Call for evidence - inclusion health

Case Studies

• Hospital, health inclusion, hostels, homelessness, dental hygiene and hope

  by Ben Jameson, almost 3 years ago

  The Health Inclusion Pathway, Plymouth (HIPP) is a multi-disciplinary team that works between the community and University Hospital Plymouth.

  The service was commissioned on the back of the PL1 report which looked at health inequalities and access to services for people experiencing homelessness and other issues in Plymouth. People experiencing multiple deprivation struggled to access care, and services were under strain. The team is a co-delivered venture, with Livewell Southwest, Peninsula Dental Social Enterprise, University Hospitals Plymouth, Plymouth Alliance and the surgeries at St Levan Road and Adelaide St. We are supported by Pathway UK.

  The team is made up... Continue reading

  The Health Inclusion Pathway, Plymouth (HIPP) is a multi-disciplinary team that works between the community and University Hospital Plymouth.

  The service was commissioned on the back of the PL1 report which looked at health inequalities and access to services for people experiencing homelessness and other issues in Plymouth. People experiencing multiple deprivation struggled to access care, and services were under strain. The team is a co-delivered venture, with Livewell Southwest, Peninsula Dental Social Enterprise, University Hospitals Plymouth, Plymouth Alliance and the surgeries at St Levan Road and Adelaide St. We are supported by Pathway UK.

  The team is made up of our Clinical Lead, who is a GP, another GP (providing 2 sessions a week), a psychologist, a mental health nurse, a social worker, an occupational therapist, a physical health nurse, a health care assistant and a health inclusion support worker. We also have a peer researcher with us part-time. We have a route to refer people for specialist dental provision to support long term rehabilitation.

  Our work is with people who are experiencing homelessness or people who have physical and mental health needs, substance use issues, criminal justice involvement and who have struggled to engage with services previously.

  We provide a service with three main aims:

  • Admission Avoidance, where we support people in the community, with work in the homeless hostels and drop-ins, to prevent “avoidable admissions” to hospital. We offer physical health clinics and mental health clinics in these areas.

  • In-patient Support, where we support people who have been admitted to UHP. We in-reach into the wards, supporting the client and the ward to team to ensure the optimum length of stay. (Historically the majority of this client group self-discharge before completion of treatment). We have at least one member of our team based in UHP every weekday morning.

  • Supporting Safe Discharge, where we support a clients discharge from UHP, into the community, when they are medically fit for discharge. The aim is for adequate accommodation and access to health provision, including registration with a local GP.

  Access to appropriate urgent health and social care input is important, but meaningful recovery is impossible without links to longer term recovery services. Our unique level of integration across health, social care and the third sector and commissioned access to oral health and dental services means people can be supported to build independent and meaningful lives.

  The understanding and system leadership inherent to our service helps us to identify gaps and to continue to innovate and advocate for the right services to meet patient needs.

  
  

• Homeless Health Services North Devon

  by Louise Scantlebury, almost 3 years ago

  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... Continue reading

  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.

• Moving on from Methadone: Depot Buprenorphine Case Study in Wakefield

  by Tom Wright, almost 3 years ago

  Traditionally Methadone has been first line opiate substitute prescribing, however Turning Point has increasingly introduced Buprenorphine as a treatment option for clients with opioid dependence, following a successful pilot in 2021.

  Turning Point initially piloted the use of Buvidal in 2021 in Wakefield and now have in excess of 70 clients prescribed Buvidal (and growing), with only one client from the whole cohort who continued to use opiates. Clients are presenting in much better health and report to be re-engaging with families, living better-adjusted lives, and giving back to the community. The success of the project has led Camerus to... Continue reading

  Traditionally Methadone has been first line opiate substitute prescribing, however Turning Point has increasingly introduced Buprenorphine as a treatment option for clients with opioid dependence, following a successful pilot in 2021.

  Turning Point initially piloted the use of Buvidal in 2021 in Wakefield and now have in excess of 70 clients prescribed Buvidal (and growing), with only one client from the whole cohort who continued to use opiates. Clients are presenting in much better health and report to be re-engaging with families, living better-adjusted lives, and giving back to the community. The success of the project has led Camerus to approach Turning Point to become a Centre of Excellence and the CQC report stated that this offer had been proven to be outstanding.

