Homeless Health Service Westminster: Severe and multiple disadvantage caseload

This pilot will test a trauma informed relational service working intensively with a small cohort of people experiencing severe and multiple disadvantage (SMD) and with unmet health needs that puts them at a high risk of avoidable harm

The pilot is delivered by the Homeless Health Team delivered by Central London Community Healthcare NHS Trust. The nursing team had identified a cohort of people experiencing SMD who were not engaging with the existing service and were at high risk of avoidable harm and, as a result call an ambulance or attend A&E frequently and funding to pilot this approach was identified from Public Health and Rough Sleeping Initiative (RSI) grants secured by the local authority over a two-year period.

The pilot team consists of two Band 7 nurses working intensively with small caseloads (10-15 people) to deliver advanced nursing care as well as to plan and coordinate multi-disciplinary working to achieve these outcomes. The role is not intervention focussed, but trauma informed and relational, delivered at a pace suitable for the person to develop self-care and confidence in engaging with health and with the nurse following the patient on their journey. The caseload will include people sleeping rough, in supported or temporary accommodation, and permanently housed with the nurses providing in-reach and outreach.

The pilot will be delivered within a multi-disciplinary framework with access to the caseload being determined through existing multi-disciplinary forums.

The aims of the service are:

• Improved health outcomes and engagement to meet identified physical health need(s)
• Reduction in use of unplanned A&E and ambulance care for community and primary care needs
• Engagement with specialist primary and other care services
• Improved wellbeing
• Wider savings to the public purse