Homeless Health Services North Devon

Jack is a 55 yr old gentleman who has been known to the Freedom Centre in Barnstaple and the North Devon Rough Sleeper Outreach Team for over 15 years.

In North Devon multiple agencies have joined together under one roof at the Freedom Centre in Barnstaple to work in partnership to meet the needs of those experiencing homelessness including those who are sleeping rough, sofa surfing, boat and van dwellers and those who are vulnerably housed. The team consists of statutory and voluntary sector organisations including; The Freedom Community Alliance, North Devon Council, Barnstaple Primary Care Network, Royal Devon University Healthcare Trust, Together Drug and Alcohol Services, Devon Partnership Trust and Devon and Cornwall Police. Opportunities arose during the pandemic for individuals representing these organisations to co-locate and provide a one-stop hub to ensure that those people who are marginalised are supported in a way that breaks down barriers and provides more accessible services. There is a day centre which provides a 3 course lunch for around 50 people each day, provides showering facilities, laundry facilities, clothes and food stores and a drop in nurse clinic. A Housing officer, rough sleeper navigator, support workers, drug and alcohol worker, mental health nurse and GP are available during day centre as a drop-in and outside of this by mutual appointment. All of the agencies named above have contributed to Health Equity events hosted by One Northern Devon, and work closely with Public Health, Devon County Council, Plymouth University and Devon ICB by raising awareness through workshops and education sessions.

Jack has led a nomadic lifestyle for several decades, moving around the country, mostly the South West, for work in agriculture and construction. He has been unable to work since 2015 due to an accident which resulted in a fracture to his shoulder and ongoing mobility difficulties. Jack is a chronic alcoholic and can consume over 100 units of alcohol per week. He has had very short periods of abstinence which he has self- managed without the need for any medical intervention but does not want to give up drinking.

In March 2021 a friend of Jack’s contacted his GP to report concerns over his pain and mobility. He was seen by his GP in Barnstaple and referred for an x-ray of his pelvis due to pain in his left leg and hip. At this time Jack was sleeping rough near the riverside cycle path and had a care of address at the Freedom Centre. He missed his appointment for an x-ray in Nov 2021 and was reluctant to ask for help to reschedule. His approach to managing his pain was to self-medicate with alcohol.

In December 2021, due to severe weather, Jack was found ‘night by night’ accommodation by North Devon Council in a house managed by the Freedom Community Alliance. There were daily welfare checks and Jack was persuaded to see the GP at the Freedom Centre to discuss his leg and hip pain. In Jan 2022 he was seen by the GP and referred again for an x-ray due to severe pain due to severe osteo arthritis. This time his appointment letter was closely monitored and he was taken to his x-ray. A series of appointments to see orthopaedic interface physiotherapist, orthopaedic surgeon, pre-op nurses and anaesthetist, resulted in Jack having a hip replacement in May 2023.

The reasons for the successful outcome for Jack were numerous;

The surgeon, anaesthetist, nurses and physiotherapist at North Devon District Hospital understanding the enhanced clinical risks for Jack due to his alcohol consumption and Jack’s fears, anxieties and vulnerabilities without being judgemental.

North Devon Council enabling Jack to continue to stay in the very temporary accommodation (for over 18 months) due to his health issues where he could receive wrap around support from the whole team.

The Freedom Community Alliance allowed equipment to be installed in the house to aid independence, Support staff provided daily welfare and support visits to ensure basic nutritional needs were being met.

Homeless and Inclusion Health Nurse transporting and accompanying Jack to each of his hospital trips, providing information and reassurance and collecting him on discharge after surgery.

GP from Freedom Centre referring to orthopaedic surgeon without patient first completing a course of physiotherapy which would have had minimal compliance. Providing Outreach Care in his temporary accommodation to monitor post operative symptoms and recovery.

Jack himself, for trusting the professionals involved, accepting the need to reduce alcohol consumption prior to surgery, for complying with all pre-op treatments and for tolerating the additional monitoring of his wellbeing by all the team.

In the past few weeks, Jack has continually praised the treatment he has received from all teams involved in his journey to his new hip and during lunch at the day centre I have overheard him encouraging others who have mobility difficulties to seek help.

Jack’s desire, following his recovery, is to live on a boat and enjoy the social time he has with friends. We hope that he can follow his dream to a reality and enjoy an active and pain free life.