  The project has been successful in:

  • Promoting patient choice.
  • Alleviating pressure on pharmacies related to dispensing and contending with often challenging behaviours.
  • Reducing criminality, promotes re-engagement with families, education and employment.
  • Addressing substance use, reduces the risk of overdose and drug related deaths.

  Turning Point’s experience of criminal justice patients has been particularly successful, with significant changes to patient lives, supporting a positive recovery and reducing re-offending. Turning Point has also witnessed improved outcomes with clients in the community. Clients are found to engage more positively with clinicians and recovery workers, engaging in more meaningful conversations about health, lifestyle, social interactions and generally getting their lives back on track.

  Buvidal’s long-acting, injectable formulation means that it can be administered to patients weekly or monthly rather than daily, which other medications (such as methadone) require. This allows for greater flexibility in treatment for people with complex needs or chaotic lives and increases the chance of successful treatment completion.

  Buvidal has allowed Turning Point to monitor clients more closely and identify issues early – being proactive to needs, rather than reactive to deterioration or crisis. This has led to a marked increase in retention of patients who previously presented as high risk, chaotic and continually dropping out of treatment.

  Pharmacy reports are positive, this focuses on the strain that clients can bring around confrontation, violence, and aggression and more generally the time taken to prepare medication for clients. Interestingly, pharmacies have also reported cost savings, which they attribute to a reduction in shoplifting. Buvidal also lessens script generation, batch and prescription transportation and reduces our reliance on pharmacists to report concerns back which is has often been an issue in the past.

• Engaging vulnerable groups in substance use treatment: DAWS Plus programme

  by Tom Wright, almost 3 years ago

  In Westminster Turning Point have a well-established assertive outreach programme which prioritises engaging with individuals which services often fail to reach, who need extra support to get to a position where they can access structured treatment- often due to them having low recovery capital and complex social problems such as rough sleepers, and people with substance use and mental health issues. We call this project ‘DAWS Plus’.

  Westminster City Council is running a system change project supported by a Changing Futures Grant to pilot excellence in the implementation of Integrated Care in one Local Authority ward in the City. Changing... Continue reading

  In Westminster Turning Point have a well-established assertive outreach programme which prioritises engaging with individuals which services often fail to reach, who need extra support to get to a position where they can access structured treatment- often due to them having low recovery capital and complex social problems such as rough sleepers, and people with substance use and mental health issues. We call this project ‘DAWS Plus’.

  Westminster City Council is running a system change project supported by a Changing Futures Grant to pilot excellence in the implementation of Integrated Care in one Local Authority ward in the City. Changing Futures is a three year programme funded as a joint initiative by the Department for Levelling Up, Housing and Communities, and The National Lottery Community Fund.

  The key aim of the new service is to ‘meet people where they are’, providing tailored support in the community, recognising that not everybody will be able to make the journey to a hub. A key issue locally has been the high proportion drug related deaths of individuals not known to treatment services.

  Turning Point have provided to this project an assertive outreach worker for 2 days a week whose role is to work within the Integrated Care System to identify and engage drug and alcohol users from within that system (as opposed to seeking to source referrals from the ICS). Hence to engage individuals who traditionally do not even become known to drug and alcohol services.

  Central to this approach is a mapping process for our worker to have a detailed knowledge not just of the best ways to encounter drug and alcohol users in the ward – such as where street drinkers gather or via key partners- but also to take an asset based approach using the concept of a ’15 minute neighbourhood’ to idenitfy local community assets that can meet someone’s needs. This new approach seeks to engage and support people in the community using many of the resources with which are available (for example education, training and employment opportunities, recovery social activities, leisure activities, social prescribing etc).

• Tackling increasing alcohol harm: Fibroscan pilot in Turning Point’s Leicester City Service

  by Tom Wright, almost 3 years ago

  Alcoholic liver disease accounts for the majority of alcohol-specific deaths. A FibroScan is a simple and non-invasive procedure used to accurately assess the health of the liver and gives the opportunity to identify poor liver health at an early stage. Fibro scanning can also be used in outreach activities and can extend service reach people who have not previously engaged in treatment but who are at higher risk (for instance; rough sleepers, military personnel, those with poor mental health).

