Call for evidence - inclusion health

Case Studies

• Inclusion health locally commissioned service for primary care

  by Alice Vickers, almost 3 years ago

  To support GP practices with caring for the needs of refugees and asylum seekers as well as other Inclusion Health, https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/what-are-healthcare-inequalities/inclusion-health-groups/ An inclusion health LCS specification has been developed. There are varying levels to this LCS:

  • Inclusion Friendly – offering training to reception staff, encouraging practices to sign up to be a safe surgery https://www.doctorsoftheworld.org.uk/safesurgeries/ and provide training about Inclusion Health practices

  
  

  • Inclusion Health Assessments – providing health assessments which are more detailed than the standard GMS new patient health check

  
  

  • Outreach support – providing outreach appointments to undertake health assessments/appointments for Inclusion Health with specific locates e.g., hostels

  To support GP practices with caring for the needs of refugees and asylum seekers as well as other Inclusion Health, https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/what-are-healthcare-inequalities/inclusion-health-groups/ An inclusion health LCS specification has been developed. There are varying levels to this LCS:

  • Inclusion Friendly – offering training to reception staff, encouraging practices to sign up to be a safe surgery https://www.doctorsoftheworld.org.uk/safesurgeries/ and provide training about Inclusion Health practices

  
  

  • Inclusion Health Assessments – providing health assessments which are more detailed than the standard GMS new patient health check

  
  

  • Outreach support – providing outreach appointments to undertake health assessments/appointments for Inclusion Health with specific locates e.g., hostels

• Partnership working: How Alliance for Better Care used the learnings from its extensive vaccination outreach programme to adapt its new health check provision and ensure equity for underserved communities?

  by Alliance for Better Care, almost 3 years ago
  

  
  Aim and Introduction

  In 2022 GP Federation, Alliance for Better Care (ABC), was asked by Surrey County Council Public Health to provide NHS health checks across East Surrey to priority populations.

  The national programme offers an opportunity to engage with people aged 40-75 and identify those most at risk of cardiovascular disease (CVD), type 2 diabetes and dementia. ABC used this opportunity to build on their comprehensive work with vulnerable cohorts within East Surrey and ensure they had equal access to an NHS health check.

  ABC’s Equity Programme works extensively with more than 30 partners in the area including local... Continue reading

  
  Aim and Introduction

  In 2022 GP Federation, Alliance for Better Care (ABC), was asked by Surrey County Council Public Health to provide NHS health checks across East Surrey to priority populations.

  The national programme offers an opportunity to engage with people aged 40-75 and identify those most at risk of cardiovascular disease (CVD), type 2 diabetes and dementia. ABC used this opportunity to build on their comprehensive work with vulnerable cohorts within East Surrey and ensure they had equal access to an NHS health check.

  ABC’s Equity Programme works extensively with more than 30 partners in the area including local authorities, councils, link workers, food banks, housing organisations and charities to target and engage with communities. During the pandemic, it initially targeted those less likely to access vaccination services and who, in many cases, had no existing relationship with primary care. Groups identified during their work were the homeless, refugees and asylum seekers, and GRT community. Many hours were spent not just vaccinating these cohorts but also listening to their needs and understanding their concerns and long-term health needs.

  Having forged relationships and earned their trust, ABC wished to invite these cohorts for an NHS health check.

  Methods

  Integral to this programme has been ABC’s willingness to meet these patients in their own settings - where they feel most comfortable. The team therefore invested in new portable health check equipment and began visiting local faith settings, community centres, GRT sites, homeless shelters and refuges. To ensure that ‘every contact counted’ the team offered access to vaccinations alongside checks at each site too.

  As the Equity team began to roll out the NHS Health Check programme, it soon became obvious that the nationally set age criteria of 40-75 was restricting access to younger patients who were at risk of cardiovascular disease (CVD), facing vast health inequalities. Additional funding was successfully secured by Kent, Surrey and Sussex Academic Health Science Network to pilot expanding the scope of the health check programme to a younger cohort.

  Clinics are always tailored to meet the specific needs of these communities, for example, some offer food to encourage a relaxed atmosphere and – it seems – a pizza can sometimes go a long way. A homeless charity donation has also funded food vouchers for those in need too.

  
  We now have over 30 partners that we work with consistently – ranging from local councils to health inclusion teams, local charities, homeless shelters, women’s refuges, baby banks, food and clothing banks, community transport teams and outreach groups.
  
  

  Results

  As this pilot is ongoing, ABC is still processing the data available. However, by lowering the programme age range the team have had a significant impact on these cohorts. To date, around 50% of health checks have been accessed by those under 40 and 60% of these have led to direct referrals to follow-up services including bespoke support with the health advocate calling and completing the call with next steps and booked appointments. The team have also called emergency services and accompanied people in emergencies. In every contact, there is the time given to those individuals, rather than just acting in a signposting capacity.
  
  Community settings include: homeless shelters, GRT sites, food clubs, health hubs and women’s refuges
  
  Initial results show:

  • 261 clinics in community settings i
  • 850 people were vaccinated in these settings, including those who agreed to having either a first or second Covid-19 dose as recent as March / April 2023
  • an increasing number of directly supported referrals by the health advocate includes:
  • drug addiction counselling
  • local A&E at hospital
  • PALS
  • Social prescribing
  • Local baby banks
  • Local food and clothing banks
  • Dentist
  • Health inclusion team
  • GP registration and appointment setting on behalf of the patient
  • Cancer support

  
  Health data shows:

  • 28% of patients had an abnormal BP readings
  • 50% had abnormal BMI scores
  • 27% had concerning cholesterol results
  • 30% had diabetes concerns

  Patient feedback
  
  “You have listened to me and treated me like a human being.”
  Homeless patient
  
  “You have saved my life and given me a second chance."
  Patient with substance misuse issues currently living in residential rehab
  
  “We are so glad there is such a service, since you provided these checks some of the users come back and have since had their GP call them. It is so good to see this go the full circle. You have given them hope.”
  Homeless shelter manager

  Conclusions

  Initial outcomes have reinforced the importance of the relationships ABC had built during the pandemic with vulnerable cohorts. Their local, mobile approach has fostered trust within the community and made people feel welcome and comfortable in their company.

  When taking into consideration the lower life expectancy of many of these vulnerable cohorts (approx. 65 compared to national average of 80+), preventative measures need to take place at an earlier age in order to address and reduce health inequalities.

  The learning of this pilot is hoped to inform a county-wide roll out across Surrey Heartlands.

  Key learnings

  By better understanding its target cohorts, ABC has been able to tailor its health check programme to meet patients’ specific needs – this has meant removing all age restrictions, creating a roving model, providing access to food or just giving people time to talk. The Equity Team’s work during the pandemic has allowed them to appreciate the disproportionate affect that Covid has had on these communities and makes it easier to design a response with a fluidity and flexibility that may not have otherwise been possible.

  The strategy is informed by the data provided by the ICB and results feedback to the patients practice, demonstrating the clear benefits of a joined-up, holistic approach.
  
  For more information, visit:
  Alliance for Better Care - Equity Programme
  
  

• Asylum Seekers and Vulnerable Migrants supported in N&W

  by Alice Vickers, almost 3 years ago

  The UK has seen a record number of asylum seekers entering the UK , Norfolk and Waveney has four contingency hotels accommodating people who need support to access health and care.

  Norfolk and Waveney ICB has been working closely with the People from Abroad Team (PfAT) a social work team located in Norfolk County Council https://communitydirectory.norfolk.gov.uk/Services/10489 , who have an integrated co-located health care team. The team supports asylum seekers and vulnerable migrants arriving in Norfolk and works alongside Norwich GP practices and the wider N&W ICS geography. The health team undertake initial health triage on arrival, holistic health assessments... Continue reading

  The UK has seen a record number of asylum seekers entering the UK , Norfolk and Waveney has four contingency hotels accommodating people who need support to access health and care.

