Homeless Health Innovation Funding Programme APPENDICES · Project aims: The Health Inclusion Team...

QNI Homeless Health Innovation Funding Programme Appendices 1

Homeless Health Innovation Funding ProgrammeAPPENDICES

2 QNI Homeless Health Innovation Funding Programme Appendices

Homeless Health Innovation Funding Programme Evaluation ReportAppendices

Appendix 1: Interview Schedule for Project Leads and OthersInterview QuestionsWhat works, for whom, in what circumstances, how and why?Interview Questions for Project Lead

The project awards had two main aims:• supporting nurses to undertake projects that provide easy-to-reach healthcare services for people who are

homeless: Objective 1: To enable specialist community nurses to deliver a specialist programme of support for people experiencing homelessness, contributing to improved health outcomes.

• development of the nurse(s) knowledge and skills to improve the care for people who are homeless Objective 2: To support on-going learning and development opportunities for nurses, allied health professionals and others working across sectors, to improve health care for people experiencing homelessness or those who are vulnerably housed.

Questions1. Can you tell me about your role, your employer, your manager and your involvement in working with people who are

experiencing homelessness, member of the homeless health network?2. Can you tell me about the project: why you applied, why QNI, did you consider other funders, how you applied, any

support in applying, how the project went, any barriers, any things that really helped the project?3. What do you consider to be the main outcomes? How did you measure the outcomes? 4. What are the key messages from the project?5. Have there been different outcomes for different people: the people accessing the service; the organisation(s); the

wider services for people who are homeless in the area; for you?6. What was it about the project which helped to achieve these different outcomes: the money, additional support from

manager, from others locally, from the QNI development days, from the QNI visits to the project, from elsewhere?7. How far have people experiencing homelessness been involved in the planning and delivery of the project? Do you

think this was sufficient? Could they have been involved differently?8. Do you think the project has made a lasting impact on the way services are delivered to this group of people here:

ongoing funding, ongoing delivery of the service, dissemination locally, other support? 9. If you were going to do the project again are there any things that you would change and why? You changed things

during the project – what were these? What difference did they make?10. Is there anything else about the project that you would like to add that we haven’t discussed?11. In relation to the development programme: how did that help you in delivering the project and in your own

development?12. What is your ongoing relationship with the QNI: member of the homeless health network; Queen’s Nurse?13. What are your plans now for your own development: greater learning about homeless health; learning in other

areas, e.g. leadership, research, service development; next steps?14. Anything else you would like to add?

Sector Wide Involvement• What involvement did the project have with other organisations concerned with the needs of people who are

homeless?• What/who supported this?• What barriers were there?• What ongoing involvement do you have with the wider sector?

• Client Involvement in the Project• How did you involve people who are homeless in developing the bid?• How were they involved in the project – helping with delivery; as clients; informing others?• What ongoing involvement do they have in the project now?


Outcome Information about the Project• Data that informed the bid for the project e.g. local homeless figures, A&E attendance• How was data collected during the project? Did anyone help with data collection?• Quantitative data, qualitative data, economic analysis• Data collection tools able to share with me• Outcomes data that can be shared• What data has been collected since the end of the project?• What has been done with this data e.g. sharing with local Health and Wellbeing Boards/PH/Commissioners

Other Sources of Information - Dissemination materials • Articles in local press• Presentations to local audiences• Presentations to wider audiences e.g. QNI regional groups, conferences• Papers for journals• Social media use including YouTube, web sites• TV/radio• Other

Questions from Original ProposalObjective 1• Did you achieve your intended outcomes?• Has access to health care for people who are homeless improved in this area as a result of the project?• Do people who are homeless feel that their needs have been listened to and that they have a leading role in their

care in this area?• Do people who have accessed the project report better ratings of quality of life and wellbeing as a result of the

project?

