Earlier this year, on the Homeless Health (HH) team, we were given the opportunity to visit two award winning health and care services aimed at supporting individuals experiencing homelessness. Here is how we got on and what we learned during the visit.
We spent the morning learning about the incredible support that is offered at Ollalo House and what a day in the life of a resident looks like. In the afternoon, we heard from the UCLH Find & Treat team about their invaluable work screening and treating residents across London. Seeing first-hand the day to day running of this one-stop-shop health service opened our eyes to what makes a service truly accessible and inclusive for people experiencing homelessness.
When the day drew to a close, we all reflected on the phenomenal impact that can be achieved with a huge amount of passion and a thoughtful approach. The two services offer lessons on how to successfully tailor health and care services to the needs of those using them. Key ingredients to the services’ successes included:
- The physical accessibility of their services e.g., ramps, lifts
- The language and cultural accessibility of the service e.g., translators, staff speaking multiple languages, or being from a range of backgrounds and cultures
- Providing a one-stop-shop so users can access multiple services or have multiple needs met at the same time and location
- Open, safe and non-judgmental environment e.g., staff trained in how to approach service user conversations
- Meaningfully involving service users or those with lived experience in the design and delivery of the service
Ollalo House – residential and holistic support for people who are vulnerable and in need
The Ollalo House team in Euston is an intermediate care service which was founded in 2008. The service offers accommodation and holistic wrap-around support to those who are vulnerable and in need. The charity supports individuals with a variety of different health and care issues, including – but not limited to:
- Homeless people who have experienced trauma and face multiple disadvantages
- Migrants facing homelessness
- Victims of human trafficking
- Individuals who have been diagnosed with tuberculosis and are experiencing homelessness
We were warmly welcomed by Pawel the Service Manager of Ollalo House and taken on a tour of the house. Colourful artwork created by residents hung on the walls, offering pops of colour and highlighting residents’ creativity as we walked from reception to bedrooms and communal spaces upstairs.
A delicious lunch in Ollalo House’s dining room, if you look closely, you can see residents’ artwork featured on the wall behind us.
Speaking with Pawel it was clear how all-encompassing the support they offer is. Individuals referred to Ollalo House are given a place to call home, with their own room, bathroom, as well as multiple living rooms and kitchens and a computer room to get online. Residents are given three meals a day, cooked from scratch on site and can also snack on food stored in the kitchen in between meals. Typically, those accessing the service are individuals who would otherwise be homeless or sleeping rough, sorting out their accommodation is one of the first and important steps to beginning their journey to a stable healthy life. Having regular meals and getting the right nutrients also forms part of that important journey.
Each individual is assigned a support worker. The most multi-lingual amongst them speak 12 languages, which Pawel highlighted was important for building relationships with clients and making them feel at ease. Cantonese and Mandarin are the two latest languages that his team can speak, and he plans to expand the team by adding Russian, Ukrainian, and Romanian speakers in the near future.
Support required varies from person to person. For instance, one resident may benefit from help navigating public transport when getting to a new job, others could need help reading documents, another signing up to a GP practice or attending an alcohol detoxification appointment. The support can also include helping residents to set up daily routines, create a healthy structure of friends and family around them, sort referrals to services, or create an action plan for anything from health, to career and finances.
If you would like to know more about the amazing work, visit the Ollalo House website.
Double doors leading to the Find&Treat mobile chest X-ray machine. On the right is the screen where the X ray images are generated and then read by the clinical team.
UCLH Find & Treat Team – bringing health services directly to those in need
The second service we visited was the UCLH Find & Treat service. This ground-breaking service has been working on the streets of London since 2008, offering care for people experiencing homelessness and other vulnerable adults. The team have taken their mobile clinic all over the UK and Ireland, with their two Find and Treat vans. The mobile units visit a wide range of sites including street kitchens, homeless hostels and prisons, or anywhere where marginalised adults who may struggle to access mainstream healthcare live or will frequently visit.
