regroup, and have a better chance of moving onto a more stable life, and can take control of their health and wellbeing in the future.

Brighton has the longest running Pathway hospital in-reach programme outside of London. Since 2012, this small collaborative team set up shop in the Royal Sussex County Hospital, now part of Sussex University Hospitals, and started to identify and support patients in hospital at that time who didn’t have a home to go to upon discharge.

• Clinical lead Dr Chris Sargeant and Pathway Housing and Team Coordinator, Katie Carter, both from Arch Healthcare, Brighton’s specialist homeless healthcare service.

• In-reach nurse practitioner Emily Greer, from Sussex Community Foundation Trust’s Homeless Health Inclusion Team, a specialist community physical health team made up of Nurses, Nurse Prescribers, Occupational Therapists, Physiotherapists and Assistants.

• A&E Support Worker Patti Kydd from specialist charity Justlife, a charity that provides health engagement and support to people living in emergency accommodation. All patients discharged to emergency accommodation are offered referral to the Justlife team.

The Pathway in-reach team works with the hospital’s clinical teams to ensure appropriate treatment, full understanding of the patients’ circumstances, and awareness of other health issues. The team also try to meet possible needs such as for toiletries and clothes, tv access and books, to ensure a dignified hospital stay, and understand the importance of building up trust with patients who may have lost faith in the system, to ensure that all treatments are fully effective. The team then work with the patients and Housing Needs colleagues to ensure that they come out to a stable environment upon discharge, including support with housing and benefits, so that patients would be able to get out of hospital and recover properly and safely.

Any patients who are not registered with a GP are registered at Arch Healthcare while they are still in hospital, to remove the need for them to do this after discharge.

The Pathway in-reach team introduced a weekly multidisciplinary team meeting to bring together services from the community and the hospital to plan discharges, and monitor progress after discharge. This developed into the Multi-agency Homeless Health Meeting (MAHHM) which has since expanded its remit to include patients who are at risk of hospital admission. MAHHM enables the journeys of patients to be traced, looking at the whole person and their story so far, in order to provide considered, effective, human treatment.

In the 10 years that Pathway has been up and running in Brighton, figures show that for people facing homelessness, despite rising rates of homelessness in the country, A&E attendances, unplanned hospital admissions and readmissions have fallen.

Dr Chris Sargeant says:

“There have been many memorable patients in 10 years. The first months were spent letting people know that we were here and looking out for our patients.

One of the first was a man who had been admitted after being stabbed. He had had a place in a supported accommodation but was told he was not welcome to come back. He was very distressed by this, as he had been the victim of a violent attack, so it did not seem right that he should lose his accommodation.

The supported accommodation were somewhat surprised when asked if he had been evicted and proper procedures followed. The manager agreed that the decision had not been taken properly, so he was allowed to return.

Another patient had been a very regular attender at the hospital, sleeping rough and presenting sometimes several times a week. After one longer admission he was given emergency accommodation after an application had been made by our team and Adult Social Care colleagues put in for regular carers. His rate of attending dropped. Further assessments took place at his accommodation which had not been able to happen previously as he often could not be found. Following these a specialist nursing home was found and he agreed to go there, settled well and now rarely comes to hospital.”