I am a community staff nurse and Queen’s Nurse working with Powys Teaching Health Board, I am also a community nurse prescriber and palliative link nurse. I qualified as a nurse in 2006. My passion for homeless health stems from my own personal experiences as a person sleeping rough. I left home at a young age fleeing abuse, and lived between the streets of London, care homes and secure units for many years.
In September 2018 I joined a 24-hour sleep-out in Cardiff to raise funds for local voluntary group ‘Hope for the Homeless’ to help feed people who are homeless, alongside a fellow District Nurse Eira Evans. Whilst on the sleep-out we met a young person who was sleeping rough who was in a lot of discomfort with his feet. After much coaxing he let us look. He had awful trench foot, his socks and boots were soaked, and he was very embarrassed.
Cardiff has many excellent services set up to manage homeless health (see box below for detailed info on these services). However, we discovered that although most people who are street homeless are accessing services, some are not. Some spoke of a fear of losing their begging pitches or tents if they were gone too long. Others felt that they had been undervalued by staff in the past, and that this had put them off accessing services. Some who had issues around addiction explained that they had no interest in the health services and some were involved in conflict with others on the street and would not venture into certain areas. Finally, some did not like to attend statutory services.
My colleague and I then decided to try to take a voluntary nursing service to the streets. Hope for the Homeless was already supporting and feeding people who are sleeping rough several times a week, and we linked into their existing service. Our first outing was in Cardiff city. We purchased the items needed for outreach basic foot care – wet wipes, nail clippers and nail file, gloves, apron and hand sanitizer, and off we went. On our first outing the people who are street sleeping were very dubious of us to begin with, and we may have delivered basic foot care to only two or three people. However, through the rapport already built by ‘Hope for the Homeless’, we began to establish ours, and now treat about 10-20 people each time we go out.
We are now one year on, and advertise what we do as a voluntary nurse-led street clinic. The people who are sleeping rough know when we are coming and look forward to our visit. More staff members have joined the service and we have a pharmacy technician, lymphoedema nurses, tissue viability nurses, community nurses, mental health and learning disability nurses, ITU nurses, a paramedic, ward nurses, blood service nurse and a Macmillan nurse and an advanced nurse practitioner that volunteers.
We also have student nurses and newly qualified nurses who join us, and many caring members of the public. Days are arranged in advance, and each street clinic normally has a turnout of 10 – 20 volunteers, shifts permitting. We have recently linked into the existing city services, and have gained knowledge around each service. This knowledge and connection will assist us to give the correct advice to encourage the people we see on the street to access professional services to ensure that their health needs are met. We have also established a system to liaise with services about any issues that concern us. By working in collaboration with the services that have long been established, we hope to provide those who are not accessing care and slipping through the net with the encouragement to take ownership of their health needs. By providing a basic street service to this group we also act as a further set of eyes to maintain their welfare.
We have now branched out to set up the service in Newport, joining with The Helping Caring Team (HCT) group, who provide food to people who are homeless on homeless Mondays, Wednesdays and Fridays. On our first visit myself and two other nurses performed basic foot care for 16 people who are sleeping rough, determining there was a need for the service. At subsequent visits up to 20 individuals have been seen, and we are slowly building trust and more are coming to us. We are working on establishing a signpost system in Newport to ensure collaboration within services to benefit people who are street homeless and vulnerable that we see.
In Swansea, we have now joined with the Sameera Foundation charity to provide a foot health day for people who are sleeping rough and are trying to encourage other vulnerable groups to participate. The Sameera Foundation (along with other sponsors) provides hot food and beverages, while we perform basic foot care and give out donations of hygiene items and warm clothing. We offer advice and links to other services and the NHS based homeless nurse has provided a signpost system to ensure we work in unity, I have also spent days in my own time working alongside the street nurse to develop my own knowledge further of the city and services available.