Once set up on site, the service offers screening, diagnosis and treatment for a range of conditions such as tuberculosis, Hepatitis B and C, HIV, cardiovascular diseases, STIs and COVID-19. No appointment is needed, you simply knock on the door of the van for an opportunity to get a comprehensive health check. If any of the above conditions are identified, then the treatment process can also be started. Much of the screening done can be interpreted and the results given on the same day. The appointment is also an opportunity to connect individuals with other health and care services they need but may not have accessed otherwise.
It’s clear from our visit how effective the mobile clinic approach is – bringing health services to individuals, rather than asking those same people to visit a fixed NHS site. The numbers they can reach daily using this approach are impressive. In the two hours while we were there, they screened 37 individuals.
The Find&Treat van with artwork adorning the body of the vehicle – the van is painted with different locations that the team visit regularly, including their home site of UCLH and HMP Pentonville.
Inside the mobile clinics
When you step onboard the larger of the two vans, service users enter a reception area for pre-screening conversations. Once the screening is complete, they walk to the end of the vehicle nearest the driving cabin and enter a room that houses the chest X-ray machine. Once finished with the scan, they step back outside and walk around to the back of the van and up the stairs to a consultation room with further diagnostic equipment, where clinical staff will test for further conditions and also deliver vaccines if needed.
On board the second van, users immediately step into the consultation room where individuals they’re met by a friendly face who asks pre-screening questions for a liver health check. Once complete, they step through a doorway to the back of the van and lie down ready for the liver scan. The liver scanner is one of multiple tests done for patients at this one-stop-show and assesses for instance identifies conditions such as cirrhosis and hepatitis.
One of the secrets to the service’s incredible success is the specialist outreach team members with lived experience of homelessness or health conditions that the service treat. As we ourselves witnessed, these individuals help put people at ease during screenings. We saw this firsthand when a woman hovers at the entrance to the van where X-rays are carried out. Uncertain about whether she wants to step on-board, she holds back and warily observes others stepping forward. George, one of the team, approaches her and begins talking, gently outlining the screening process and explaining the support that is available both on-board and after the van has left for the day. Buoyed by his assurances, she seems calmer and climbs the stairs to begin the Tuberculosis screening happening on board the larger X-Ray bus. It’s clear that the warmth and friendliness of the team help alleviate worries about the process.
A photo pit stop from our tour with UCLH Find & Treat team member George.
An inclusive approach
The Find & Treat service is such an important service for London because it allows vulnerable populations to receive the care they need without discrimination and judgement. Having a warm approachable team member who is focused on encouraging someone to begin their screening and treatment journey is key, talking them through what is involved and making sure they feel safe and comfortable. The Find & Treat Team actively encourage you to step onboard and are keen to help answer questions or calm any concerns.
Thanks to the hard work of the team who are continually highlighting the needs of their patients and advocating for further funding for this overlooked population, the service has grown both in the number of conditions it can screen and treat. As we move through 2022, the team aims to continue the wide range of diagnostic tests available with visits planned across the country and even overseas in Dublin.
Taking Learnings Forward
We would like to thank the amazing generosity and kindness of both Ollalo House and UCLH Find & Treat teams in welcoming us to their services and sharing their experiences of supporting individuals who are experiencing homelessness.
The visits were invaluable for deepening our understanding of just how important these services are. Going forward when we work with health and care commissioners this knowledge will be key and mean we can draw attention to the importance of maintaining and expanding these invaluable services.
Interested in finding out more? Visit the Find&Treat website and Ollalo House website.
For more information, or resources for people experiencing homelessness, see our resources page.here.
The following guide and resources is intended for frontline workers, primary care workers, community health and outreach teams who work with people experiencing, or at risk of, homelessness.
The impact of mpox for homeless and inclusion health populations:
People experiencing homelessness often have poor underlying health and high levels of undiagnosed and untreated chronic disease. This means they could be particularly vulnerable to mpox and may find it harder to self-isolate. They also often experience challenges when accessing healthcare and many individuals experiencing homelessness are not GP-registered, making it difficult to identify those who are clinically vulnerable.