  The use of FibroScan technology by the Turning Point Leicester City service was initially funded by Leicester City Council with the... Continue reading

  Alcoholic liver disease accounts for the majority of alcohol-specific deaths. A FibroScan is a simple and non-invasive procedure used to accurately assess the health of the liver and gives the opportunity to identify poor liver health at an early stage. Fibro scanning can also be used in outreach activities and can extend service reach people who have not previously engaged in treatment but who are at higher risk (for instance; rough sleepers, military personnel, those with poor mental health).

  The use of FibroScan technology by the Turning Point Leicester City service was initially funded by Leicester City Council with the aim to increase the number of Leicester City residents accessing alcohol treatment and to support positive behaviour change to reduce harmful drinking behaviour. Funding was initially agreed as part of an 8 month pilot for use of a FibroScan with 2 specific cohorts:

  • Offered as part of Turning Point’s alcohol dependent treatment pathway to Leicester City residents who are identified to have potential alcohol dependence and in structured treatment with Turning Point.
  • Offered to registered patients within a pilot primary care GP site (Saffron Group Health) who are identified to have potential alcohol dependence but ambivalent/reluctant to engage in treatment.

  1. Offered as part of Turning Point’s alcohol dependent treatment pathway to Leicester City residents who are identified to have potential alcohol dependence and in structured treatment with Turning Point. Between August 2021 and July 2022, 123 structured treatment service users were offered FibroScan exams. 31 (32%) people who had the scan were referred to Hepatology, 28 had a liver stiffness higher than normal, five had a score indicating advanced Fibrosis and 16 had scores indicating cirrhosis of the liver.

  1. Offered to registered patients within a pilot primary care GP site (Saffron Group Health) who are identified to have potential alcohol dependence but are ambivalent/reluctant to engage in treatment. During the same period, 55 patients from this group were offered FibroScan exams. 11 (29%) had a liver stiffness higher than normal and were referred to Hepatology, five had a score indicating advanced Fibrosis and one service user had a score indicating cirrhosis. Approximately 30% of patients subsequently accepted a referral and entered structured treatment with Turning Point.

  Our ambition is to offer FibroScan to all new alcohol treatment presentations and to existing service users within the next 12 months. The use of FibroScan has been recognised by Turning Point and resulted in our national alcohol pathway being updated to include the offer of a FibroScan exam at the earliest opportunity.

• Reducing drug-related deaths in rough sleepers: Increasing naloxone provision in Oxfordshire

  by Tom Wright, almost 3 years ago

  In Oxfordshire, Turning Point has used universal funding to enhance existing harm reduction work including expanding the availability of naloxone. In 2021/22, 2,467 naloxone kits were provided to service users, families and friends; including 73 service users who are subject to a court mandated Drug Rehabilitation Requirement (DRR), and 212 rough sleepers.

  Oxfordshire has increased naloxone distribution to opiate users through a comprehensive harm reduction approach and trained local stakeholder professionals in Naloxone distribution.

  • 1,154 (98.21%) of Opiate Drug Users in treatment received naloxone within last 12 months with average 2.3 kits distributed per person
  • 43 Police Officers trained to... Continue reading

  In Oxfordshire, Turning Point has used universal funding to enhance existing harm reduction work including expanding the availability of naloxone. In 2021/22, 2,467 naloxone kits were provided to service users, families and friends; including 73 service users who are subject to a court mandated Drug Rehabilitation Requirement (DRR), and 212 rough sleepers.

  Oxfordshire has increased naloxone distribution to opiate users through a comprehensive harm reduction approach and trained local stakeholder professionals in Naloxone distribution.

  • 1,154 (98.21%) of Opiate Drug Users in treatment received naloxone within last 12 months with average 2.3 kits distributed per person
  • 43 Police Officers trained to carry naloxone across a range of Thames Valley Police problem solving and strong hold teams.
  • 36 Probation staff trained in either approved premises or local Probation Service office locations across the county.
  • 134 Housing and homelessness professionals trained.

  As a result, Oxfordshire has seen a 50% reduction in drug-related deaths; from 26 in 2020 to 13 drug related deaths in 2021.

• Partnership working: SUMH teams in Leicester, Leicestershire & Rutland

  by Tom Wright, almost 3 years ago

  In 2021 an audit identified 55% of 3804 service users across Turning Point's Leicester, Leicestershire & Rutland in treatment as having a mental health treatment need. Across the service, 320 clients (8.4%) were also identified as high-risk based on their existing risk assessment.