Objective 2• Have you improved your knowledge of homeless healthcare through undertaking the project?• Have you increased your confidence in working with people experiencing homelessness though undertaking the

project?• Have you used the learning to make positive changes in the way you work?• Do you consider that the people who are experiencing homelessness have improved health as a result of your new

learning?• What evidence do you have that these people’s health has improved?

Other People1. Can you tell me about your role, your employer, your manager and your involvement in working with people who are

experiencing homelessness, member of the homeless health network?2. Can you tell me about the project: how the project went, any barriers, any things that really helped the project, how

the project affected you?3. What do you consider to be the main outcomes? Key messages?4. Have there been different outcomes for different people: the people accessing the service; the organisation(s); the

wider services for people who are homeless in the area; for you?5. How far have people experiencing homelessness been involved in the planning and delivery of the project? Do you

think this was sufficient? Could they have been involved differently?6. What was it about the project which helped to achieve these different outcomes: the money, additional support from

manager, from others locally, from the QNI development days, from the QNI visits to the project, from elsewhere?7. Do you think the project has made a lasting impact on the way services are delivered to this group of people here:

ongoing funding, ongoing delivery of the service, dissemination locally, health and wellbeing boards, other service providers, other support?

8. If the project was going to happen again are there any things that you would change and why?9. Is there anything else you would like to add?


Appendix 2. Email to Project Leads Prior to VisitsDear ….In preparation for my visit, in addition to spending time with you (both), it would be good to meet up with the key people who have knowledge of your project and would be happy to talk to me about their views of the project: what facilitated it, what were the barriers, what did it achieve, what could have been done differently, and their thoughts about its continuation and dissemination to other similar sites. These people may include your line manager, other staff and team members, people who have been impacted by the project, people from statutory or voluntary services who have been involved in the project etc. I appreciate that it may not be possible to meet with all these people, and some may not be relevant to your project, but these are suggestions of the types of people who may be able to contribute to the evaluation. I would also like to spend some time with you to explore the above and also the impact of the project, the workshops, network with the other project leads etc. on you (both). Please let me know if you have any other information that would be helpful.

Appendix 3: Programme of Visits and People Met on VisitsName (s) Project Title Visit Date

Patsy Dodd[Charlotte Swan]

Wirral Ark. Homeless Drop-In ClinicWirral Churches Ark ProjectBirkenhead

14.10.1909.30 – 13.00

Kendra SchnellerSerina Aboim

The Health Inclusion Team (HIT) Plus Project Guy’s and St Thomas’ NHS Foundation Trust

16.10.1910.00 – 13.00

Kelly SmithRebekah Jeavons

Self-Harm ProjectNorth Somerset

21.10.1909.30 – 13.00

Claire O’ConnellSheila Shatford

Five Ways to Wellbeing Bristol

22.10.1910.00 – 13.00

Julie McLoughlinHanna KaurKim Bruton

Stop TB. Latent TB Screening and Awareness at HMP BirminghamUniversity Hospitals Birmingham NHS Foundation Trust Birmingham

1.11.1910.30 – 12.00

Julia MullaneyAnn Neville

Leap Ahead.Nurse-led Drop-inDarwe, Lancashire

6.11.19 12.45 – 15.00 (interview 14.00 – 15.00)

Sihle MalapelaAbdul RawkibSultan Ahmed

Health Champions for the HomelessNewhamLondon

7.11.1913.00 – 14.00

Margaret O’Sullivan Touch Base ProjectBrighton

8.11.1910.00 – 12.00

Lisa GavinMark Haythorne

Gypsy/Romany/Traveller Health Out-reachEast Surrey

11.11.1910.00 – 15.00

Paul Coleman[Jennifer Adu]

New Clothing for Rough Sleepers and Asylum SeekersCroydonLondon

12.11.1910.30 – 12.00


1. Drop-in and NHS Health Check, The Ark, Birkenhead, The WirralProject lead: Patsy DoddCEO The Wirral ArkManager Mary Cole HouseResidents Mary Cole House