  Norfolk and Waveney ICB has been working closely with the People from Abroad Team (PfAT) a social work team located in Norfolk County Council https://communitydirectory.norfolk.gov.uk/Services/10489 , who have an integrated co-located health care team. The team supports asylum seekers and vulnerable migrants arriving in Norfolk and works alongside Norwich GP practices and the wider N&W ICS geography. The health team undertake initial health triage on arrival, holistic health assessments and ongoing complex case management for example where there are mental health needs, long term conditions and with safeguarding concerns of varying severity.

  This multi-agency response which was set up initially by the ICB, had an operational locality/Place focused group pulled together from key statutory and non-statutory partners. This includes district councils, police, mental health, public health, primary care and ambulance service. The ICB funded an enhanced health care offer of support from GP practices through a health inclusion Locally Commissioned Service (LCS). This covers all inclusion health groups, ncluding asylum seekers and refugees. The LCS supports education, skills and training and capacity to care for vulnerable migrants within primary care. Further, the Locality Placed based operational groups now have the oversight of a newly formed Asylum and Migration Partnership Board which is a system wide strategic group.

  To find out more about the PfAT and the work they do, please see video here: https://m.youtube.com/watch?v=mmIy6mtEs6U&feature=shares

• Welcoming Displaced People in Somerset - A system response

  by Eileen D'Souza, almost 3 years ago

  Welcoming Displaced People in Somerset - A system response

  Somerset has seen a shift in its demographic population in recent years. Historically, the county has comprised a population with minimal diversity, with pockets of migrant workers from other countries living across the area. Over the years however, the landscape has changed, and we have witnessed one of the most significant population changes in a long time. This is partly due to the rise in planned resettlement schemes, such as the Syrian Vulnerable Persons Scheme, Afghan Relocation and Assistance Policy and the UK Resettlement Scheme, but also from the Homes for... Continue reading

  Welcoming Displaced People in Somerset - A system response

  Somerset has seen a shift in its demographic population in recent years. Historically, the county has comprised a population with minimal diversity, with pockets of migrant workers from other countries living across the area. Over the years however, the landscape has changed, and we have witnessed one of the most significant population changes in a long time. This is partly due to the rise in planned resettlement schemes, such as the Syrian Vulnerable Persons Scheme, Afghan Relocation and Assistance Policy and the UK Resettlement Scheme, but also from the Homes for Ukraine which saw over 1500 Ukrainians move into Somerset since April 2022. Furthermore, Somerset saw its first Contingency Interim Accommodation stood up last year, and further arrivals through Asylum Dispersal, further diversifying the county

  It is estimated that Somerset has now welcomed approximately 1800 displaced people, and we are likely to see this figure grow further. There will be other displaced people who have arrived in the County via the Ukrainian Family Scheme and BNO Hong Kong scheme. No data is available for those arrives through these routes.

  This case study will discuss the approach the Somerset system has taken to collaboratively welcome and support the needs of asylum seekers and refugees in a rural county.

  
  

  Multi-agency tactical approach

  At the core of all of the work in Somerset has been the approach to work together as a system. Multi-agency tactical meetings were set up to help coordinate the work – these brought together partners from Health, VCFSE, Local Authority (social care, education, public health etc), Police, Home Office and other colleagues to effectively respond.

  This way of working has proven to be highly effective; this approach was used when liaising with Home Office colleagues on the proposal of new asylum contingency accommodation sites to decide their suitability. By pooling together knowledge of local areas, we were able to prevent two sites being set up in unsuitable areas; these had limited access to healthcare or where health services were already highly pressured, lack of public footpaths and limited transport options, and schools with no further capacity. Further, due to the rural nature of these sites, the impact of social isolation and limited access to support services and other amenities, was also considered. It is important to state that Somerset welcomes collaborative working with Home Office and ClearSprings Ready Homes colleagues, therefore whilst the suitability of proposed sites were being discussed, the Somerset system also propose alternative sites, informed by local knowledge.

  We hope to continue the excellent partnerships we have built for any future responses.

  
  

  Creating infrastructure to support organisations and professionals

  Given the growth in people who are displaced in Somerset, it has been important through the services offered to ensure the infrastructure in place is sufficient and appropriate to the needs of this inclusion health group.

  Six Welcome Hubs have been created across the county, originally in response to the Homes for Ukraine scheme, but with the wider aim of supporting any displaced person in Somerset. The welcome hub infrastructure has meant that support is available in the local community, delivered by the VCFSE sector, utilising their skills, local knowledge and experience. This model has tried to account for the rurality in Somerset; each hub is able to tailor the support they offer according to the needs of the individuals based in those specific communities. Support in the hubs can include benefits and employment advice, ESOL classes, housing advice, and health and wellbeing sessions – Ukrainian accredited psychologists also volunteer to provide mental health and wellbeing support; these help to address some of the most pressing wider determinants that impact the health of displaced people.

  Embedding Welcome Hubs into existing communities has also allowed for further professional development when working with asylum seekers and refugees, which will help to build resilience should any further planned or unplanned schemes be announced.

  
  

  Health system response

  Somerset ICB, Somerset Foundation Trust, Primary Care and Local Authority Public Health colleagues quickly rallied together to respond to the health needs of asylum seekers placed in a contingency hotel to ensure that health services were accessible and available in a timely manner, and to minimise the potential risk of infectious disease spread to the general population, following concerns of diphtheria. It was essential to consider the lack of government funding, and the semi-rural nature of the accommodation site, together with the existing pressures on health systems, when planning services.

  An operational ICB health cell, a multi-agency tactical cell (with health presence), and a core health steering group were set up to respond. Clinical space was arranged within the hotel for supporting health services. Within weeks, the Mass Vaccination team were present in the hotel delivering immunisations for COVID-19 and Diphtheria Prophylaxis; their presence continues seven months later, where they are now additionally supporting with 0–5-year-old immunisations.

  Integral to the health response is an onsite health check service delivered by Taunton Vale Healthcare, a practice which is not local to the accommodation site but who are passionate about inclusion health. This service has ensured new arrivals are seen by a GP in a timely manner, and through effective communication with the local primary care network, patients are referred on for further timely health care interventions.

  Somerset Wide Integration Sexual Health service (SWISH) have also provided onsite support and care, tailoring their offer to account for the cultural perceptions towards sexual health, and the complex needs of some individuals who present with previous history of sexual trauma. Health visitors provide needs-based support and advocacy for children and their families, as do Maternity service colleagues whom at present, are supporting ten pregnant ladies with onsite and offsite care.

  
  

  Mental health and wellbeing support

  It is well known that asylum seekers and refugees can experience multiple traumas on their journey to seek asylum. Studies have shown that 30-40% of asylum seekers and refugees are found to experience PTSD symptoms (Blackmore, et al., 2020), and they are five times more likely to have mental health needs over the general population (The Kings Fund, 2021).

  Mental health and wellbeing support has therefore been a priority in Somerset for this group. Open Mental Health is an innovative mental health and wellbeing support network for adults providing 24/7 support in Somerset; it comprises an alliance of mental health organisations offering access to a range of support services such specialist mental health services, money and benefits support, housing support to community activity and support workers. Open Mental Health, VCFSE, Public Health and accommodation staff have proactively engaged to explore ways to provide appropriate and timely support in a system that is already stretched.

  Access to services has improved greatly, with translation and interpretation being considered at the forefront now. Additionally, through the delivery of donated laptops, Taking Therapies have adapted to not only seeing patients in person locally, but also through virtual appointments when at the top of the waiting list, to enable support to be delivered quicker, and by ensuring all materials are translated and interpreters are present. Additionally, the VCFSE community have been providing a range of low-level interventions for both adults and children to improve emotional well-being; activities include ESOL classes, arts, cooking classes, tennis and cricket sessions and peer support groups, to name a few.

  Furthermore, The Trauma Foundation South West have recently concluded a 13-month training programme on working effectively with interpreters and mental health workers. The funding has supported 109 mental health and support workers to feel more confident about working effectively with interpreters, 10 interpreters to feel better equipped to work in mental health settings, and 38 hosts or workers on the Ukraine scheme to be better able to support their own self-care and avoid vicarious traumatisation in their work. The noticeable change in appetite to consider groups who do not speak English as a first language will no doubt support more individuals to access mental health and wellbeing services.