  This level of cross-over between mental health and substance use should therefore be properly reflected in service provision and integration. In response, the Substance Misuse and Mental Health project (SUMH) was set up by the local service provider in September 2021 for an initial 6-month pilot to seek to test out approaches to better integrate substance misuse... Continue reading

  In 2021 an audit identified 55% of 3804 service users across Turning Point's Leicester, Leicestershire & Rutland in treatment as having a mental health treatment need. Across the service, 320 clients (8.4%) were also identified as high-risk based on their existing risk assessment.

  This level of cross-over between mental health and substance use should therefore be properly reflected in service provision and integration. In response, the Substance Misuse and Mental Health project (SUMH) was set up by the local service provider in September 2021 for an initial 6-month pilot to seek to test out approaches to better integrate substance misuse and mental health services for this cohort. The project was expanded in April 2022 and continued for a further year.

  The SUMH team seeks to address the issue of service users falling between the gaps between substance misuse and mental health services. A dedicated team, embedded within the substance misuse services, deliver substance misuse and mental health interventions in tandem in addition to enabling better links and integration with mental health services improving engagement. The team operates in an integrated way with Leicestershire Partnership NHS Trust (LPT) Dual Diagnosis services including alongside the Dual Diagnosis Consultant Nurse and LPT Substance Misuse Workers located at the Bradgate Unit.

• Engaging minority communities within substance use treatment: the Sikh Recovery Network (SRN)

  by Tom Wright, almost 3 years ago

  Working alongside community/faith-based partners the Sikh Recovery Network (SRN), Spinney Hill Recovery (SHR), Turning Point, and community leaders, they have opened doors to culturally sensitive mainstream treatment such as co-delivered bilingual (Punjabi/English) peer-led alcohol recovery groups at the local Gurdwara in Leicester.

  Proactive engagement with the Sikh community via East Park Road Gurdwara has provided Turning Point with a deep understanding of community-specific substance use issues, notably poppy seed dependence and hazardous/dependent drinking among older men. Grassroots media/networks are key to raising awareness/engagement among minority communities. Turning Point and SRN have recorded a podcast series on substance use issues (Spotify/YouTube)... Continue reading

  Working alongside community/faith-based partners the Sikh Recovery Network (SRN), Spinney Hill Recovery (SHR), Turning Point, and community leaders, they have opened doors to culturally sensitive mainstream treatment such as co-delivered bilingual (Punjabi/English) peer-led alcohol recovery groups at the local Gurdwara in Leicester.

  Proactive engagement with the Sikh community via East Park Road Gurdwara has provided Turning Point with a deep understanding of community-specific substance use issues, notably poppy seed dependence and hazardous/dependent drinking among older men. Grassroots media/networks are key to raising awareness/engagement among minority communities. Turning Point and SRN have recorded a podcast series on substance use issues (Spotify/YouTube) and are co-producing a substance use series for Punjabi TV. Community football club GNG FC have agreed to feature Turning Point and SRN logos on all banners/e-mail marketing.

  At Turning Point, our specialist Family, Friends and Carers Recovery Workers are trained to deliver high-impact interventions and support to affected others, including 5-Step. Developed by AFINet, the 5-Step Method is a structured, evidence-based brief intervention for family members affected by a relatives’ alcohol or drug use. Based on theories of stress coping, 5 Step recognises that family members are affected by a unique and complex set of stresses and therefore need help.

  As part of our integrated substance use treatment service in Leicester, Turning Point is piloting the delivery of tailored 5-Step support to Asian women in the locality. Based on local intelligence and community outreach, we identified that in the Asian community, women affected by their loved ones’ substance use were not accessing available support, primarily due to cultural barriers and stigma around addiction and substance use. To overcome these barriers and gain clients’ trust, delivering the 5 Step intervention in Gujarati and Hindi on a one-to-one basis to Asian women affected by their loved ones’ substance use. There is flexibility regarding meeting locations – be it at home or in informal, neutral locations where they feel comfortable.