Mpox stigma:
There is potential ongoing stigma associated with mpox due to disproportionate prevalence of the disease among men who have sex with men (MSM), including gay and bisexual men as well as transgender women who have sex with MSM. These individuals face discrimination and violence because of this and may need additional safeguarding support to protect them.
It is important to identify whether an individual who has, or is at risk of having, monkey pox is at risk of being persecuted due to contracting mypox. Individuals subjected to homophobia may not always be gay or bisexual.
Having a mpox safeguarding conversation:
Due to this potential stigma and homophobic discrimination faced by someone in a shared accommodation setting, it’s important to identify whether the individual is returning to a safe place to stay. The conversation guide below has been developed to help with these potentially sensitive conversations.
Conversation objectives:
- To establish whether there are potential safeguarding risks for an individual related to a confirmed or suspected case of mpox
- In suspected cases, to understand previous contacts and type of contact of an individual to determine risk of developing mpox in near future (e.g., sexual activity or other close contact)
| Topic | Guidance |
| Having the conversation |
| Find a comfortable environment | Find a place to talk that’s private and allows the person to be at ease. Acknowledge that the topic isn’t easy to talk about but explain why it’s important to talk about it, including:
1. To allow you to protect against safeguarding concerns
2. To help you understand their particular needs and to better inform appropriate discharge settings
3. To provide appropriate public health information and advice to help to reduce the spread of mpox infection.
|
| Give the facts about mpox | Give the individual some background on mpox and how it is typically passed between people, i.e., through close contact with others including shared bedding and/or towels. Refer to the latest UKSHA guidance, found on gov.uk: Mpox: background information.
Make them aware of where they can go to access medical support for mpox if they haven’t done so already:
• Contact NHS 111 or call a sexual health clinic immediately. Their call will be treated sensitively and confidentially
• Avoid close personal or sexual contact with others until they know that this is not mpox. Individuals should contact sexual health clinics ahead of visits and avoid close contact with others until they have been seen by a clinician
Cases and suspected contacts will be followed up with by Health Protection Teams, who will provide advice on self-isolation and work with cases to identify any contacts.
|
| Listen | Be person centred and have an open conversation, making sure the person feels heard and listened to and understands that you are interested in their safety. |
| Be non-judgemental | Try to avoid showing strong emotions such as shock or embarrassment in response to something someone says. This might discourage people from sharing their experiences with you.
Remember, sex work is work. Be mindful of stigma around sex work and avoid raising conversations around ‘exiting’ sex work when people are seeking healthcare advice.
|
| Be open and honest | Encourage them to ask questions. Answer them as honestly as possible. If you don’t have an answer for something, refer to UKHSA guidance.
Any medical concerns should be handled by a clinician, and individuals should follow the advice above if they have any questions or concerns.
|
| Use simple and appropriate language | Use simple terminology that can be easily understood. Avoid using jargon or acronyms that are not obvious. You can use find language in UKHSA guidelines and on the Healthy London Partnership (HLP) website.
Try to mirror the language people use to describe their sexuality and gender identity if discussed.
|
| Confidentiality | It’s important that people feel able to share their experiences with you. However, if their safety may be at risk, don’t promise to keep things a secret and explain that you have a responsibility to tell people who can help you. Concerns about someone's wellbeing, should be reported through your standard safeguarding pathways. |
| Taking action |
| Referral | Contact 111 or local sexual health service to access assessment and testing for monkeypox (highlight if you think they are clinically vulnerable and/or immunocompromised).
You can also contact UKHSA for additional health guidance, contact via LCRC (LCRC@phe.gov.uk), or phone: 0300 303 0450.
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| Housing contacts | For local housing authority and related housing contacts in your area, please consult the London Hospital Discharge Housing Options Directory, found on the Future NHS website.