  Further engagement through questionnaires is taking place with the wider VCFSE and health sector to gain understanding into confidence levels when supporting this group and highlight any gaps too. The responses will help inform training need and identify any unknown barriers for access into services. Interviews were also held with residents living in the hotel to help inform any service development, taking into account their experiences when navigating the mental health system in Somerset.

  
  

  Looking forward:

  • TB service - Somerset is a low prevalence TB area. However, the needs of displaced population has led to partners in Somerset co-producing a new TB screening service which will support health inclusion groups who will have a higher risk of TB acquisition, in particular asylum seekers and refugees and the rough sleeper community. The needs of these groups will be considered when designing the service, and consideration will be given to any barriers faced with accessing these services.
  • Health and Wellbeing Champions - A key element for the future sustainability of healthcare for residents in the hotel is the co-production of ‘Health and Wellbeing’ champions from a variety of cultures; the aim of project is to not only improve health literacy and understanding of NHS systems, but to also consider the needs of this group when planning for public health initiatives, to maximise engagement ad sustainability. At the heart of this initiative is to empower individuals so they are able to take autonomous control of their healthcare, in turn reducing reliance on accommodation staff and allowing for their right to privacy with regards to their health.
  • Health Checks - There are plans to commission a Health Check service more widely across Somerset for all Displaced People, taking into account the needs of these groups, who are living in a rural county with limited access to transport, together with the pressures currently faced in Primary Care.
  • Wellbeing Practitioners - Additionally, work is underway to commission Wellbeing practitioners jointly between Public Health and the Open Mental Health Alliance to provide support to all refugees and asylum seekers across the county in Welcome Hubs.

  
  

  We still have a long way to go to ensure services and systems are set up to support asylum seekers and refugees as they would for other population groups. However, there is an ever-growing presence of individuals, communities, and services championing for the needs of this inclusion health group. The Displaced People Service at Somerset Council has recently been set up to support and build infrastructure across the county, and together with Somerset partners, we hope to improve knowledge and awareness about this group within services but also across the county, so that asylum seekers and refugees will continue to be welcomed in Somerset.

  
  

  Permission has been granted to share this case study from partner organisations and for NHSE to publish it as part of the framework.

• a case study looking at the joint working between the Manchester Mental Health and Homeless Team and Change Grow Live, drug and alcohol service.

  by Hannah Kirk, almost 3 years ago

  
  

  MMHHT MHP Case Study
  Report Date:	23/03/2023
  Location:	Manchester
  Author:	Jade Snowdon

  OHID Dual Diagnosis: Overview

  Greater Manchester Mental Health NHS Foundation Trust (GMMH) provides a range of mental health, addiction and dual diagnosis services within Greater Manchester and beyond. These include homelessness services, community mental health, psychology, offender health and a range of specialist addiction services from drug and alcohol addiction to gambling. The RSDA Pathway (rough sleeper drug and alcohol) is a pathway within the core Manchester Mental Health and Homeless Team (MMHHT) offering mental health support for people who are known to Change Grow Live (CGL) drug

  ... Continue reading

  
  

  MMHHT MHP Case Study
  Report Date:	23/03/2023
  Location:	Manchester
  Author:	Jade Snowdon

  OHID Dual Diagnosis: Overview

  Greater Manchester Mental Health NHS Foundation Trust (GMMH) provides a range of mental health, addiction and dual diagnosis services within Greater Manchester and beyond. These include homelessness services, community mental health, psychology, offender health and a range of specialist addiction services from drug and alcohol addiction to gambling. The RSDA Pathway (rough sleeper drug and alcohol) is a pathway within the core Manchester Mental Health and Homeless Team (MMHHT) offering mental health support for people who are known to Change Grow Live (CGL) drug services and are rough sleeping or in temporary ABEN (A Bed Every Night) accommodation, this pathway comprises of joint workings with staff members from CGL in order to provide a comprehensive and joined up approach to service users . The Mental Health Practitioner (MHP) Role The MHPs (mental health pratitioner) work with service users and liaise with staff to support recovery, engagement and understanding of the complex challenges for people with dual diagnosis needs and those who support them. Their work includes engagement, assessment, and support for service users to help people access appropriate pathways to assist them in achieving improved outcomes. In addition to this the team also deliver training for staff within the CGL service to promote mental health awareness

  Background

  Background to the person’s case – how they came to be referred to the service, notable clinical picture, concerns, risks etc Mr Z is a 33 year old male who has lived in Greater Manchester most of his adult life. Growing up he had a difficult childhood and experienced emotional and physical abuse. He has a complex mental health history which is complicated by poly drug use. Mr Z’s primary diagnosis is Emotionally Unstable Personality Disorder, and he currently experiences paranoid ideation, low mood and auditory hallucinations of a derogatory nature. Due to a significant life bereavement and ensuing episode of psychosis, Mr Z has had serious self-harm/suicide attempts and overdoses which resulted in two section 2 admissions in 2019/20. He was under the care of a Salford Community Mental Health Team, but was discharged following a change of care coordinator which resulted in lack of engagement exacerbated by homelessness. Mr Z came known to the MMHHT team after presenting to A&E due to an episode of psychosis and thoughts to self-harm. Over time the MHP has developed a strong relationship with Mr Z and he now has very good engagement with mental health services. Mr Z currently resides in temporary accommodation and his long-term goal is to acquire his own tenancy through the private rented scheme. It has taken a number of months to help support Mr Z to the stage where he feels able to engage with other services and he is now in the phase of his recovery to address his substance misuse. He currently takes crack cocaine, diazepam and intermittent GBL use. Mr Z’s drug use increases his vulnerability as he is currently financing drug debts accumulated through periods of high usage. This year there were also safeguarding concerns for his physical safety after he received threats of harm from previous peers due to his drug taking behaviour. However, Mr Z is a very low risk to others. Due to his drug use Mr Z also has physical health concerns including kidney stones.

  Interventions and Support

  What happened next, what did you do, what was your role, who else was included, why etc The MHP’s work with Mr Z was initially focused on developing trust to re-engage him within mental health services and to obtain suitable accommodation so they could better stabilise his mental health and commence mental health medication. After the initial assessment was conducted, a review with a consultant psychiatrist was organised to re-commence Mr Z on anti-psychotics. Mr Z was started on a small dose of Olanzapine, which was later increased after his negative symptoms were notably improved. However, as Mr Z engages in chaotic drug use it was agreed when he was ready he would consider CGL intervention, which he initially declined due to feeling unsettled and overwhelmed. As per person centre practice the MHP supported this decision and regularly reviewed this stance so a timely referral could be submitted once he was ready. Mr Z finds it challenging to maintain temporary accommodation due to his drug taking pattern and paranoid ideation associated with sharing facilities with other residents. When intoxicated, Mr Z also loses track of time stays out for extended periods of time and thus breaches his tenancy agreement resulting in eviction. He is currently on his final warning before cessation of duty. A large proportion of the MHP’s time with Mr Z has been dedicated to advocating on his behalf for housing and providing emotional support. Therefore, CGL intervention and multi-agency working was imperative to utilize their specialised knowledge and expertise to support Mr Z to reduce his drug use safely with the goal of promoting his physical well-being and prevent homelessness. After the safeguarding concern mentioned previously, Mr Z felt prepared to engage with CGL. A referral was made through the OHID Pathway and was triaged and allocated for an assessment in very timely manner. After the assessment, CGL quickly agreed to keep Mr Z’s assessor as his allocated drug worker to commence therapeutic work. It was hoped a regular key worker would be able to promote stability and reduce feelings of paranoia and stress. This could only be accomplished with both agencies working collaboratively and sharing information. Mr Z’s next goal is to register with a local GP so a referral can be made to a Community Mental Health Team, who will be able to provide him with regular medication reviews and continued therapeutic intervention. It is felt that once Mr Z has stable accommodation and continues to engage with drug services, he will not require supported accommodation under the Care Act 2014. Therefore, the OHID pathway has helped to facilitate independence in trauma informed, least restrictive manner.

