Your Shout - members' questions
In August 2009 the QNI launched a new online forum at www.qniforum.org.uk . To join the forum you need to register on the site. There is a special forum area for Homeless Health questions. Please let us know if you join. If you have any difficulties registering, please let us know.
Therefore we will not be adding new questions on this page. The following questions have previously been asked by HHI members. If you would like to answer any of them (all personal details are kept confidential), please email barbara.walsh@qni.org.uk
August 2009
“I am a Harm Reduction nurse working in the community and wish to be able to give broad spectrum antibiotics under Patient Group Directions (PGD) to our injecting drug users who present with injection site infections or ulcers. Can other members please advise how they go about doing this? Could I have a copy of your PGD? Thanks for your help.”
May 2009
Question from a homelessness specialist nurse
We are a homeless PMS Practice and our prescribing budget is set through national/PCT rules means we not have an adequate prescribing budget to meet the needs of the homeless population – this means our budget overspend each year is impressive despite best efforts and success re generic prescribing, cheapest drugs etc etc. Are there other PMS Practices like ourselves who have similar issues around fixing an appropriate prescribing budget? Is there a solution or calculation out there that can be applied to give us a fairer budget which we might then just be able to work within?
Question from a homelessness specialist nurse:
I am looking for a job description and a Knowledge and Skills Framework for a band 8 nurse working with homeless people. Does anyone have either or both of these?
March 2009
Working with travellers
An HHI member working with travellers asks, "I would like to liaise with other members who work with this group, and have health promotion resources on breast feeding, pregnancy and antenatal care, child development (immunisation, weaning, play, speech, language) smoking cessation, sexual health (including cervical screening) mental health and wellbeing."
Running sessions with medical students
A specialist homeless nurse asks, "I have a regular flow of medical students visiting the centre and sitting in on various sessions when we run our health clinics for homeless and vulnerable adults. They have enjoyed the placement so much that they have asked if they can do more voluntary work via the medical school. I know that some medical schools do have outreach/voluntary opportunities for medical students to work with homeless people. Does anyone know of such a scheme or have any ideas about how it could be run?"
Violent patients removed from GP lists
Question from a specialist nurse for the homeless - January 2009
I would like to ask HHI members generally regarding what other PCTs deliver for Violent Patients that have been removed from GP lists and are now unable to register with a GP in the usual fashion. With these violent patients, I am also interested in knowing specific answers to the following points:
a) If the services provided are suited to each client, or do all clients receive the same service?
b) Do services provide male and female GPs and do clients have a choice about seeing a specifically gendered GP if needed (for example becasue of a history of abuse, or for a personal examination)
c) Does the service offer Primary Health Care Services or is the service problem focused when clients decide they need health treatment?
d) Is there a review process for these clients, what is the frequency and who does the review, or do they indefinitely remain on a Violent Patient Scheme?
e) Do the clients receive any home visiting, Nursing Services, access to same appointments if needed?
Clinical outcomes measures
Question from a homeless health specialist nurse - December 2008
I wonder if any teams have done work on clinical outcome measures in terms of measurable outcomes? If so, have they incorporated them into their client records?
Clear pathway for referrals
Question from homlessness specialist health visitor - December 2008
I would like to define a clear pathway for referrals in and out of my service. This is to ensure that other professionals are clear where referrals are likely to come from , who can refer, who the client group is, and which service the client is likely to move onto and when. Is anyone currently using a pathway of this type?
Community matron service for homeless people
Question from a community matron - October 2008
'I am trying to set up a community matron service for those hostel dwellers or rough sleepers to try to meet their physical health needs. Has anyone set up such a service and could let me have any info or possibly arrange a visit?'
Recording flu vaccinations
Question from a health visitor - October 2008
'The PCT have agreed to fund flu vaccinations for the homeless day centre where I offer health advice, but I am concerned about how I will record this. Do you know of similar schemes or health records that are kept apart from GP records?'
Personal health records
Question from a health visitor, Health for the Homeless, Asylum Seekers & Travellers - October 2008
'Do you have any information/prototype Personal Health Records for adults? I know there was one around a few years ago, but can't find anything recent.'
Signposting tool
Question from a student health visitor - October 2008
'I have a particular interest in homeless families and those in temporary accommodation and their access to information regarding their local community. For example, local amenities, health services, access points and support groups. In addition, I am interested in the inequalities of their health needs and those who are in permanent accommodation.
Therefore I have decided to design a sign posting tool that will encourage the meeting of the health needs/requirements of families in temporary accommodation. It is a client-centred project in its very early stages and I will be meeting with hostel clients next week to identify their needs and what they would like in the information pack. In addition, I will be communicating closely with the local council temporary accommodation department and multi-disciplinary professions and others like yourself to gain knowledge and experience in the community. If you know of anything that has been done in the past or is similar to the idea of a signposting tool in the form of an information pack based on health and health promotion for this specific client group, I would appreicate any advice or help.'
Verbal abuse
Question from a nurse working with homeless people - August 2008
'We are looking into the subject of verbal abuse and what is acceptable and what isn't. Sometimes our clients come and 'sound off' about treatment they've received elsewhere or a problem they have, their language can be offensive and abusive, but rarely aimed at us. Do other members set boundaries that are written down? Or is no offensive/abusive language acceptable? Do they have a grading system of abuse, zero=no action, 5=report to police or has anyone created a policy specifically for their service (which they would be willing to share)?
Attitudes to violence amongst homeless young people
Question from a homeless liaison nurse - August 2008
'Do any of you have any experience of looking at attitudes to violence with young (18-25) people experiencing homlessness? I have become more and more aware of the casual acceptance of extreme acts of violence by this group both as victims and perpetrators, the common significant event history from their childhoods is experienceing and/or witnessing regular violence. I am really interested in working with such a group, who also have many co-occuring issues such as addictions, mental ill-health, physical ill-health etc, either as a small group or individually but I am unsure whether to start with 'examining attitudes to violence' or look at working on improving self esteem/confidence building first. I would greatly appreciate hearing if others have experiences of working on this issue and could offer any advice.'
If you would like to answer any of these questions, please contact Barbara Walsh at the QNI.
Disclaimer: Network members are welcome to use the HHI network to ask questions of each other and share information on local practice. However, the QNI is not responsible for the content or quality of information shared through this informal route. All members should consult local policies and procedures before changing practice on the basis of information obtained in this way.
