Physical health:

Whilst we have delineated physical, mental, emotional and public health for the sake of clarity, we are very aware that one 'category' overlaps or impacts another.

In the homeless community, 73% of people report physical health problems with 41% saying these were long-term problems.  

Minor illness – our nurses are skilled at assessment and diagnosis of minor illness.  This means that they are able see an individual presenting with various symptoms, ask appropriate questions, examine, and make a working diagnosis then offer advice or refer on to the GP for further support.  This may be a prescription, investigations, referral to other services.  Some services we can refer to directly.  We also have access to the Outreach GP service provided by PELC (hyperlink).

Long term conditions management – few of our service users attend the GP for their annual check-ups for conditions such as diabetes, heart disease or COPD.  Therefore, we bring the service to them, do the necessary checks and report back to the GP.

We tend to have significant numbers of clients with diabetes, respiratory illness and heart disease.  We do a lot of health promotion work around heart disease risk – there are strong links to mental illness and homelessness: depression, smoking and poor diet increase risk; due to high levels of smoking, respiratory illness is common. Epilepsy and seizures are common, in some cases, due to high levels of alcohol or alcohol withdrawal.

We are also now seeing a small but significant number of people with debilitating and life limiting neurological disease where there is need for ongoing and regular check-ups and referrals to other services as the disease progresses.

Repeat prescribing – very few service users think to order their repeat prescriptions and thus health may deteriorate rapidly.  To mitigate this risk, we maintain a diary of repeat prescriptions and when due, email the respective GP and request the prescription is sent to the pharmacy of choice.  We include the support/key worker so that they remind the client to collect.  We have noted in so doing, a marked improvement in compliance and concordance in use of medication

MED3 (sick certificate) – this operates in much the same way as with repeat prescribing.  When MED3 is forgotten about or is out of date, this disrupts benefits and thus increases the risk of eviction due to non-payment of rent.  Ensuring that MED3s are ordered appropriately and on time, mitigates the risk of the rough sleeping cycle continuing.

Phlebotomy – due to service users rarely having blood tests when needed, one of our nurses trained in phlebotomy.  Blood forms are now sent to us, and we take the service to the patient.  This means that safety monitoring and diagnostic tests are generally done and acted on in a timely fashion.

NHS Health Checks – it is important to determine risk of heart disease and diabetes and advise accordingly. We are able to risk assess and where risk is high, clients are offered appropriate medication and ongoing support.  This is a people group at significant risk of heart disease due to lifestyle and multiple other factors.

The NHS Health Check programme is a national vascular risk assessment and management programme targeting adults aged between 40-74 years with no pre-existing diagnosis of cardiovascular disease, stroke, diabetes and kidney disease. The programme aims to reduce the burden of morbidity and mortality from these conditions by assessing individuals' risk and giving support and advice to reduce or manage that risk.

Using our initial health check at registration and checking random blood glucose, we are able to identify and advise those who are hypertensive and diabetic as well as those who are at risk.

First Aid – all staff have tri-annual first aid training and CPR/anaphylaxis ever 12 – 18 months.

Smear tests – very few of our female service users think about preventative care.  Smear tests are offered every three years from age 25 – 49, and then every 5 years from 50 – 64.  We are now able to bring the smear test to these vulnerable ladies.  We now have a mobile consulting room*(hyperlink to separate page) and can offer smear tests on board, in privacy, with a team who are known and trusted by the service user.

Chiropody – people who are experiencing homelessness, particularly, rough sleepers, tend to have very poor foot health.  We also encourage service users with diabetes to access the service at least bi-monthly.  Our chiropodist attends the day centre monthly and the service is accessible to all.

HC1/2 – for those with no recourse to public funds or not on appropriate benefits, a HC1 is completed.  The HC2 certificate provides free prescriptions, optician and dental treatment.  A barrier to health is not being able to afford to pay prescription charges.  This is particularly relevant for those needing life sustaining treatment.  We complete the form with the client and when the certificate is received, scan to the client record in case of loss.

2WW referrals – in the last 12 months we have seen 20 clients with symptoms suggestive of cancer.  2WW referrals have been requested and made by the GP and all clients have been facilitated to attend appointments.  Had the Homeless Healthcare service not been available, none of these service users would have attended the GP.

Palliative care – we maintain a palliative care register. The question 'would you be surprised if X died in the next twelve months' is discussed between the team.  If the answer is 'no', the client is added to the register and appropriate referrals and follow-up are made.  This could apply to someone with cancer or somebody with liver failure, commonly due to alcohol misuse, for example.

Visiting individuals in hospital to support appropriate and timely discharge – as soon as we are made aware that someone is in hospital and is homeless, we will visit, introduce ourselves to the ward staff (and client if previously unknown to us).  Liaison with the hospital team has resulted in better discharge planning

Sport and exercise – we work closely with Vision Redbridge on their Exercise on Prescription programme.  Referrals can be made for our service users.