If you do not have a Future NHS account, you can apply for one on the site.
|
| Additional mpox resources | Additional information on mpox:
• Details on all confirmed cases: https://www.gov.uk/government/news/monkeypox-cases-confirmed-in-england-latest-updates
• UKHSA mpox guidance: https://www.gov.uk/guidance/monkeypox
• NHS mpox page: https://www.nhs.uk/conditions/monkeypox/
• Terrence Higgins Trust mopox information: https://www.tht.org.uk/news/monkeypox-uk
• Queer Health from the Love Tank mpox page: https://www.queerhealth.info/monkeypox
• WHO global perspective and information: https://www.who.int/news-room/fact-sheets/detail/monkeypox
• Follow @UKHSA and @UKHSA_London on Twitter for the latest Mpox updates
• Campaign Resource Centre communications assets: https://campaignresources.phe.gov.uk/resources/campaigns/145-monkeypox/resources
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| LGBTIQ+ and sex worker specific sexual health resources and hate crime reporting services | LGBTIQ+ Homelessness services:
• The Outside Project LGBTIQ+ Centre: https://lgbtiqoutside.org/
• Stonewall Housing: https://stonewallhousing.org/
• AKT (under 25's): https://www.akt.org.uk/
LGBTIQ+ Hate Crime:
• Galop: https://galop.org.uk/types-of-abuse/hate-crime/
• LGBTIQ+ Sexual Health Clinic, Dean Street: https://www.dean.st/
Trans Specific Sexual Health Clinic:
• 56T: https://www.dean.st/trans-non-binary/
• CliniQ: https://cliniq.org.uk/
LGBTIQ+ Sex Workers Sexual Health:
• SASH: https://londonfriend.org.uk/sash/
Sex Workers Sexual Health:
• CLASH and SHOC: https://www.sexualhealth.cnwl.nhs.uk/clash-and-shoc/
Sex Worker Support:
• SWARM: https://www.swarmcollective.org/
• United Sex Workers: https://www.uvwunion.org.uk/en/sectors/united-sex-workers/
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| Further reading on safeguarding and stigma | Adult safeguarding and homelessness: Experience-informed practice (LGA and ADASS): A briefing report detailing some practical guidance on managing safeguarding issues with people experiencing homelessness. Useful to see lived-experience feedback on safeguarding and as a reminder of the six safeguarding principles outlined in statutory guidance
Breaking the Cycle of Stigma in Academic Writing (Stephen Parkin, 2022): A guide to language including a dictionary of words that can be harmful for vulnerable groups, including why they may be harmful and alternative words that can be used
Communication practices in conversations about sexual health in medical healthcare settings: A systematic review (Kedler et al., 2021): A report that highlights some common pitfalls and successes of conversation about sexual health
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Are you, or any other members of your team interested in creating and running a community of practice in your area, around supporting people experiencing homelessness who have poor health?
Pathway and Marie Curie, together with experts in the field (and supported by NHSE and the Oak Foundation), have developed a suite of resources to help you set up and lead regular meetings for anyone in your area that is supporting people experiencing homelessness with advanced ill health.
This is an opportunity to bring people together in your local area who are working with this population (e.g. from hostels and other frontline homelessness services, health, social care and addiction services etc.).
They provide videos in which leading experts share tools, resources and tips for supporting people experiencing homelessness with complex ill health in homelessness settings, such as hostels. In these videos you hear from people with lived experience of homelessness, hostel staff, health and social care professionals and from experts in palliative and end of life care. The resources can be used to support the first eight online sessions of your community of practice.
Topics include:
- links between homelessness
- health and palliative care
- complex trauma
- communication strategies
- frailty
- neurodiversity
- mental capacity
- care act assessments
- palliative and end of life care planning & bereavement.
The course also provides a detailed facilitator guide to help you support the sessions that you run, with suggested discussion questions and ideas for how to get your groups to come together, support each other and create actions for difficult situations.