  Since starting the pilot, the women we have worked with are gaining confidence to speak up and are also learning techniques to successfully cope with their loved one’s substance use, thereby limiting the negative impact on their health and wellbeing. Many of the women facing multiple vulnerabilities, e.g., domestic violence, now feel safe enough to disclose it to the service and are more receptive to being connected with local support.

  We are also planning to launch an on-site women’s group at the premises of our partner (Spinney Hill Drugs, Alcohol and Addiction Support), a culturally sensitive recovery provider serving the Asian community in Leicester. The group sessions will take place when only women (including staff) are in the building. Play facilities for young children will be available as well as prayer facilities for women attending.

• Outreach Inclusion Health Provision for those who are homeless or vulnerably housed in Somerset.

  by Andy Lloyd, almost 3 years ago

  Outreach Inclusion Health Provision for those who are homeless or vulnerably housed in Somerset.

  In Somerset we recognise that people who are homeless or vulnerably housed experience some of the most severe health inequalities and report much poorer health than the general population. Many have co-occurring mental ill-health, drug and alcohol dependence and physical health needs, and are likely to have experienced significant trauma throughout their lives. We know that people who experience homelessness are also likely to sit within other inclusion health groups definitions including drug and alcohol dependence, being vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers... Continue reading

  Outreach Inclusion Health Provision for those who are homeless or vulnerably housed in Somerset.

  In Somerset we recognise that people who are homeless or vulnerably housed experience some of the most severe health inequalities and report much poorer health than the general population. Many have co-occurring mental ill-health, drug and alcohol dependence and physical health needs, and are likely to have experienced significant trauma throughout their lives. We know that people who experience homelessness are also likely to sit within other inclusion health groups definitions including drug and alcohol dependence, being vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system and victims of modern slavery.

  Supporting the needs of this cohort is complex and we know that this complexity often proves too challenging for both the client and the systems in place to deliver good Health, Wellbeing and Housing.

  Since 2019 Somerset has fundamentally reframed homelessness from a housing issue to one of health and wellbeing. This has been achieved as a consequence of developing long term, trusting, professional relationships with colleagues in Somerset from the NHS, Public Health, VCFSE sector and local government who together as part of a wider piece of work (Better Futures), have successfully developed an approach to meeting the health needs of some of the most vulnerable adults in our communities.

  We have:

  • Reframed ‘Homelessness’ from a ‘housing’ issue to one of a health and wellbeing concern for Somerset – a cultural shift supported by the Somerset Health and Wellbeing Board
  • Worked with the LGA to develop the Somerset ‘Better Futures’ programme.
  • Authored and adopted ‘Improving Health and Care Through the Home in Somerset’ - A Memorandum of Understanding’ (MoU)
  • Galvanised system wide commitment to implement our Homelessness Reduction Board (HRB) approach for Somerset – which now owns and drives the Better Futures Plan.
  • Capitalised on ‘Everyone In’ to pursue the WHO aim for the eradication of the hepatitis C virus (HCV) by offering dried blood spot tests to hostel residents, screening for HCV and subsequent treatment where required.
  • Supported innovation and secured NHS HEPP funding with which to pilot a needs-assessed Homeless Nursing Team which has now been adopted as BAU for Somerset (see below)
  • Pursued a comprehensive Covid-19 protect and vaccinate offer using a range of approaches including:
    • GP in-reach
    • GP out-reach
    • Bespoke NHS Vaccine team sessions at community and accommodation settings and surgeries in all districts.
    • Vaccine Centre extended opening

  Our vaccine and monitoring approach was cited by OHID as an example of good practice to other areas within the SW.

  • Delivered bespoke Health Protection training to accommodation and support providers.
  • Commenced Oral Health Prevention and Treatment development activity.

  This activity demonstrates a system wide commitment to ALL five inclusion health draft principles:

  1) Commit to action on inclusion health

  2) Understanding the characteristics and needs of inclusion health groups locally

  3) Developing the workforce for inclusion health

  4) Developing integrated and accessible services for inclusion health

  5) Demonstrating impact and improvement for inclusion health

  Since 2021, as part of this incremental system wide response we have embedded or established:

  • Specialist Outreach Health Inclusion GP provision (Core NHS funded GP in Taunton (1 day per week) and Yeovil (1 day per week) with an additional short term funded GP offer in the Mendip area (1.5 days per week).
  • The introduction of a countywide specialist Homeless and Rough Sleeper Nursing Service (HRSNS) following a successful NHS Heath Equalities Partnership Programme pilot. ( Homeless and Rough Sleeper Nursing Service for Somerset - Homeless and Rough Sleeper Nursing Service for Somerset (somersetft.nhs.uk) ) comprising a Clinical Lead, 4 x Band 7 Nurses, 4 x Health Link workers and 1 x Administrator
  • Additional specialist MH Nursing and Peer Support provision utilising NHSE Long Term Plan funding (the new posts sit within the HRSNS). 2 x Mental Health Nurse and 2 x Peer Support workers
  • Somerset Inclusion Health Practitioner’s forum where professionals working in this arena can meet and discuss current issues, challenges and learning with a view to embedding a wider team ethos.

  Working together, the Nursing Service and specialist GP’s, are now very much the vanguard of health provision for the homeless inclusion health cohort – a group of adults whom we know experience significant difficulty accessing health care which is further exacerbated by the rural nature of the county.

  We are confident we are now meeting previously unmet need and can evidence significant increases in case finding and supporting clients to successful health outcomes or improved health care.

  Initial analysis of local data conducted as part of the Better Futures programme and Somerset Homeless Health Needs Assessment (2023)* including SomersetFT NHS data is showing us that:

  • Specialist Outreach GP caseload; Taunton – 100, Yeovil - 116, Mendip – 71 = (+/-) 287
  • Homeless and Rough Sleeper Nursing Service - Since Sept 2021 the nursing team have worked with approx. 700 individual people and have approx. 300 contacts per month (many of these will be with the same people – weekly for example) (Their Data shows a total increase in referrals from 2021 (153) to 2022 (590) of 285%)
  • The population of the Better Futures analysis (those accessing supported or temporary accommodation) identified over 300 adults with combined Health and Care needs.
  • Somerset FT/NHS are telling us that the known population of homeless/NFA patients they are seeing = approximately 300 individual adults at any given point in time.

  This assertive approach to patient finding and care has produced many case studies where; through preventative action and safeguarding activity, lives have been saved or dignity provided at the end of life.

  Homelessness has now been identified as a key area for enhanced service provision through the NHS Core 20 Plus programme in Somerset.

  Together we continue to secure funding and invest time into further enhancing the homeless health offer in Somerset – such as:

  • NHS England Dental activity – South Somerset; Commissioned by Healthcare Public Health Directorate, NHS England South-West. This is funded activity where a dental provider, working together with VCSE, Specialist Outreach GP and the Homeless and Rough Sleeper Nursing Service will pilot a specialist offer for the homeless community. A Clinical Psychologist from Second Step (who provide support for adults with significant complexity – which is funded by Adults Social Care) has delivered Trauma Informed training for the dental staff.
  • Innovation for Healthcare Inequalities Programme (InHIP) - Cardiovascular case finding and treatment optimisation in primary care to improve uptake of innovative technologies with an emphasis on support for those homeless or rough sleeping. This is an NHS Innovation funded piece of work being undertaken by NHS and Public Health. In addition to case finding and treatment activity there is a data element which should benefit the wider inclusion Health workforce (looking at patient record EMIS and RIO).
  • The Rough Sleeping Drugs Alcohol Treatment Grant (RSDATG) which is funded by DLUHC and is managed by the Office for Health Improvement and Disparities. Originally targeted at the Mendip area of Somerset this has been extended because of local government reorganisation to become countywide.

  The main aims of the RSDATG being:

  • to help support people who sleep rough, or who are at risk of sleeping rough, to access and engage in drug and alcohol treatment and to sustain engagement as they move into longer term accommodation.
  • to build resilience and capacity in the local drug and alcohol treatment system to continue to meet the needs of this population.

  MEAM Somerset has also been accepted as part of the national MEAM Network helping focus our commissioning and support activity for this cohort still further.

  
  

  The work being undertaken in Somerset was recognised by the Royal Society for Public Health as an example of Best Practice and the team was shortlisted in the 2021 RSPH Awards. RSPH | Health & Wellbeing Awards 2022 | The Royal Society for Public Health UK

  What next?