  Outcome

  What happened Due to housing stressors unfortunately Mr Z had an accidental overdose of diazepam and GBL which was quickly communicated with CGL to collectively create a safety plan and update risk. He was also regularly discussed in the MMHHT red zone meetings to ensure that all the risks were being monitored closely and both the team manager and the MHP worked closely with CGL and other agencies to ensure his mental health needs were being met alongside his substance misuse. Mr Z was also regularly considered in the MMHHT multi-disciplinary team meetings to ensure all professionals including psychiatry, nursing and social work were able to provide advice and risk management plans. Mr Z currently resides in hotel where he feels happy and supported. However he has been relocated outside of Manchester, so his CGL worker continues to support Mr Z via telephone as requested. The long-term goal is to obtain Mr Z a detox to maximise his physical and mental health. The MHP and CGL worker continue to participate in joint visits to collaboratively achieve this goal in congruence with Mr Z’s timeline and circumstances to provide the optimal opportunity to be able to maintain sobriety.

  Shared Learning and Recommendations

  Any identified good practice, joint working, positive outcomes. Any gaps, unmet needs, shared learning, recommendations etc This piece of work particularly evidences the benefits of swift intervention, which is facilitated by the OHID pathway due to strong links developed with CGL and the MMHHT. Joint working was paramount in this case due to Mr Z’s diagnosis and paranoid ideation. Therefore, as the professionals involved Mr Z’s care worked positively together in a timely manner Mr Z was able to quickly develop trust and rapport with his CGL worker and was able engage in substance misuse intervention. Additionally as the meeting was conducted at the Mustard Tree HUB, the professionals were easily accessible to one another to liaise and discuss risk/overview of support needs prior to the assessment. This case study demonstrates the professionals and service user benefitting from one another’s expertise to provide person-centred and trauma informed care. Due to the MHP building a foundation of a positive relationship with Mr Z it meant they could then draw upon CGL’s knowledge and vital guidance when the time was right. The RSDA pathway in this case was utilized to promote improved mental/physical health, prevent homelessness and reduced risk of safeguarding due to the successes of reinforcing clearly defined roles, open communication and efficient intervention.

• Temple Street Job Centre Covid-19 Vaccination Clinic - Updated

  by Sally Quigg, almost 3 years ago

  Permission: Do you give permission from the individual/group to share this case study?

  Yes

  Permission: Do you have permission from your organisation to share this case study? Do you have permission from any partner organisations also named to share this case study?

  Yes

  Permission: Do you give permission for NHSE to share this case study and publish it as part of the framework?

  Yes

  Logo: Would you like to share your logo for use? If yes, do you give permission for it to be published with your case study in the framework?

  NHS logo with BNSSG underneath plus Bristol City... Continue reading

  Permission: Do you give permission from the individual/group to share this case study?

  Yes

  Permission: Do you have permission from your organisation to share this case study? Do you have permission from any partner organisations also named to share this case study?

  Yes

  Permission: Do you give permission for NHSE to share this case study and publish it as part of the framework?

  Yes

  Logo: Would you like to share your logo for use? If yes, do you give permission for it to be published with your case study in the framework?

  NHS logo with BNSSG underneath plus Bristol City Council (BCC) Logo [do not see how to submit these]

  Organisation/s: What organisation/s were involved?

  BNSSG C-19 Vax programme, BCC Community Development Team, Sirona care & health, community pharmacy, and a variety of voluntary organisations.

  The challenge: What was the issue you were trying to solve? Include which Inclusion Health Group the initiative focused on and its level i.e. community/locality/system

  Despite a strong focus on vaccination outreach, in February 2022 (12 months into the Covid-19 Vaccination Programme) our data and feedback from Inclusion Health colleagues working in Inner City Bristol told us that some people remained less likely to have their primary Covid-19 vaccinations. This included people experiencing homelessness, people with insecure immigration status and sex workers. Colleagues reported that these groups have historic challenges in accessing all health and wellbeing services, not just Covid-19 vaccinations.

  We wanted to build trust and resilience with these groups by removing access barriers to Covid-19 vaccination and saw an opportunity work with system partners to provide underserved people with integrated services alongside a vaccination offer - making every contact count. Also, we recognise how vital it is to bring a wider determinants lens to tackling inequalities.

  7) The approach/solution: What did you do? What help did you receive? How did you go about delivery?

  As an extension of our Covid-19 vaccination outreach approach of ‘going where people are’, we wanted to establish a regular, weekly vaccination clinic in a central-Bristol space that was trusted, accessible and felt safe for Inclusion Health Groups. In partnership with BCC’s Community Development Team, we identified the Temple Street Job Centre in central Bristol as an ideal site to support people with their unmet needs. The clinic was supported by two of BCC’s Inclusive Community Facilitators and Community Champions who were known to and familiar with the people we hoped to target, alongside our community service provider, Sirona care & health, community pharmacy and vaccination programme staff.

  Effective partnership working through collaborating with these colleagues and the voluntary sector, we created a warm, welcoming space within the Job Centre that provided tea and biscuits alongside Covid-19 vaccination and other services. This included supporting people who experience poor health and outcomes practically with health literacy, mental health advice, first aid treatment, sign-posting and housing support. Importantly, the support of BCC’s Community Facilitators and Community Champions meant we were able to do this in people’s spoken language.

  8) Insights and impacts: What evidence proves it worked? What difference it makes to the Inclusion Health Groups? How did this improve experiences, access and inclusion? How did this improve their health and help address health inequalities?

  Between May 2022 and March 2023, we had 2,480 conversations with people at the Temple Street Job Centre Vaccination Clinic; over 450 people went on to have Covid-19 vaccinations (a high proportion of which were primary doses); and over 70 had their flu vaccination. Many of these people were at high risk of a worse outcome from a Covid-19 infection.

  The clinic had a consistently high attendance of around 80 people at each clinic, particularly among men, with many people returning for follow-up conversations. It opened up an opportunity to support people’s health and wellbeing, linking to community and NHS services through social prescribing.

  Co-locating vaccination alongside other services in an accessible location meant we were able to reach people from inclusion groups who might otherwise have been missed. We supported people fleeing domestic violence, people who had been incarcerated, rough sleepers, sex workers, people with insecure immigration status and people from the LGBTQ+ community. Notably, we also supported extremely vulnerable people who intersected some of these Inclusion Groups.

  Through the clinic we had success in supporting people with registration into Primary Care, especially rough sleepers. By treating minor wounds, we were able to avoid visits to A&A, reducing hospital admissions and associated costs by early intervention.

  We were able to arrange for a Sudanese BCC Community Champion to support a Sudanese man who didn’t speak English. In Sudan there is no free health care and little State intervention, and he didn’t know how to engage with the NHS or manage his healthcare. We supported him to register with a GP and when he raised some issues around housing, the Community Champion was able to translate some documents, which he hadn’t understood.

  We created an opportunity to gain people’s lived experiences through conducting a survey at the clinic to gain more in-depth insight into people from Inclusion Health Groups and their needs, and preferences. We had 276 responses, 177 people who took up offer of a Covid-19 vaccination, and 99 who declined. Two thirds of respondents were men. The survey captured that people attended from the most deprived areas in Bristol, also people who voices are marginalised and with a majority of respondents from Black and Asian heritage. Many of the people who attended highlighted how they have experienced racism, discrimination and exclusion in their capacity of being regarded as vulnerable or disadvantaged.

  9) What people said: Any quotes or feedback from service users, staff, management or decision makers

  BCC’s Inclusive Community Facilitator, said: “This clinic has shown what can be done with a tea urn, some biscuits and determination to make sure everyone knows why it’s important to get vaccinated.”

  Feedback from the survey cited the following key reasons for taking up the offer of a Covid-19 vaccination at the Temple Street Job Centre Clinic:

  • the opportunistic convenience of vaccination availability,
  • as well as encouragement from BCC’s Community Champions, and
  • realisation it was important to have all their doses.

  Some things people told us in the survey:

  “Was at Temple Street and was spoken to by [named BCC Community Champion] who explained that I could get 4th jab. So decided to get it done today as had missed an appointment at the doctors.”

  “Hadn't realised that I needed a 3rd jab, [named BCC Community Champion] explained why it was important. Decided to get it done today.”

  “Was at the job centre so was easy to get the jab.”

