WY-FI+ Inclusive Health Service: supporting inclusion for homeless adults

Service context

The Inclusive Healthcare Service was introduced in Wakefield in 2021 to provide urgent support for homeless adults and rough sleepers during the COVID-19 pandemic. At that time, homelessness in Wakefield had surged by a third and the local authority needed a nurse-led outreach project to engage with homeless people in safe areas (eg. in hostels, churches) guiding them to health and housing support and reducing pressure on A & E departments.

In October 2022, this provision was incorporated into WY-FI+ - a new service funded through the NHS Core20PLUS5 initiative to improve outcomes for vulnerable adults.

A need for inclusion

Homeless adults are one of the most marginalised populations in society, facing multiple barriers to healthcare, financial support and other public services. They are:

• 50 times more likely to have blood borne viruses
• 34 times more likely to have Respiratory health needs including TB, Asthma, COPD
• 6 times more likely to have heart disease
• 5 times more likely to have a stroke.
• 20 times more likely to die from illicit drug use

Despite these risks, homeless populations face many barriers to accessing health services and frequently do not appear ‘on the radar’ until they are at crisis point

Our primary aim is to reduce health inequalities faced by homeless people, help them to access health interventions and engage them with support services.

As part of this, a nurse-led team of two carries out community outreach and conducts drop-in sessions in hostels, hotels, day centres and community kitchens, as well as receiving direct referrals. Our nurse offers basic health checks like blood pressure and BMI, then takes a clinical history – looking at a person’s physical and emotional health, vaccination status, financial needs, and so on, before directing them to appropriate follow-up care. Clients experiencing severe need or health risks are allocated onto the IHS caseload for intensive 1:1 intervention.

Our results

The Inclusive Health Service has supported over 100 homeless people, helping them to improve their health and make vital links with community services. Our nurse, Faith, has a caseload of around 20 people who have consistent 1:1 engagement. Faith’s work is also supported by a non-clinical Navigator, who supports liaison with partner agencies.

Case Study: Sindy

Sindy* attended a weekly drop-in session that our nurse holds at the Community Awareness Programme centre in Wakefield. She was in tears and in pain due to extensive leg ulceration, which she had tried to bandage on the street using sanitary towels from a supermarket. She was not registered with a GP and was under the impression that she would not be able to access health services due to homelessness and drug misuse problems.

The IHS Nurse assessed Sindy and drove her to an emergency walk-in centre for wound dressings and antibiotics. After this, she was assigned to Faith’s caseload, assessed, supported to register with a GP and to make links with District Nurses for ongoing wound care. Faith suspected correctly that the client had signs of peripheral neuropathy and discussed this with a GP to support a diagnosis.

For more information about the Inclusive Healthcare Service and WY-FI+, please email wyfiplus@spectrum-cic.nhs.uk