2. Five Ways to Wellbeing, Homeless Health Service, BristolProject lead: Claire O’Connell, Specialist Homeless Nurse and Project LeadSenior Health Link WorkerTeam Manager, The Compass Centre

3. Gypsy/Romany/Traveller Health Outreach, East SurreyProject lead: Lisa Gavin, Homeless Health Lead NurseGRT Health Outreach AdministratorCommissioner

4. Health Champions for the Homeless, Newham, LondonProject lead: Sihle Malapela, Nurse Practitioner

5. Health Inclusion Team Plus, Southwark, LondonProject lead: Kendra Schneller, Nurse PractitionerSerina Aboim, Nurse PractitionerService Manager

6. Latent TB Screening and Awareness, HMP Birmingham, West MidlandsProject lead: Julie McLoughlin, TB Clinical Nurse SpecialistJoint Project lead: Hanna Kaur, TB Lead Nurse

7. Leap Ahead, Nurse Led Drop-In, Darwen, LancashireProject lead: Julia Mullaney, Advanced Nurse PractitionerPractice NurseManager of the HostelAnn Neville, Business Manager – email contact as she was off sick when I visited

8. New Clothing for Rough Sleepers and Asylum Seekers, Homeless and Refugee Health Services, Croydon, LondonProject lead: Paul Coleman, Nurse Consultant Homeless and Refugee Health ServicesNewly appointed nurse member of the Homeless Health TeamFacilities Manager, Crisis Croydon

9. Self-Harm, Community Outreach Team, Weston-super-Mare, North SomersetProject lead: Kelly Smith, Community Matron Outreach TeamRebekah Jeavons, Community Matron Outreach TeamService Manager, Outreach TeamPeople experiencing homelessness attending a day centre

10. Touch Base, Community Viral Hepatitis Service, Brighton, East SussexProject lead: Margaret O’Sullivan, Community Viral Hepatitis Nurse SpecialistHostel staffHostel residents


Appendix 4: Project Posters

1. Drop-in and NHS Health Check, The Ark, Birkenhead, The Wirral

2. Five Ways to Wellbeing, Homeless Health Service, Bristol

o

5 Ways to Wellbeing Connect Be Active Keep Learning Take Notice Give to others

Having the time and space to consider how to look after our emotional and mental wellbeing has shown to be a simple, cost effective intervention. Our homeless clients have rarely had the opportunity to consider these ideas and have enthusiastically taken part in the discussions and exercises. The atmosphere during the sessions has overwhelming been trusting and mutually supportive; it has been an honour to be part of these amazing people’s journeys. Claire O’Connell, Project Lead

“

In 2015 Bristol had the second highest number of people rough sleeping in England, Wales & Northern Ireland. Homeless Link reports that over 70% of people using homelessness services experience mental distress and over 45% felt they needed more support to cope with their mental health needs. Bristol Homeless Health Service predominantly provides physical health care and gives a significant amount of mental and emotional health support alongside this but without any specifically allocated time to do so. Much of this support is focussed on trying to help people find ways to raise their own self-esteem and manage anxiety so that they are better able to negotiate the systems on their path towards health and housing. The project used the ‘5 Ways to Wellbeing’ approach as a framework to help people look at their mental and emotional wellbeing in a positive way, in a non-judgemental environment.

• 22 clients attended the wellbeing sessions in total

• 50% got greater than 6 point increase in their Warwick Edinburgh Score

and 38% greater than 7 points increase (clinically significant)

• 100% of clients rated the sessions as helpful, 59% as extremely helpful

• Positive learning between clients

• Client involvement in running project and speaking at QNI events.

• Increase in confidence of group facilitators and co-facilitators.

Outcomes:

To improve the emotional wellbeing of people experiencing homelessness in Bristol, using the ‘Five Ways of Wellbeing’ approach.