  “Spoke with [named BCC Community Champion] at Temple Street who explained more about the vaccine and encouraged me to get done today.”

  10) Tips for success: Approaches or links that make a difference or lessons learned.

  To reach Inclusion Health Groups it is particularly important to co-locate vaccination services in convenient, accessible locations where people already are.

  The support of trusted, relevant organisations was crucial. In particular, the engagement work before and during clinics by BCC’s Community Champions made a huge difference to attendance and vaccination uptake at the clinic.

  The Vaccination Clinics were able to do so much more than just offer Covid-19 vaccinations. They allowed early intervention and prevention for people experiencing multiple inequalities, not just health. In particularly the opportunity to engage with people at the intersection of multiple Inclusion Health Groups was clear.

  Covid-19 vaccination uptake is low within Inclusion Health Groups so the good vaccination rates within this clinic directly reduced the risk of Covid outbreaks among vulnerable people, alongside supporting their overall health literacy.

  It is important to provide a consistent offer with the same staff and regular clinics over a period of time. Many people made repeat visits to the clinic and trust of recognisable faces built over time.

  All of these components are important to the success of this clinic model. In June 2023, BCC’s community engagement team were focused on other initiatives and the clinic was not as well-attended and vaccination numbers were a lot lower.

  11) What next: What are you doing next?

  This approach needs to be more sustainable, rather than a temporary solution to Covid-19 vaccination uptake.

  We are taking a paper to the Bristol’s Health and Wellbeing Board, highlighting the success of co-locating vaccination and health services in accessible, central locations to reach Inclusion Health Groups who might otherwise be missed. If the Board supports this approach, we hope to gain funding from all our system partners to run a similar clinic in Autumn alongside the seasonal Covid-19 offer.

  Following this, we plan to submit a proposal to BNSSG’s Integrated Care Board to raise awareness and encourage their support and funding for this this approach for the Autumn seasonal Covid-19 and flu vaccination programme.

  In the meantime, we continue to collaborate with system and community partners across all our community vaccination clinics. Most recently, we have invited voluntary and community organisations to attend any of our community vaccination clinics, which are located in underserved areas to pilot this approach for the autumn seasonal flu and Covid-19 vaccination campaign.

• Embedding health and wellbeing opportunities for people experiencing homelessness in a wider support system.

  by Martha Paisi, almost 3 years ago
  

  Introduction

  A collaborative project by the Plymouth Soup Run, The Plymouth Alliance and the University of Plymouth created a novel context and effective partnership of providers from the academic, statutory and voluntary sector to support people experiencing homelessness. Through Saturday morning sessions managed by representatives of the Soup Run and the Plymouth Alliance partners Shekinah and Plymouth Access to Housing (Path), and hosted by Shekinah, rough sleepers and people in emergency accommodation were able to come into a safe and calm space, have a cooked breakfast, a shower and change of clothes, meet health practitioners, get advice on housing issues... Continue reading

  Introduction

  A collaborative project by the Plymouth Soup Run, The Plymouth Alliance and the University of Plymouth created a novel context and effective partnership of providers from the academic, statutory and voluntary sector to support people experiencing homelessness. Through Saturday morning sessions managed by representatives of the Soup Run and the Plymouth Alliance partners Shekinah and Plymouth Access to Housing (Path), and hosted by Shekinah, rough sleepers and people in emergency accommodation were able to come into a safe and calm space, have a cooked breakfast, a shower and change of clothes, meet health practitioners, get advice on housing issues, and join in recreational activities, or simply relax. The sessions brought services to clients rather than the opposite, and offered support in a familiar and trusted setting at a time outside normal Monday-Friday ‘9-5’ service schedules.

  The case study links to the following inclusion health draft principles:
  1) Commit to action on inclusion health.
  2) Understand the characteristics and needs of inclusion health groups locally.
  4) Developing integrated and accessible services for inclusion health.
  5) Demonstrate impact and improvement for inclusion health.

  1-4. Permissions:

  We have the necessary permission to share the study and have anonymised any individuals. We give permission for NHSE to share this case study and publish it as part of the framework, including use of logos as displayed here.

  5. Organisations:

  The case study involves the following lead organisations plus the University of Plymouth and a range of statutory and third sector service providers who joined the project on a voluntary basis:

  The Plymouth Soup Run is a community voluntary service established some 25 years ago. Every night of the year, it provides free food, hot drinks, clothing, toiletries and sleeping bags to people experiencing homelessness, poverty and severe disadvantage. It lends a non-judgemental listening ear and also signposts people to appropriate services (e.g. housing support, healthcare). It offers a lifeline to Plymouth’s most vulnerable people.

  The Plymouth Alliance was set to coordinate a complex needs system which will enable people to be supported flexibly, receiving the right help, at the right time, in the right place. Alliance partners provide housing advice and support, access to temporary and settled accommodation, treatment and support regarding substance use, including prescribing. The partners, Shekinah and Path, as below, plus 5 other support organisations commissioned by Plymouth City Council aim to improve the lives of people with complex needs, supporting the whole person to meet their aspirations and to participate in and contribute to all aspects of life.

  Shekinah provides opportunities for people who are experiencing all forms of homelessness and other challenges they may be currently facing. Working with key strategic partners, Shekinah supports people to make meaningful changes in their lives and receive specialist support to address any health issues, find and support them in a home of their own and learn new skills.

  Plymouth Access to Housing (Path) is an independent local charity based in Plymouth. It was set up in 1995 to support people who are vulnerable to homelessness by providing a range of services from work with rough sleepers through to support for people to maintain their tenancies.

  6. The challenge

  Homelessness impacts negatively on health, wellbeing and life expectancy. People experiencing homelessness suffer significant mental and physical health problems often in combination, and it is widely accepted that poor health can be both a cause and a consequence of homelessness. More than 7 out of 10 people experiencing homelessness suffer from one or more physical health problems, and an even higher proportion report a mental health issue. Both physical and mental health conditions are much more prevalent than in the general population. The most common physical health issues encountered by people experiencing homelessness include problems with bones and muscles and dental/teeth problems. Severe mental health conditions in the homeless population include major depression, schizophrenia and bipolar disorder, as well as extensive substance misuse. Data also show that they are three and a half times more likely to commit suicide than the general population. People experiencing homelessness are also heavy users of emergency services, exhibit frailty and die 30 years earlier than the general population, and often from treatable conditions. Their severe and multiple disadvantages raise personal and institutional barriers to using health, social and housing services.

  People experiencing homelessness are not able to access universal services in an equitable way. Despite their greater needs, responses from health and social care organisations do not always accommodate complexity, clients’ conflicting priorities or multiple comorbidities. Often without a voice or advocacy, they can be deterred by settings where they feel excluded or stigmatised. This community is often described as ‘hard to reach’ but, in fact, it is the services that they need which may be hard to reach as a result of location, accessibility or scheduling constraints. Even when efforts are directed towards delivering a responsive service, capacity issues may mean that they are further disadvantaged.

  7. Our approach:

  The Plymouth Soup Run encounters clients every night and in all weathers. As the last service regularly out on the streets at night, volunteers are very familiar with the challenges that homeless clients experience, not least the bleakness, loneliness and lack of support that Monday-Friday service patterns impose, especially on rough sleepers and those in emergency accommodation.

  A response to this need was piloted in late 2021 by the Plymouth Soup Run and Alliance partners who opened Shekinah’s Centre on a Saturday morning to offer support including breakfast, a shower, and accommodation advice. It quickly became clear that the service would be appreciated by clients, would be well attended and, importantly, that it created an opportunity for wider engagement and support, especially on health and wellbeing matters. This possibility was turned into a reality by the awarding of a 6-month grant from Plymouth University’s Higher Education Innovation Fund (HEIF). The grant enabled a team of partners from different relevant professional backgrounds/organisations and with extensive academic, healthcare and community experience to support a programme of activities with the following aims:

  (i) Meeting basic human needs for nutrition, personal hygiene and connectedness.

  (ii) Offering weekly engagement opportunities with activities supporting health/ wellbeing, recovery and personal development.

  (iii) Providing data to evidence client needs and improve engagement with health/wellbeing opportunities.

