The Queen's Nursing Institute

The Queen's Nursing Institute works with the public, nurses and decision-makers to make sure that good quality nursing is available at home for everyone when they need it.

Healthcare at home

The Health Exchange

The Health Exchange, based in Birmingham, near the City Centre is well placed to serve the health needs of the Homeless population. Their definition of homelessness is quite broad and includes those that are street homeless, hostel dwellers, those living in B+B’s squats and temporary accommodation. Their service has evolved from being an outreach service with a portacabin to having a base at the back of the William Booth centre (a hostel for single homeless men). In 2005 they began offering a primary care service with the aim of offering a package of health care to clients that meets their individual needs. This includes treating them holistically by linking up with statutory and voluntary organisations to help address their accommodation and financial issues as these have a great impact on their mental and physical health.

The Health Exchange encourages clients to register on a permanent or temporary basis providing continuity of care. They have regular GP sessions every afternoon that run alongside nurse led clinics. They have found it best to operate on a “drop-in” basis but offer appointments to those who prefer them. Every morning there is a nurse led clinic for chronic disease management and minor illness/injury clinics. One of the primary care nurses also works on an “outreach basis" visiting hostels and “drop-in centre’s" where many eastern Europeans and asylum seekers attend for food and clothing. Service user groups are held here to enable the clients to have their say in how to improve the services available and importantly to highlight the barriers to health care.

Alongside this The Health Exchange has three clinical nurse specialists in alcohol who keywork clients, working with them to address their alcohol problems. These nurses also join a substance misuse agency and the accommodation team once a week to do an early “outreach” to access people sleeping on the streets to let them know the help that is available. In order to gain peoples trust the team have found this work very valuable.

Mental health is another big problem among the homeless population. Homelessness can cause deterioration in mental health and vice versa; mental health can lead to homelessness. There is a mental health team at The Health Exchange which includes a CPN, a sessional Psychiatrist who holds a once weekly clinic, a mental health gate way worker offering psychological therapy and CBT on the presenting issue of the client e.g. panic, anxiety and depression. They also have a counsellor who works from a person centered basis encouraging clients to express their feelings and encouraging personal growth and wellbeing. The team has a weekly meeting which includes a psychiatrist to discuss those whose illness can be managed and supported within primary care and those who do need referral to other secondary services. The clients find it easier to attend appointments at the Health Xchange as it is more accessible than hospital and they know the staff here and feel more comfortable.

Theyare also fortunate to have the services of the podiatrist who visits on a weekly basis. Their clients can walk several miles per day causing foot problems e.g. “trench Foot".

They have weekly meetings that include the whole team when possible, including the practice manager and the receptionist who are on the “front line" so to speak and can give valuable insight into some of the clients problems. They are always looking for ways to improve their service and to work in more flexible and creative ways to address the health needs of this vulnerable group. If you would like to visit or have more information please get in touch with Clare Cassidy [email protected] or visit


Supporting Carers

Transition to Community

Homeless Health