  • Working with partners the ICB are reviewing the existing Specialist Outreach Health Inclusion GP offer with an aspiration to deliver an equitable offer for this cohort across the whole of Somerset.
  • We are currently finalising our Homeless Health Needs Assessment for Somerset to understand our population, inform future commissioning and service development activity – including both health and specialist housing provision. This is due to be published in Summer 2023 and we have a plan to refresh key data sets annually.
  • We are working with the two main hospital settings to improve both; the approach to this cohort on admission and also the planning around their leaving hospital to avoid people being discharged to the streets.
  • We intend developing a Somerset Homeless Health strategy to underpin the Somerset ICB NHS Core 20 Plus commitment where Homeless and Coastal Communities have been identified as priorities.

  This submission is endorsed by colleagues from; Public Health (Somerset Council), Somerset NHS FT and Somerset ICB (including salaried GP’s as referred to above).

• Integration of a GP into the rough sleeping outreach team in Newcastle.

  by John McGonigle, almost 3 years ago

  
  

  Integration of a GP into the rough sleeping outreach team in Newcastle has led to improved health outcomes for many clients. The shockingly low expectancy and problems accessing primary care for people experiencing homelessness (PEH) are well documented and previously in Newcastle the rough sleeping outreach team had no specific primary care input. This led to the predictable problems of struggling to get timely access to primary care for PEH and thus a concern that the opportunity to treat both acute and long term health conditions were being missed. Following funding secured by Newcastle City Council through the Rough Sleeping... Continue reading

  
  

  Integration of a GP into the rough sleeping outreach team in Newcastle has led to improved health outcomes for many clients. The shockingly low expectancy and problems accessing primary care for people experiencing homelessness (PEH) are well documented and previously in Newcastle the rough sleeping outreach team had no specific primary care input. This led to the predictable problems of struggling to get timely access to primary care for PEH and thus a concern that the opportunity to treat both acute and long term health conditions were being missed. Following funding secured by Newcastle City Council through the Rough Sleeping Initiative a GP has provided weekly sessions to outreach to those who are sleeping rough.

  The benefits to this initiative have been significant and far reaching. Those sleeping rough can be offered GP registration, BBV screening as well as a holistic health review. Individuals are routinely screened for a learning disability as we know this is a common and under recognised condition in many PEH, and standard NHS cancer screening is also arranged for those who are eligible. Individuals are discussed at a weekly MDT along with housing and drug and alcohol services and the health input that is shared (with consent) has been important in provoking a more co-ordinated and patient centred approach from statutory services. The below anonymised case study highlights the role that GPs can play in people who are rough sleeping.

  Mark (name changed) had been rough sleeping in Newcastle for a number of months. Originally from Europe he had came to the UK for work but had fallen victim to modern day slavery and fled to avoid the perpetrators. He had found the asylum process difficult to navigate and had failed to submit the appropriate documentation and he was under the no recourse to public funds condition. The street outreach team and the GP met him sleeping rough and he was offered lunch and a hot drink whilst he was assessed with an interpreter via the phone. He described a traumatic childhood with little formal education, and he could not read or write in his own language. He also described a significant head injury in his early teens. This raised concerns regarding either a pre-existing learning disability or a traumatic brain injury that was impacting on his decision making and ability to navigate the asylum and legal systems.

  Through the support of Newcastle City Council Social Work Department, the local Learning disability (LD) service and a third sector organisation, Mark was offered high quality temporary accommodation whilst a LD assessment was arranged with a clinical psychologist from the LD service. On the initial review it was clear that Mark had either a mild or moderate learning disability and further assessments are planned to categorise this fully and he remains settled in his accommodation. The GP continues to support his mental health and he is being assisted to complete his asylum application and work with the police around his previous experience of being a victim to modern day slavery.

  The next steps in developing our collaborative response to individuals who are rough sleeping is continuing to build an evidence base locally that GP involvement in this cohort is a beneficial and a cost effective approach. The ambition is that every rough sleeper is offered a comprehensive health review when first identified as sleeping rough in the hope that it can help assist not only the individual to address unmet health needs but also the City Council in finding suitable and high quality accommodation for that individual as appropriate.

  
  

  Extra information

  We have permission from the individual and the organisation to share this information and we are happy to share the logos for the organisations involved.

  The Learning Disability Screening Tool referenced in the text can be found here https://learningdisabilitymatters.co.uk/adult-learning-disability-form/