If becoming a facilitator sounds like something you would be interested in, please join one of the virtual information sessions on either Thursday 7th July at 2-3pm or on Tuesday 19th July at 2-3pm to hear more. To sign up to the session, complete this short form. Attending this initial meeting does not commit you to becoming a facilitator!
If you are interested but cannot make either date please email: homelesspalliativecare@mariecurie.org.uk
Dr Olivia Farrant is a member of the University College Hospital (UCLH) Respond team, a community-based service delivering holistic care for asylum seeker communities in London. Olivia is also a Centenary Fellow at the UCLH Hospital for Tropical Diseases.
In 2021, 48,540 people claimed asylum in the UK, the highest level since 2003. The majority of these applications were made by people from Iran, Iraq and Syria, aligning closely with conflict in these areas. This rise of almost two-thirds from the previous year, together with the impact of the COVID-19 pandemic on pre-existing delays to the processing of asylum claims, resulted in the placement of many families and individuals in ‘contingency accommodation’ across the UK. Forced migration due to persecution, conflict or natural disaster is not a new phenomenon, and the principles of the 1951 Refugee Convention remain just as relevant 70 years on since its inception.
Bringing health and care into contingency accommodation
Although contingency hotels had been used prior to the pandemic, the scale of their use since then has been unprecedented. Thousands of vulnerable migrants were placed in inner-city areas during a pandemic when health and social care resources were already stretched to their limit. People seeking asylum are known to be commonly affected by complex and inter-generational needs, affecting mental, physical and social health, and may have experienced limited access to prior healthcare. This made it exceptionally challenging to provide an equitable and accessible service for this population, despite the best efforts of frontline staff.
To address these problems, our team from UCLH designed a new integrated, community-based, model of delivering care for asylum seekers called ‘Respond’. This model is designed to overcome barriers in access to healthcare, provide a wrap-around, holistic and trauma-informed service and deliver equitable healthcare for an underserved group.
An integrated and holistic response
Through the Respond model, we support GP registration, screen for a range of physical and mental health needs, including communicable and non-communicable diseases, refer and signpost to key services, and provide a patient-held record of our assessment, as show in Figure 1. We work with expert multidisciplinary input from a range of specialists with expertise in migrant and refugee health. We were commissioned by North Central London Clinical Commissioning Group in July 2021 to deliver services across Barnet, Camden and Islington.
Figure 1. The Respond model
We have assessed over 700 people in family groups and as individuals to date. We have learnt the importance of partnership working and the benefits of integrated care across traditional boundaries: primary and secondary care, adult medicine and paediatrics, health and social care. We have learnt the crucial importance of bringing healthcare into the community, of understanding where people live and their experiences in the design of an equitable service. We’ve had to overcome funding shortfalls to continue our work and have learnt the limitations of short-term retrospective funding models when trying to build sustainability into the system.
Looking ahead
Moving forwards, from a clinical perspective we will be upscaling, strengthening our partnerships and bringing in peer advocates to work with us in the implementation of our service. From an academic perspective we will be developing one of the largest clinical datasets to date describing the health needs of asylum seekers in the UK, conducting in-depth qualitative work and economic evaluation to assess for acceptability and cost-effectiveness. We will be sharing the results of an interim service evaluation of the first 12 months shortly and will be seeking feedback from key collaborators across the region and from patient advocates.
Our work is designed to address health inequalities through equitable service delivery, partnership across traditional system divides, digital innovation and cutting-edge research for an underserved group. We remain at a pilot stage and welcome feedback from collaborators and other stakeholders as we move forward.
Further reading
Farrant O, Eisen S, van Tulleken C, Ward A, Longley N. Why asylum seekers deserve better healthcare, and how we can give it to them BMJ 2022; 376 :n3069 doi:10.1136/bmj.n3069
Contact
Find out more about the Respond service here: https://www.uclh.nhs.uk/our-services/find-service/tropical-and-infectious-diseases/respond-integrated-refugee-health-service
Or email the team via: uclh.respondadmin@nhs.net
World Refugee Day is an international day designated by the United Nations to honour refugees around the globe and takes place annually on 20 June. Learn more about HLP’s work to support people experiencing homelessness and other inclusion health groups.
