The project aims to reduce the demand on secondary care by providing in-hostel care. The team works to stop acute conditions developing, so that clients do not need to visit hospital.
The Three Boroughs Primary Healthcare Team are a nurse led outreach team providing services for homeless and vulnerable groups. The project aims to reduce the demand on secondary care by providing in-hostel care. The team works to stop acute conditions developing, so that clients do not need to visit hospital. The project began after St Mungo’s identified a need for intermediate care services for homeless people. A steering group was set up to assess how this could be achieved, and funding was secured from the NHS, St Mungo’s, and Guy’s and St Thomas’ Charitable Foundation.
The service is now an intensive case management service due to the complex needs of the client group at the Thames Reach hostel where it continues to operate. Approximately 2 years ago it expanded into another Thames Reach hostel in Clapham to provide the same care. In June 2017, the nurses started providing a virtual service within a supported housing hostel, which ensures clients are referred appropriately and can access a peer advocacy service to help support their attendance at medical and dental appointments. The team also provides support and training to hostel staff.
The lead nurse, the health support worker (HSW) and a GP for the main hostel provide the service. The nurse and the HSW, work in partnership with the hostel workers, psychologists (only at the main hostel), community mental health teams, local drug and alcohol services and the pathway co-ordinators (in terms of resettlement). From their reports, they continue to reduce A+E attendance. Hospital admissions have however increased but this is due to the clients complex medical histories (and as we are working in a first stage hostel there is active poly substance use), length of stay has also increased but this is because we aim to ensure certain investigations are done, with an aim to reduce the revolving door effect and the number of people missing outpatient appointments.
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