  8. 9. Impacts, insights and what people said:

  Reach and engagement

  Over the lifetime of the HEIF project (1^st February 2022 and 30^th July 2022), total of 174 people accessed the sessions: 25 (14%) women and 149 (86%) men. An average of 19 people attended per week; the vast majority were rough sleepers (59%) or in emergency or supported accommodation (37%). The average number of visits was 3 and the highest number by an individual was 20. There was considerable turnover and diversity in the levels of use. The most frequently attending clients appeared to have a high degree of entrenchment and/or impediments to their accessing accommodation and other support.

  Comparison of attendance records with the number of rough sleepers evidenced in the city by Path shows that the reach of the project extended from 59% of rough sleepers initially to 82% by the end of the project. Current figures of attendance to June 2023 remain similar, with 20-25 people accessing the service each Saturday.

  Engagement with healthcare providers during the project lifetime varied. Oral health educators interacted with the majority of clients present on any one day, whereas podiatry services or blood born virus testing reached 30-40% of those present. Engagement with mental health peer mentors took time for trust to build but produced some of the most effective interactions reaching around 20% of clients present. Numbers engaging in art activities ranged from two to seven (i.e. up to ca. 30% of those attending), some clients engaging briefly and/or sporadically and others immersing themselves in the activity for a whole session.

  Impact

  In pursuit of the project’s first aim, the Saturday morning sessions provided a well-staffed, safe, and quiet environment offering social interaction and support for physical needs. Rough sleepers and those in emergency accommodation were provided with a cooked breakfast, other refreshments, and a packed lunch. In addition, they were offered access to bathroom/shower facilities, clean clothing, sleeping bags and rucksacks as well as opportunities for companionship and enjoyable conversations. Through meeting basic needs, the service enhanced clients’ wellbeing and self-esteem through improved hygiene and connectedness.

  Clients, staff and volunteers were enthusiastic about the sessions, feeling that they worked well with benefits to all. Time to get to know clients as individuals was appreciated, and clients valued the personalised service and the opportunity to have a “normal” conversation where they felt they could share their views and did not feel they were a “case” to be solved or “a number in a system”.

  “It makes a lot of difference to people opening on the weekends. It’s changed my weekend, it’s changed my whole week. It’s left me on a positive note. If I hadn’t come today I wouldn’t have been able to sort out my appointments and I’d have been stuffed.” (Client)

  “Yeah if it wasn’t for this place I probably wouldn’t have ate today and would be off doing something stupid.” (Client)

  “The Saturday sessions offered clients the rare opportunity to make choices – about food offered, clothing and the possibility of joining in activities.” (Volunteer)

  The sessions provided the opportunity for targeted, focused work, rather than reacting to crises. Clients could receive support and advice on accessing housing. Volunteers working in this field felt that it gave them a greater, more nuanced understanding of clients’ situations. The sessions also facilitated the building of links between organisations and supported collaborative working, with wider benefits for clients.

  “So actually, quite a lot of situations have been resolved by my attending these sessions and giving them the information they need. I think through Shekinah I’ve been able to [help] quite a lot of people just by giving them the advice and the tools and the things they need to do… which has been good.” (Professional volunteer)

  “Having the housing volunteer there on a Saturday means that, if a client is particularly vulnerable, they can be accommodated immediately and don’t have to wait until Monday.” (Staff)

  The relaxed atmosphere created by the Saturday team, has clearly created health promotion opportunities as covered by the second aim. It made a great environment for working with people that would not normally engage, thereby promoting increased connection with health and community services by people who experience significant morbidity, mortality and social exclusion. It also promoted partnership working among health professionals.

  “What it does identify is that interprofessional relationships are paramount in providing all-round healthcare.” (Visiting partner)

  Health-related activities included: general wellbeing advice and treatment for medical issues including injuries by engagement with community outreach nurses; advice on smoking cessation/vaping; Awareness-raising on eyecare; blood-borne virus testing; oral health advice; mental health peer support; and podiatry treatment. As well as one or more of these activities each week there was always access to accommodation/ housing support, and the opportunity to participate in arts and crafts and table-top games.

  “Mental health is a huge thing. Having the Heads Count [mental health peer support] people there is definitely good. To show [clients] that there are other things available and get them down to start meetings. I think that's a big, big thing.” (Professional volunteer)

  “It’s amazing how you can come down here and have a shower and there’s the ladies with the toothbrushes and toothpaste. Little things that make you feel human again. You get treated as an equal as well which is brilliant.” (Client)

  Health assessments and on-site treatment, as well as assistance with transport, promoted prevention and facilitated referral to other healthcare providers plus immediate treatment of conditions that would otherwise escalate and require access to A&E. Information, signposting and engagement with visiting partners increased awareness of health-related issues and available services, and increased client proactivity around health. Clients, professionals and volunteers all felt that the sessions filled an important gap in services.

  Creative pursuits appeared to offer a valued activity and provided an opportunity to escape (even momentarily) from everyday concerns and reduce stress. The opportunity to express creativity often gets squeezed out in a life impacted by homelessness, therefore including art and craft activities was experienced as positive and appears to have been well received by the clients. Art sessions also stimulated rich conversations around life experiences and hopes, and opened up possibilities for discussing wider concerns including health. Client feedback revealed appreciation of the distraction from everyday worries and the opportunity to be expressive. It was felt that having an artist who is focussed on letting clients have some leisure time and to think about things creatively was not just a beneficial distraction, but it makes them feel that “they are a person again, that they are human” which is good for their mental health.

  “Being able to have an in-depth conversation … and when you get people doing, say, drawing, painting, colouring, it's just amazing what conversations you can have and they talk about their earlier life. They'll talk about their current worries as well. It's just these happenstance conversations. They're just lovely and enable you to really get to know people.” (Lay volunteer)

  “I was very, very touched this Saturday, where we had a woman who was very active in the art activity. She gained so much from it. Quite often people find it easier to open dialogue when they're not making that direct eye contact and they're doing something.” (Professional volunteer)

  To address the third aim, data were collection by volunteers and professionals, experienced peer researchers and University staff. These, as well as field observations, provided insight and knowledge from diverse perspectives on evidenced needs, peer, practitioner and service provider experiences, and ways of improving client engagement with health/wellbeing opportunities. The project leads, functioning as embedded volunteer researchers, developed the evaluation framework and recorded personal reflective notes. Embedding evaluation into the workplan created learning opportunities and enabled flexibility in service provision to tailor it to clients’ needs and providers’ capabilities.

  On-the-ground learning has led to:

  • improvements in the delivery of Saturday provision and integration of insights from hands-on service providers, practitioners, peer researchers and service users into activities,
  • building of and more effective utilisation of volunteer capacity,
  • more effective cross-sector working among volunteers and professionals in different spheres (medical, social care, housing etc.).

  The learning is being used to inform local strategies and practice for supporting patients with complex needs. Synthesis with existing research evidence has generated new knowledge and insights that feed into wider service improvements and capacity building, and out to service leaders/funders to advocate for strategic change.

  Insights

  By definition, all clients needed housing advice, but addressing health issues is an important aspect of supporting clients to come out of homelessness and transition to a healthier and more stable life; the reality that housing is indeed a health need is very clear when working with this community. So, embedding health interventions in a wider support context alongside accommodation advice made sense.

  “We can learn about what each of the professionals do, how they work and the pressures they are up against. Can bring that into own daily work and provide a more joined up approach. So the service we deliver has more congruence.” (Staff)

  “Building these links allows for the cross-fertilisation of ideas between different individuals and organisations in the city.” (Volunteer)

  The needs of the client population are diverse, each individual is unique, calling for adaptation of engagement styles and flexibility to respond e.g. to the anxieties of a meeting a healthcare provider for the first time in many years. Trauma and shame surfaced as issues hanging over many clients. Hence, relationship building was important, as was offering help within a service that clients trusted and found familiar.

  Each healthcare session brought learning: above all, the realisation that taking services to people – meeting them where they are, not only physically but also mentally and emotionally – works. The Saturday sessions provided an opportunity to explore and address the low health expectations of many clients, create opportunities for them to engage with healthcare providers, raise their health aspirations, and promote proactivity.