Project aim:

Claire O’Connell and Sheila Shatford, Primary Care Nurses, Homeless Health Service, Bristol.Project team:

5 WAYS T WELLBEING

”Five Ways to Well Being.indd 1 06/06/2019 12:07:17

WIRRAL ARK

HOMELESS DROP-IN CLINIC

Every Monday, 9.30 - 12.00

Wirral Ark, 7 Sidney Street, Birkenhead, CH41 1BF

A nurse drop-in service

available for homeless

people, requiring

treatment for minor

ailments.

Drop in Outreach Clinic OUTLINES.indd 1 11/06/2019 11:01:43


3. Gypsy/Romany/Traveller Health Outreach, East Surrey

4. Health Champions for the Homeless, Newham, London

Project team:

Project aim: To improve the health of people living in the Gypsy, Romany and Traveller Communities in East Surrey.

Outcomes: • adults offered screening for blood pressure, weight and BMI

• weighed, blood pressures taken and body mass index taken

• children needed urgent treatment (including multiple extractions) which were completed with the fast tracking pathway developed by the project

• Worked with the community to build awareness about the need for immunisations. discussions about immunisations and delivered

• referals, signposting, direct advocacy

• Other issues picked up: hypertension, domestic violence, sexual health and contraception, mental health, safeguarding, child sexual exploitation, grooming

• Development of new Vulnerable Children’s Dental Pathway for Surrey.

• Subsequently successfully bid for £250,000 to expand project across Surrey. Project Team of 6 recruited and project went live on 1.4.19.

• NHS staff across Surrey will be offered Cultural Awareness Training to improve engagement with GRT communities and reduce the inequalities they face trying to access healthcare.

542226

8 2

42 316 44 40

The Health Bus project 2.indd 1 06/06/2019 12:10:30

HEALTH CHAMPIONS FOR THE HOMELESS

Stills from a film featuring the project, available to see here: www.qni.org.uk/explore-qni/nurse-led-projects/homeless-health/

Before, you feel like you don’t exist... You always look down... You don’t meet people. When we got involved with this programme, you feel more human. Homeless Health Champion

“

One in 25 people are currently homeless in the London Borough of Newham - the highest number in the capital. 13,607 people out of the population of 340,978, and an increase of almost 1,500 in the past year. The figures do not include ‘hidden’ or unrecorded homelessness which “is very difficult to quantify, but known to be sizeable”. The health of people experiencing homelessness is known to be significantly worse than that of the general population. This project tried to address this inequality and improve the health of people experiencing homelessness in Newham, in partnership with Newham Transitional Practice and Newham Clinical Commissioning Group.

Project team: Sihle Malapela, Nurse Practitioner; Abdul Rawkib, Commissioning Manager; Sultan Ahmed, Administrator; Newham, London

Project aims: • To improve the general health of people experiencing homelessness in Newham.• To identify undiagnosed long term conditions with a focus on diabetes, mental health and respiratory conditions.• To start patients on a treatment plan and social support.

Outcomes: • health champions recruited and managed to complete the programme• Predominantly user-led: health champions helped co-design the structured

health programme• health education sessions completed and evaluation sessions• Successful and well-attended health event, arranged with health champions• Health champions interacted with a number of different homeless peers and

signposted to a range of services• Very positive feedback from the health champions, who reported feeling

more empowered to better manage their own health needs and have more awareness of local services.

7 5

210

Health Champions for the Homeless project poster.indd 1 06/06/2019 11:31:44


5. Health Inclusion Team Plus, Southwark, London

6. Latent TB Screening and Awareness, HMP Birmingham, West Midlands

“

”

HIT PlusThere is currently a cohort of clients experiencing homelessness who are unable to access day centre services due to the restrictions in place with regards to substance/alcohol use. Therefore these clients are not seeking advice regarding their health. This will have an impact on hospital services as the clients are more likely to present to A+E in a state of crisis. The project is also needed to help reduce the burden and costs to the NHS as a whole, by providing specific primary care advice and services, reducing A&E attendances. It also helps with GP identification and proof of address issues, targeting a cohort of rough sleepers who do not access day centres for individual reasons and to respond to issues related to public health concerns.