Find podcasts and webinars produced by Transformation Partners in Health and Care’s (TPHC) Homeless Health programme team and partners in London, sharing insights and the latest work developments in homeless health from colleagues across health, housing and the third-sector.
Find more content on our homeless health learning and resources page.
London Health Podcast episodes on homelessness
The TPHC Homeless Health team is hosting a new podcast series for the London Health Podcast to help debunk myths about homelessness and homeless health through minimal jargon and honest conversations.
This series is open to all: for health and care workers who don’t always work with people experiencing homelessness, individuals and teams providing homelessness support, and for anyone else out there who wants to learn a bit more about homeless health.
Public Health Voices Webinar Series
The UCL Health of the Public team hosted a webinar series themed around public health voices. In the ‘Everyone In: Citizen Voice in Inclusion Health’ webinar, inclusion health experts discussed the importance and value of involving people with lived experience of social exclusion and how this is key to designing effective interventions and solutions.
Homeless Link online training and webinars
Homeless Link’s national, regional and online training and events are an opportunity to network with other homelessness professionals – share knowledge and experience, find solutions and develop expertise within the sector.
Local Government Association webinars
As part of the Out of Hospital Care (OOHC) Models Programme, the Local Government Association (LGA) are holding webinars around OOHC and housing every fortnight until the end of January.
Presentations from previous webinars are linked below.
Housing and accommodation: maximising local opportunities and resources (30 November)
Engagement through and with emergency department Teams: what works well? (16 November)
Step-down and onwards accommodation: good practice models and resources (14 December)
Developing the evidence base (11 January)
Discharge from acute mental health settings (25 January)
Feedback
We welcome feedback on the resource and will update it from time to time. If you have any comments please the Homeless Health team.
Back to Homeless Health
The START team is a Community Mental Health Team for people sleeping rough in Southwark, Lambeth and Croydon. Dr Jenny Drife has been the Consultant Psychiatrist in the team since 2016.
Loneliness makes everything harder
In our community mental health team (CMHT) for people sleeping rough, loneliness is something we see every day. The woman whose paranoia has led her to abandon her hometown, and who hopes setting up camp in a South London park will keep her safe. The man who has travelled from his war-torn country plagued by symptoms of Post-Traumatic Stress Disorder, unable to speak English or explain his distress. The teenager who has suffered abuse and neglect from childhood and drifted into a life of drug use and self-harm. Often, it can seem that the one thing our clients have in common is that they are alone.
Unfortunately, being alone makes everything harder. Asking for help, even when surrounded by a loving family or friends, can be difficult. Struggles with mental health and substance misuse can make reaching out even more tough. Left alone, it’s much easier to listen to the internal voices, withdraw into a depressive episode, or seek solace in drugs or alcohol.
Reconnecting people can have lasting impact
A lot of our work centres around relationship-building. We meet our clients on the streets and do what we can to establish a connection, gradually building up trust by trying to help meet their individual needs – be that with a cup of coffee, helping with benefits paperwork, or with medication. It can be slow and tedious work. If we get up at 6am to go on outreach, we know that there’s a high chance we won’t find the person we’re looking for, or that we’ll be told to go away. We persevere and are lucky to have a psychologist on our team who works with people from the earliest stages of their homelessness experience with us, to help them address their trauma.
Little by little, the beginnings of change emerge. Sometimes the outcomes are well beyond our hopes. Clients who have seemed the most entrenched in homelessness have made it off the streets and found peace. Perhaps the most satisfying part of the work is when we have been able to reconnect people with family they lost touch with, years or decades before.