  “They are prepared to engage with the voluntary [podiatry] service because it is immediately available to them at the point of their visit to the soup kitchen. I am not sure they would all go out of their way to seek or engage with other outreach services if it wasn’t so convenient for them or know where else to look.” (Visiting partner)

  “The relaxed atmosphere created by the soup run team at Shekinah makes a great environment for [blood-borne virus] testing people that would not normally engage.” (Visiting partner)

  Clients have a range of health care needs that often reach a critical point due to difficulties in accessing routine care. Embedding care in a service that targets this population group’s specific needs was identified as crucial in halting deterioration and averting preventable health conditions.

  “I’ve seen the nurses and the podiatrist and [been referred to] the doctor, they are very good. Otherwise, it’s difficult to see the health professionals because have to go up to [the local hospital] and when you’re disabled it’s hard to get around … getting on and off the bus with crutches is difficult.” (Client)

  Limitations

  Not all healthcare needs could be met at the Saturday sessions, so the possibility for onward referral and signposting was an important aspect of the healthcare activities. Clients were successfully connecting with GP services, A&E and mental health peer support groups. However, participating dental professionals felt that whilst they were able to demonstrate self-screening for oral cancer and deliver oral healthcare messages, there remained a need for immediate acute intervention. In response, a mechanism has been set up to refer urgent cases to a specialist Community Dental Clinic for disadvantaged patients.

  Findings have been published in an academic paper:

  https://journals.sagepub.com/doi/full/10.1177/17579139231157527?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org

  10. Tips and lessons:

  A cost-effective approach: There is a minimum cost to providing the service described here but a small investment to cover essentials, combined with flexible working on the part of salaried professionals and significant leveraging of volunteer time and value, can enable an impactful and highly cost-effective service to be provided.

  Supporting the workforce: Staff and volunteers, particularly those with lived experience, should be provided with appropriate support to ensure their wellbeing and a consistent service for clients, within a wider trauma informed approach.

  A multidisciplinary integrated approach: We recommend that health issues, not least mental health, gain a higher profile in the range of support services provided to people affected by homelessness, through co-location of services, and increased collaborative and integrated working. A model of this approach can be seen in the recently established Health Inclusion Pathway, Plymouth (HIPP), which coordinates care across outreach, primary, secondary and emergency care, social care and housing services for people experiencing severe and multiple disadvantage.

  Data collection and evaluation: Any service being started up could benefit from embedding evaluation into the workplan to create learning opportunities. Such an approach could use flexibility to enhance the service offer, tailoring it to meet clients’ needs and providers’ capabilities, and further promote positive relationships with partners. Effective evaluation and learning can also lead to practice improvement and capacity building.

  11. What next:

  On completion of the project funding in August 2022, the Saturday sessions have continued with a core of volunteers, flexible working by housing staff, and a year’s funding for essentials from Plymouth City Council. Health inputs continue to include fortnightly podiatry clinics, occasional GP and nurse sessions, regular mental health peer support, and dental clinic referrals. Clients are also supported to access wider primary and secondary care health services including through help with transport. Outside the framework of the sessions but stimulated by them, discussions are underway for collaborative activities on health issues including eyecare and smoking cessation. Regular art sessions continue to provide a significant means of engagement and a creative outlet for clients.

  In the near future, the host organisation (Shekinah) will relocate to a new building with enhanced facilities for support activities and medical services. This will provide the opportunity to review health and wellbeing inputs to the Saturday service, including continued close collaboration with the HIPP programme.

  A full evaluation report is available upon request.

  For further information or to receive a copy of the report please contact:

  Martha Paisi: martha.paisi@plymouth.ac.uk

  Lyndsey Withers: lyndsey.withers@btinternet.com

• Wellness on Wheels bus

  by Alice Vickers, almost 3 years ago

  The bus gave colleagues the opportunity to go on board and meet the teams who deliver a range of health and wellbeing services such as vaccination, health advice and guidance as well as vital opportunities to signpost people to relevant local health and care services. The bus has expanded its timetable and will be offering much more over the coming months.

  The bus began its journey as the SOS bus back in October 2021, supporting the COVID-19 vaccination of our homeless community across Norfolk and Waveney. It was hugely successful and well received across local communities. The SOS bus has... Continue reading

  The bus gave colleagues the opportunity to go on board and meet the teams who deliver a range of health and wellbeing services such as vaccination, health advice and guidance as well as vital opportunities to signpost people to relevant local health and care services. The bus has expanded its timetable and will be offering much more over the coming months.

  The bus began its journey as the SOS bus back in October 2021, supporting the COVID-19 vaccination of our homeless community across Norfolk and Waveney. It was hugely successful and well received across local communities. The SOS bus has now evolved into WOW bus, with a particular focus on wellness.

  The WOW Bus has been developed in partnership with Norfolk Integrated Care System and Voluntary Norfolk, with a specific focus on reaching out into those communities who do not access health and care in more traditional ways.

  RT hon Patricia Hewitt, Chair of NHS Norfolk and Waveney said:

  The Wellness on Wheels mobile bus has been brilliant during the difficult COVID-19 period. It enabled us to reach people who otherwise wouldn’t have had the support they needed. I’m thrilled to see it being further used now to extend the reach of even more health and care services across Norfolk and Waveney.”

  Cllr Bill Borrett, Norfolk County Council’s Cabinet Member for Public Health, said:

  “I was so impressed with the public response to the SOS Bus, which toured Norfolk supporting the hugely successful COVID-19 vaccination effort; it shows just how great an impact the service had. This new service, taking vaccinations, support and advice around Norfolk and Waveney, will continue the good work. It helps residents, who may not be able to travel far, have the chance to access health services and get the support they need. If the WOW Bus is coming to your community, let your friends and family know if they are struggling to access more mainstream services for vaccinations.”

  Alan Hopley, Chief Executive Officer at Voluntary Norfolk said:

  “If people can’t get to healthcare providers, for whatever reason, then we need to take care and services to them. This bus is an asset to a community that needs reaching but it is also creating a wider community, providing care where it’s needed the most.”

  Tracy Williams, Clinical Lead for Health Inequalities for NHS Norfolk & Waveney said:

  “We are delighted the WOW bus will continue with its journey across Norfolk and Waveney, delivering a range of health interventions to some of our most underserved communities including inclusion health groups, who tell us they often find health care services in our traditional settings are challenging to access.

  “There has been a real partnership approach to this initiative between public, health, NHS, local councils and the voluntary sector, where different services are coming on board to deliver their service receiving really positive feedback from communities.”

  Over the coming months, with the dedication and commitment from colleagues, the WOW bus will be traveling for miles across Norfolk and Waveney to support those who need extra help with their health and care.

  Services that are currently offered on the bus will vary between vaccinations, screening along with health and financial advice. And depending on what our communities need; the focus could well be expanded further.

  
  

• Under 5 Referral Pathways: Supporting Pregnant Women, New Mothers and Children Under 5

  by Newham Public Health, almost 3 years ago

  Newham’s under 5 Task and Finish Group work in partnership to generate and deliver actions that meet the acute needs of pregnant women, new mothers, and children under 5 years of age living in Home Office contingency hotels. One of the main challenges the group initially identified was that families are not always connected to existing support services across the system, and front line staff do not always know what services offer or how to refer.

  To strengthen access to support services, the group developed a suite of referral pathways to statutory and voluntary services, including the Acorn Maternity Team... Continue reading

  Newham’s under 5 Task and Finish Group work in partnership to generate and deliver actions that meet the acute needs of pregnant women, new mothers, and children under 5 years of age living in Home Office contingency hotels. One of the main challenges the group initially identified was that families are not always connected to existing support services across the system, and front line staff do not always know what services offer or how to refer.

  To strengthen access to support services, the group developed a suite of referral pathways to statutory and voluntary services, including the Acorn Maternity Team (vulnerable women), Health Visitors, Children’s Centres, Newham’s Multi Agency Safeguarding Hub, Newham Nurture, The Magpie Project, and Sister Circle. The referral pathways include anonymous case studies, assisting frontline staff by bringing ‘to life’ examples of how services can support pregnant women, new mothers and children under 5.

