Sue Grave, a student district nurse from Cheshire, writes about her experience of the vital care given to people on the margins, during her alternative practice week in London.

I attended an event about End of Life Care and Homelessness in October last year, and this opened up a passion in me to delve further into the ways in which nurses care for people who are homeless. I subsequently arranged my alternative practice week in London with various organisations and charities who offer all types of help and support to people who need it and will accept it.

Patience and engagement

It is true from this experience that some people are so entrenched in homelessness, they decline any form of help.  This can be due to drug or alcohol intake, or because of not knowing any other form of lifestyle at that time. I have learned it can take weeks, months or even years to foster engagement from some people, which is a challenge, but continuous presence and offers of support will prevail eventually.  There are many who want to turn their lives around; even through adversity they have the will to change! They inspired me very much.  One of the things I noted was how others can misunderstand and stigmatise people who are homeless; and how this leads to feelings of isolation, depression and a sense of hopelessness about their situation.

Worries on the street

I learned a lot by carrying out a ‘hotspot patrol’ of the areas in and around King’s Cross, with an outreach worker from the Safer Street Team, a police officer and a presence officer from the local authority.  One man we woke up was local to the area. We talked to him and learned that for various reasons he began taking drugs when he was younger, leading to his parents eventually ‘kicking him out’ of their home.  It was apparent to me that he was very scared sleeping on the streets, as he had woken up during the night to discover another person had bedded down next to him.

Finding a safe home

He talked about getting help and feared he would be given a place in a hostel. He was now clean from cocaine and was worried that if he met previous acquaintances and cocaine users he would start using again. The outreach worker tried to allay his fears and said that accommodation in a shelter was being sought for him, which he accepted.

As we talked I noticed that he was very concerned with his body image. He had facial spots, and they had opened up due to him picking them.  He asked me if they looked okay, to which I replied, “They look fine, but please don’t pick them!” He giggled and said he would try.

Compassion and care

I witnessed fantastic work from many health professionals, charity workers, and volunteers in places such as day centres, night shelters, hostels, floating hubs and in outreach teams.

I was humbled by the amount of extra support offered to people.  Two homeless day centres I attended had a specialist nurse based within them.  This service was paramount, offering wound care, flu, and pneumonia vaccinations and Hepatitis B testing. The help and advice people received from day centre staff was invaluable; it enabled them to apply for universal credit (UC), or open a bank account.  The challenges people face and the negative impact it can have if they have no bank account when applying for UC and conversely, no UC when applying to open a bank account was very evident and upsetting to see. The stress this caused is something the staff endeavoured to alleviate through reassurance and support, which was second to none.

On one occasion, when dealing with a safeguarding issue, the specialist nurse was able to adapt her knowledge and skills to contact and involve relevant health professionals and agencies to ensure the safety of the people involved.  It highlighted even more the importance of this role. The compassionate care delivered by all was amazing and inspiring to me.

Risks for women

I was informed about some of the many issues women face when homeless, such as becoming involved in prostitution. Some men will take advantage of their vulnerability and introduce them to drugs, then offer the services of these women through ‘pimping’ them to others.  They are then trapped in a cycle of owing money and being controlled through abuse and coercion.

Health professionals try to reach out to them to ensure they know they have someone they can turn to, hoping that one day they will take them up on the offer of finding accommodation and support. They work tirelessly with charities to try and separate people in this situation, in order to protect and work with the vulnerable persons involved, be they male or female.

Hospital support

I have been fortunate enough to spend time with Pathway’s Homeless team at The University College London Hospital. This involved carrying out ward rounds with the doctor and specialist nurse, to see how they support people in hospital and the challenges they face, when seeking substance misuse support or being discharged somewhere safe, while they recuperate from their illness or operation. The team has navigators and peer workers that work to support patients by attending local authority appointments with them; to help them find accommodation, and deal with any issues relating to their status to remain in the United Kingdom. Accessing support for people who have no legal status in the UK and have no recourse to public funds can be traumatic for the people involved.

Find and treat Tuberculosis

Other interventions I saw included the  Find and Treat Tuberculosis van, which is run by a team from the NHS and has a clinical lead, a nurse, a radiographer and two volunteers, ex-substance misusers who have been homeless themselves. The volunteers are an invaluable resource to the team, as they liaise with hostels and homeless hubs to encourage people to attend the van ‘there and then’, to have an X-ray and/or vaccinations.  People who attend a screening on the van are given the results immediately and are urged to seek an appointment with their General Practitioner.  This is the only screening van in the country and has been used in many areas around the UK.

Small acts of kindness

I spent time in a ‘floating hub’ which was run by the charity St Mungo’s.  They then moved to another location for 12 days. These locations included churches and disused buildings, where they offered accommodation, food, and showers. The hub offered advice and support and the workers acted as advocates for their clients. I was truly touched to hear that while they had been at this particular ‘floating hub’, a chef local to the area had attended to cook and serve food every night.  He had not asked for any money; staff and clients alike were very grateful for this act of kindness.

Final thoughts

The World Health Organisation (WHO, 1948) recognises that full health can only be achieved by having a combination of physical, mental and social well-being.  If one or more of these statuses are not met, then the person as a whole is not fully well; this was very apparent during my time in London.

I feel extremely fortunate to have been given this opportunity to experience first-hand the issues faced by those who are homeless and to have witnessed the extensive work that is continuously carried out by many dedicated people who really care and strive to make a difference to eradicate health inequalities for our most vulnerable people.

I have since learned that two of the people we saw in and around King’s Cross St Pancras have now been found accommodation.

Acknowledgements

I would like to thank Dr Caroline Shulman, Dr Trudy Boyce, Dr Tim Robson, the Health Inclusion Team, Camden Safer Street Team, Single Homeless Project, Turning Point, Ace of Clubs, West London Day Centre, TB and Treat Team, St Mungo’s Westminster Floating Hub and all the people I have met during this experience, who have gone out of their way to show and support my learning in caring for the homeless and hard to reach groups, I am truly inspired.  I look forward to staying in touch and developing my learning further.

Sue Grave

Student SPQ District Nursing

Photo by Simon Rae on Unsplash.

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