In our work we are aware we work within a voluntary remit, and try to protect ourselves as much as possible, and think about health and safety. For example, we use a knee pad to kneel down, and always ask rough sleepers to remove their own shoes and socks and roll up trousers to knees. Personal protective equipment is always used. Hand mirrors are used to look under feet and heels. Footcare bags provided to volunteers have wipes, disposable gloves, an apron, dressing sheets, alcohol gel, nail clippers, nail files (single use only), talc, barrier cream and a mirror.
Only Registered Nurses perform foot care and the other volunteers help with donations, and clothing people. We clean feet using hygienic wipes, and then use softening creams for dry calloused feet. If the person who is sleeping rough has wet feet with evidence of trench foot, we clean their feet and use talc to draw out moisture. We provide them with clean dry socks and dry footwear, and the advice required to maintain healthy feet themselves. If nails require cutting, we seek consent and clip directly across the nail ensuring that nails are not cut in, which could cause further discomfort. Any concerns found are highlighted to the person, and they are encouraged to attend the professional services available. It is important to note that nobody insures this work specifically – nurses are bound by their Code of Professional Conduct, and the limits of their own personal professional insurance.
Our work currently receives much interest from nurses in other areas, including Aberdeen, Stoke, Lincoln, Norwich and other areas in Wales, who would like to set up their own voluntary health clinics for people who are homeless. I would personally like to see the service working in conjunction with our professional services in every city in the United Kingdom.
Volunteers who join me often say they feel humbled to have had the opportunity to help, and that they would never look at a person who is homeless the same again. As an ex rough sleeper, I understand fully the vulnerability of those who have nothing. When you join that community, you have a feeling of invisibility, and an overwhelming feeling that no one cares about you. This is my chance to do something practical – I personally feel that giving is everything and costs nothing. I would personally encourage anyone thinking of setting up a service like this to contact the services available within their area, and discuss with them services already set up. Once knowledge is gained around the available services you then have the correct information to offer advice and work together to establish further services.
Donna Thomas, Queen’s Nurse
Cardiff Homeless Health Services
Nurse service within Housing Options
An open access clinic with a nurse runs Monday to Friday 09:00-11:00am, with additional access to a tissue viability nurse at the Housing Options Service, in Hansen Street, Cardiff. On a Wednesday a blood borne virus clinic is held here, and once a month the integrated sexual health clinic is also held there, where people who are street homeless and vulnerably housed can access condoms, testing and advice. A Social Worker for people who are homeless is also based within housing options.
Homeless GP service
An open clinic with a GP runs at Butetown Medical Practice daily from 9:00-11:00am.
Substance misuse services (embedded in a homeless ‘one-stop-shop’ day centre)
The Huggard Centre run a day centre which opens every day of the year, with an advocacy service, substance misuse service, and needle exchange programme, volunteer groups and skill share programmes. The Huggard also offers regular emergency accommodation, and in the very cold weather opens their day centre as a night shelter. Shower and laundry facilities are also available which can be accessed daily.
Outreach nurse / outreach mental health support
There is a team of outreach workers funded by the council, in collaboration with The Wallich (a voluntary sector agency supporting people who are sleeping rough) and volunteers, who provide daily street visits and a breakfast run to people who are street homeless. There is a dedicated outreach nurse who joins the outreach team on the streets and on the breakfast run. The nurse links in with the people who are sleeping rough, and those in tents who choose not to access the services at the Housing Options nurse led open clinic. The outreach team also have a councillor, addiction worker, psychiatric social worker, and advocates.
Tresillian House is a hostel next to the Huggard which offers a range of services to help people back into independent living, including helping to access health care. There is a supportive network and team set up within to ensure the welfare of all. The YMCA also offer emergency beds and support to develop independent living skills.
There is also The Salvation Army, The Wallich, a Homeless bus which pulls up at city hall at night to offer food, a street pastor service, and numerous voluntary groups which visit the city to assist and support the homeless and vulnerable.
For more information contact: Geraldine Jones, Nurse for Homeless Adults
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