  Members of the group stress tested partner’s referral pathways to evaluate how they work in practice and identify any areas of improvement. Developing the referral pathways has strengthened collaboration across the system and helped ensure more inclusive and equitable access to services.

  In addition, the referral pathways illuminated gaps in support across the system, helping inform the under 5 task and finish group’s next steps and areas of focus.

• Temple Street Job Centre Covid-19 Vaccination Clinic

  by Sally Quigg, almost 3 years ago

  When submitting your case study please answer the following questions:

  Permission: Do you give permission from the individual/group to share this case study?

  Yes

  Permission: Do you have permission from your organisation to share this case study? Do you have permission from any partner organisations also named to share this case study?

  Yes

  Permission: Do you give permission for NHSE to share this case study and publish it as part of the framework?

  Yes

  Logo: Would you like to share your logo for use? If yes, do you give permission for it to be published with your case study in... Continue reading

  When submitting your case study please answer the following questions:

  Permission: Do you give permission from the individual/group to share this case study?

  Yes

  Permission: Do you have permission from your organisation to share this case study? Do you have permission from any partner organisations also named to share this case study?

  Yes

  Permission: Do you give permission for NHSE to share this case study and publish it as part of the framework?

  Yes

  Logo: Would you like to share your logo for use? If yes, do you give permission for it to be published with your case study in the framework?

  Yes: NHS logo with BNSSG underneath and Bristol City Council logo

  Organisation/s: What organisation/s were involved?

  BNSSG C-19 Vax programme, Bristol City Council (BCC), Sirona care & health and a variety of voluntary organisations.

  The challenge: What was the issue you were trying to solve? Include which Inclusion Health Group the initiative focused on and its level i.e. community/locality/system

  Despite a strong focus on vaccination outreach, in February 2022 (12 months into the Covid-19 Vaccination Programme) our data and feedback from Inclusion Health colleagues working in Inner City Bristol told us that some people remained less likely to have their primary Covid-19 vaccinations. This included people experiencing homelessness, people with insecure immigration status and sex workers. Colleagues reported that these groups have challenges in accessing all health and wellbeing services, not just Covid-19 vaccinations.

  We wanted to build trust and resilience with these groups by removing access barriers to Covid-19 vaccination and saw an opportunity work with system partners to provide underserved people with integrated services alongside a vaccination offer - making every contact count.

  7) The approach/solution: What did you do? What help did you receive? How did you go about delivery?

  As an extension of our Covid-19 vaccination outreach approach of ‘going where people are’, we wanted to establish a regular, weekly vaccination clinic in a central-Bristol space that was trusted, accessible and felt safe for Inclusion Health Groups. In partnership with BCC’s Community Development Team, we identified the Temple Street Job Centre in central Bristol as an ideal site. The clinic was supported by two of BCC’s Community Champions who were known to and familiar with the people we hoped to target, alongside our community service provider, Sirona care & health, and vaccination programme staff.

  Collaborating with these colleagues and the voluntary sector, we created a warm, welcoming space within the Job Centre that provided tea and biscuits alongside Covid-19 vaccination and other services. This included supporting people with health literacy, mental health advice, first aid and housing support. Importantly, the support of BCC’s Community Champions meant we were able to do this in people’s spoken language.

  8) Insights and impacts: What evidence proves it worked? What difference it makes to the Inclusion Health Groups? How did this improve experiences, access and inclusion? How did this improve their health and help address health inequalities?

  Between May 2022 and March 2023, we had 2,480 conversations with people at the Temple Street Job Centre Vaccination Clinic; over 450 people went on to have Covid-19 vaccinations (a high proportion of which were primary doses); and over 70 had their flu vaccination. The majority of these people were at high risk of a worse outcome from a Covid-19 infection. The clinic had a consistently high attendance of around 80 people at each clinic, particularly among men, with many people returning for follow-up conversations.

  Co-locating vaccination alongside other services in an accessible location meant we were able to reach people from inclusion groups who might otherwise have been missed. We supported people fleeing domestic violence, people who had been incarcerated, rough sleepers, sex workers, people with insecure immigration status and people from the LGBTQ+ community. Notably, we also supported extremely vulnerable people who intersected some of these Inclusion Groups.

  Through the clinic we had success in supporting people with registration into Primary Care, especially rough sleepers. By treating minor wounds, we were able to avoid visits to A&A, reducing hospital admissions and associated costs by early intervention.

  We were able to arrange for a Sudanese BCC Community Champion to support a Sudanese man who didn’t speak English. In Sudan there is no free health care and little State intervention, and he didn’t know how to engage with the NHS or manage his healthcare. We supported him to register with a GP and when he raised some issues around housing, the Community Champion was able to translate some documents, which he hadn’t understood.

  We conducted a survey at the clinic to gain more in-depth insight into people from Inclusion Health Groups and their needs, and preferences. We had 276 responses, 177 people who took up offer of a Covid-19 vaccination, and 99 who declined. Two thirds of respondents were men. The survey captured that people attended from the most deprived areas in Bristol with a majority of respondents from Black and Asian heritage.

  9) What people said: Any quotes or feedback from service users, staff, management or decision makers

  BCC’s Inclusive Community Facilitator, said: “This clinic has shown what can be done with a tea urn, some biscuits and determination to make sure everyone knows why it’s important to get vaccinated.”

  Feedback from the survey cited the following key reasons for taking up the offer of a Covid-19 vaccination at the Temple Street Job Centre Clinic:

  • the opportunistic convenience of vaccination availability,
  • as well as encouragement from BCC’s Community Champions, and
  • realisation it was important to have all their doses.

  Some things people told us in the survey:

  “Was at Temple Street and was spoken to by [named BCC Community Champion] who explained that I could get 4th jab. So decided to get it done today as had missed an appointment at the doctors.”

  “Hadn't realised that I needed a 3rd jab, [named BCC Community Champion] explained why it was important. Decided to get it done today.”

  “Was at the job centre so was easy to get the jab.”

  “Spoke with [named BCC Community Champion] at Temple Street who explained more about the vaccine and encouraged me to get done today.”

  10) Tips for success: Approaches or links that make a difference or lessons learned.

  To reach Inclusion Health Groups it is particularly important to co-locate vaccination services in convenient, accessible locations where people already are.

  The support of trusted, relevant organisations was crucial. In particular, the engagement work before and during clinics by BCC’s Community Champions made a huge difference to attendance and vaccination uptake at the clinic.

  The Vaccination Clinics were able to do so much more than just offer Covid-19 vaccinations. They allowed early intervention and prevention for people experiencing multiple inequalities, not just health. In particularly the opportunity to engage with people at the intersection of multiple Inclusion Health Groups was clear.

  Covid-19 vaccination uptake is low within Inclusion Health Groups so the good vaccination rates within this clinic directly reduced the risk of Covid outbreaks among vulnerable people, alongside supporting their overall health literacy.

  It is important to provide a consistent offer with the same staff and regular clinics over a period of time. Many people made repeat visits to the clinic and trust of recognisable faces built over time.

  All of these components are important to the success of this clinic model. In June 2023, BCC’s community engagement team were focused on other initiatives and the clinic was not as well-attended and vaccination numbers were a lot lower.

  11) What next: What are you doing next?

  This approach needs to be more sustainable, rather than a temporary solution to Covid-19 vaccination uptake.

  We are taking a paper to the Bristol’s Health and Wellbeing Board, highlighting the success of co-locating vaccination and health services in accessible, central locations to reach Inclusion Health Groups who might otherwise be missed. If the Board supports this approach, we hope to gain funding from all our system partners to run a similar clinic in Autumn alongside the seasonal Covid-19 offer.

  Following this, we plan to submit a proposal to BNSSG’s Integrated Care Board to raise awareness and encourage their support and funding for this this approach for the Autumn Covid-19 vaccination programme.

  In the meantime, we continue to collaborate with system and community partners across all our community vaccination clinics. Most recently, we have invited voluntary and community organisations to attend any of our community vaccination clinics, which are located in underserved areas to pilot this approach for the autumn Covid-19 vaccination campaign.