Project aims: The Health Inclusion Team (HIT) Plus project aimed to ensure that rough sleeping clients have the same access to health care services as the population in general.

Project team: Kendra Schneller, Serina Aboim, Nurse Practitioners, Guy’s and St Thomas’ NHS Foundation Trust, Southwark, London

• patients seen for same day healthchecksOutcomes:

Clients have reported a better quality of life and wellbeing as a result of the project. Some clients have become more self-aware about their own health needs and how and when to manage themsleves or when to seek advice and support from those with specialist knowledge. Project lead

• clients seen on the street whilst on outreach

• health interventions completed

• Interventions included: health assessments, immunisations, making successful

housing applications for clients, supporting the addiction service, to ensure timely

commencement of opiate replacement therapy (ORT), wound assessment and

management

• HIT Plus model expanded into two other boroughs: Lambeth and Lewisham

• The service has also been profiled on radio stations and was featured on BBC

London news

• Project is sustainable and has secured funding from the Ministry of Government and

Local Housing’s Rough Sleepers Initiative and will continue to provide the service until

2020 when it will be reviewed.

2

10969

77

HIT Plus project 3.indd 1 06/06/2019 11:13:24

STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB 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The prisoner was only discovered to have TB because of the QNI project. Had he not been tested, it would have led to a major public health incident and extensive screening at both the hospital and at the prison. He is now on treatment and doing well. Project lead”

“

STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB















TB or not TB?

Ask staff for more information

Are you under

years old?

65Would you like

testing?TB
















TB or not TB?


Are you under

years old?65Would you like

testing?TBSTOP TB STOP TB STOP TB STOP TB STOP TB STOP TB STOP TB















TB or not TB?


Are you under

















TB or not TB?


Are you under

















TB or not TB?


Are you under

















TB or not TB?


Are you under


testing?TB
















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Are you under


testing?TB
















TB or not TB?


Are you under


testing?TB
















TB or not TB?


Are you under


testing?TB

Stop TB project.indd 1 06/06/2019 11:56:55


7. Leap Ahead, Nurse Led Drop-In, Darwen, Lancashire

8. New Clothing for Rough Sleepers and Asylum Seekers, Homeless and Refugee Health Services, Croydon, London

Leap AHEAD

Leap AHEAD

For more information go to www.darwenhealthcare.co.uk

or call 01254 226 691

Darwen Health Centre, James St West, Darwen, BB3 1PY

•Areyouhomeless?

•Areyouworriedaboutyourhealt

h?

•Doyoufeeluncomfortable

attendingamedicalcentre?

CometoourNurseLedDrop-InSession

s

every other Tuesday afternoon.

Wecouldeaseyourworries!

• Areyouhomeless?

• Areyouworriedab

outyour

health?

• Doyoufeelunco

mfortable

• attendingamedicalce

ntre?

CometoourNurseLed

Drop-InSessionse

very

otherTuesdayaf

ternoon.

LeapAHEAD

Darwen Health Centre, James St West, Darwen

www.darwenhealthcare.co.uk, 01254 226 691

Next clinic appointment :Date: Time:Date: Time:Date: Time:Date: Time:

Project resources

LEAP AHEAD project

A recent Healthwatch Report that provided information on Darwen’s homeless population suggested that reaching vulnerable groups could improve health outcomes for the local population. Evidence shows that 30-50% of people who are homeless have mental health problems, 45% have physical health problems and 60% have substance misuse issues, yet people who are homeless are 40 times less likely to be registered with a GP. The project aims to improve knowledge about health, encourage engagement and provide much easier access to medical care with hard-to-reach groups.

Project team: Julia Mullaney and Ann Neville, Advanced Nurse Practitioners, Darwen, Lancashire.