We can do more by working together
These days it can feel as though the battles we are helping our clients to fight are getting harder. Systems are under pressure, hospital admissions are increasingly harder to achieve, waiting lists for CMHT support are long, and accommodation is in short supply so when it is offered it may be far away – meaning the networks our clients have started to form are lost.
This is a population that is extraordinarily vulnerable. In 2020-2021, 44 per cent of people sleeping rough reported a mental health support need, 29 per cent needed support around alcohol use, and 31 per cent around drugs. There is a huge burden of physical ill-health, and the average age of death for a man sleeping rough is, incredibly, just 45. Mental health awareness week is not something that will enter the minds of many of our patients; they are too busy trying to survive, and may not even understand their struggles as part of a mental health issue.
However, as a society we need to be aware of this marginalised group and recognise that many will avoid or push people away because of the distress they have been subjected to by others. We need to remain hopeful that trust can grow again when people start to feel safe. We need to be aware of the extent to which mental ill-health both causes and is caused by homelessness, so that we ensure that the network of housing, health, and community organisations continue to work together to provide expert support to the most isolated.
If you would like to learn more about the work we do on the START outreach team, check out NHS South London and Maudsley website here: https://slam.nhs.uk/search/service/homeless-outreach-team-start-lambeth-southwark-and-croydon-171
For more useful information on homeless health and resources to help improve homeless health services, look at our resources page.
Co-Clinical Leads Dr Jasmin Malik and Dr Caroline Shulman joined HLP’s Homeless Health programme in September 2021. Jasmin and Caroline bring valuable skill sets to their joint leadership role having worked with inclusion health groups in primary care across London for a number of years.
Working within the homeless health network, their combined knowledge, experience and understanding of the homeless population, frontline practitioners and the commissioning landscape, enables Caroline and Jasmin to bring their joint clinical voice into the development of pan-London homeless services.
Jasmin’s background includes being a clinical lead for homelessness and mental health in Camden/NCL since 2017. This role has involved working with commissioners at a local level supporting the development of local homeless services, bringing together local networks of clinicians and frontline staff, and providing training and support to local hostels prior to and during the pandemic.
Caroline is a clinician, researcher and trainer and has led a number of projects in homeless and inclusion health. She was also a clinical lead for a multidisciplinary hospital Pathway team for a number of years. Her projects include highlighting unmet palliative care needs and high levels of frailty within the homeless population, and development of interventions to advocate for – and improve access of – high-quality services. She is also developing training resources for inter-professional learning to support localised communities of practice to better address the needs of people with multiple and complex needs.
Through their joint role for the HLP Homeless Health programme, they are supporting a number of areas and contribute to the Homeless Health Leadership Group and ICS meetings. Their work includes building upon and chairing the Homeless Health Clinical Leads Group which is an open forum for clinicians and other frontline practitioners working in homeless services, ensuring the clinical voice is heard. Members can share experiences, discuss problems and potential solutions – where necessary escalating to commissioners and other appropriate bodies, and learn from regular speakers sharing their expertise.
Jasmin has been working with ICSs to conduct a mapping of homelessness provisions across boroughs, and has convened a new steering group to take forward the Primary Care workstream. Caroline is supporting the out of hospital programme and led rapid surveys capturing a snapshot of COVID cases across London between December 2021-January 2022. She also led a subsequent winter snapshot audit to capture a more in-depth picture of hospital inpatients’ needs, helping to identify difficulties in facilitating timely and safe discharges and any gaps in step-down accommodations. Caroline is currently working on developing a survey with St Mungo’s to explore the unmet needs of people with care and support needs living within homeless hostels.
Caroline and Jasmin are also involved in work addressing the health needs of the most vulnerable rough sleepers in London as part of the T1000 project. They are also bringing their clinical voice into the mental health and substance misuse workstreams, as well as highlighting the needs raised by experts and frontline practitioners regarding other areas of need such as women rough sleepers, homeless children and families, and the transitional years between the ages of 16-25.
Click here to read related content from the London Homeless Health Partner April 2022 newsletter.