Project aims:

“I knew that it would be a difficult project but it resulted in me being more determined to make a difference and get further people on board.”Team lead

• To reduce inequalities and improve the access to general practice for individuals at a local hostel

• To increase uptake of flu, pneumococcal, MMR and meningitis immunisations, reduce smoking rates, and reduce the risk of diabetes and heart disease through targeted education.

Outcomes: • 31 residents given flu vaccination (0 given flu vaccine in hostel last year)

• 1 MMR vaccine delivered

• 1 Meningitis vaccine delivered

• 11 healthchecks carried out

• 1 life saved! On one initial routine health check a resident was found to be in acute kidney injury stage 3 and renal failure which required immediate hospital admission.

Leap Ahead project.indd 1 06/06/2019 12:09:19

Project team:

Project aims:

“The itching [from scabies or other skin infestations] that prevents sleep can be very distressing to people who have already endured so much suffering prior to claiming asylum.” Paul Coleman, Project Lead

• 3 patients seen with skin conditions that the service was able to treat who had not previously engaged with the health team

• Patients’ engagement improved and compliance with the rest of the treatment seemed to improve in 4 cases • A number of staff at Crisis reported psychological benefits including improved self–esteem and general

wellbeing• The CQC stated that The Homeless Health Team were a “stand out service”• Offering new clothing (as part of a health intervention) had a very positive impact on the mental health of the

homeless patients • New care pathway for patients created• Great inter-agency working (Crisis)• One patient reported that access to new underwear as part of her treatment for urinary tract infection was

an unexpected (positive) additional treatment. Because of this project she received treatment for her urinary tract infection and was referred to the No Recourse to Funds team who helped her to move into temporary accommodation.

• Secured £6,000 further funding from NHS England to continue the project 2019/2020.

Outcomes:

.

Improving Skin Conditions project poster.indd 1 06/06/2019 11:59:38


9. Self-Harm, Community Outreach Team, Weston-super-Mare, North Somerset

10. Touch Base, Community Viral Hepatitis Service, Brighton, East Sussex

Come and see the nurses

Kelly and BeckyTel: 07554 438 751/07825 753 240

Email: [email protected]

Available at Somewhere To Go, or Addaction.

Do you SELF-HARM?Do you need first aid equipment?Do you want to chat

about it?We can provide a safe, confidential environment

where all health needs, treatments and support can

be carried out.

Date: Time:Date: Time:Date: Time:Date: Time:Date: Time:Date: Time:Date: Time:

People who are homeless are some of the most disadvantaged and socially excluded in our society. 1 in 10 young people self-harm; some eventually take their own lives. The risk increases with age and is much greater for men (RCPSych). Within North Somerset there are no support groups available for individuals who are homeless that self-harm sotheprojectaimedtoprovidethisandinsodoing,makeasignificant impact on both patients’ physical and mental health.

“I had known Mark for around 5 years. I would treat his wounds and wonder what else we could do to help him. His arms always looked so sore, they would be dressed in toilet roll and tape. He would look ashamed of what he had done but would continue to cut himself on a daily basis.”

Outcomes:

:

:

• clients helped

• decrease in self-harm

• decrease in wound infections

• safer self-harm methods

• group sessions were not popular, so one-to-one sessions were developed

• reduced number of visits to A&E because patients either looked after wounds themselves and then saw the project team or because they reduced the number of times they self-harmed

• emergencyfirstaidkitshandedout80• identifiedpeopleamonthonaveragewhoself-harmed.5

SELF HARM PROJECT

Self Harm project by Kelly Smith.indd 1 06/06/2019 12:15:45

Liver disease is one of the five “big killers” in the UK and is the only one where mortality is rising. Hepatitis C is the third most common cause of liver disease which is catastrophic in terms in early mortality but also on NHS resources. Hepatitis C is preventable, treatable and now curable with the newer medications available. The majority (90%) of Hepatitis C virus (HCV) positive individuals in England are people who inject drugs who have suboptimal engagement with health services. The prevalence of Hepatitis C is four times higher in the homeless population, but they are far less likely to engage with health services. Hepatitis C is a public health concern that needs to be addressed to prevent onward transmission. The project aimed to increase testing, diagnosis and treatment of Hepatitis C in the homeless population in Brighton.

Touch Base Project

project lead: Margaret O’Sullivan, Community Viral Hepatitis Nurse Specialist, Brighton

project aim: To increase testing, diagnosis and treatment of Hepatitis C in the vulnerable homeless population.

outcomes: Touchbase • Staff trained to raise awareness around Hepatitis C.• 60 clients tested with HCV saliva tests carried out by non nursing staff.• Staff had a clear referral pathway. 24 were seen at follow up.• 4 new HCV diagnosed, 1 was co-infected with active hepatitis B. • All 4 diagnosed with cirrhosis with ongoing follow up with services as required.• 2 of the 4 clients started and completed treatment, were street homeless and • are now HCV negative.• 1 new HIV diagnosis with supported engagement with HIV services and

currently on treatment.• 3 other known HCV clients regularly used the service and were also homeless.

They have also completed treatment and are HCV negative.

Equinox women’s service• 10 tested, 2 clients seen at follow up and HCV positive.

St Thomas Fund• 6 tested of which 2 positive were HCV antibody positive. On follow up their

HCV PCR bloods were negative so no treatment needed.

• HIV/HCV joint working community domain group established in Janaury 2019 to improve testing and treatment for homeless community.

“We have been able to prove that you can and should treat people with HCV who are homeless. There is a great sense of professional achievement as I truly believe that healthcare needs to be where the patient is.”Margaret O’Sullivan, Project Lead

Touch Base project poster.indd 1 06/06/2019 12:02:42


Appendix 5: Resources Developed by Some of the ProjectsDrop-in and NHS Health Check, The Ark, Birkenhead, The WirralAssessment Sheet showing incorporation of learning from the Touch Base and Self Harm Projects

Self-Harm Kit Leaflet – incorporating learning from the North Somerset Self-Harm Project


Gypsy/Romany/Traveller Health Outreach, East Surrey: Service Model and Resources


Leap Ahead, Nurse Led Drop-In, Darwen, Lancashire


Self-Harm, Community Outreach Team, Weston-super-Mare, North Somerset


Touch Base, Community Viral Hepatitis Service, Brighton, East Sussex


Appendix 6: AcknowledgementsI would like to thank all the project leads, other staff and clients whom I met on my visits to the 10 projects for sparing the time to discuss the projects with me. It was inspiring to meet you all and to feel your enthusiasm for your projects and your work. I would also like to thank Dr Crystal Oldman CBE, Chief Executive, QNI, for inviting me to undertake this evaluation which has been an education for me about an area of health care about which I knew very little.

Appendix 7: Rosamund Bryar BiographyRosamund graduated from the BNurs programme at the University of Manchester where her first nursing experience was with a Queen’s Nurse in Eccles. She has held posts in health visiting, midwifery, primary health care development, teaching and research. In 2000 she joined City, University of London and was appointed Professor Emerita Community and Primary Care Nursing in 2015. Rosamund is a Fellow of the Queen’s Nursing Institute, an Honorary Member of the Faculty of Public Health and a Fellow of the Royal Society for Public Health. She is a founding trustee and honorary fellow of the Institute of Health Visiting and honorary treasurer of International Collaboration for Community Health Nursing Research (www.icchnr.org). She is a founding editor of Primary Health Care Research and Development https://www.cambridge.org/core/journals/primary-health-care-research-and-development, a member of the Collaborating in Pregnancy and Early Years (COPE) research group (https://blogs.city.ac.uk/cope/) and a consultant to WHO Europe on Moving Primary Care Nursing Forward in North Macedonia.

Copyright The Queen’s Nursing Institute 2020

Homeless Health Innovation Funding Programme APPENDICES · Project aims: The Health Inclusion Team...

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