We joined the team around 9am, just after they had got back from their first task of the day, which was a visit to the overnight shelter.
They generally get a report telling them who is there, so they know what to expect but sometimes there will be new patients that they have never seen before. They will check in with each person and assess if they need any healthcare, dressing changes or any other support and signpost to the relevant agencies.
In addition to their everyday work and caseload, the team was also faced with the second day of the heatwave, which put their already vulnerable patients at an even greater risk. However, the team was prepared, working with their system colleagues to ensure that members of the homeless population had a safe place to sleep and spend the day.
The team are highly skilled and knowledgeable and it’s a part of their role to make sure that patients are able to make informed choices about their healthcare and in many cases, their future.
The team performs a full range of services including outreach services to hostels, those living on the street and those living in temporary accommodation and in-reach to Royal Bolton Hospital and drop-in clinics. They provide their patients with complete health assessments of their immediate health needs, access to GP registration and to support patients in accessing health, social and housing services.
It’s a small team, made up of 7 staff, of which 4 we met on the day.
Joanne Dickinson is the service lead and she helped start the service back in 2006 after working with the homeless at St Luke’s church. Now she leads a team with a caseload of 200 patients. The team also works closely with Bolton Council teams such as the rough sleeping outreach team, to provide a full range of care.
Heather Faulkner, Health Care Assistant. She works with the team preparing supply bags, helping at clinics and organising discharges. “I’ve always wanted to work with the homeless community, so this is my dream job. The team is great. We all help each other.”
Ava Tinsley, Sister in the Homeless and Vulnerable team, has been with the team for just over a year. Previously a Children’s Nurse, Ava is passionate about reaching out to those who need it the most. She enjoys the various aspects of her role but in particular, she takes pride in the huge difference the team are able to make to their patients.
Rebecca Lace, Trainee Advanced Clinical Practitioner. Her day started by a visit to the overnight shelter. Rebecca told us that it’s part of her role to make sure that those accessing our services are able to make informed choices about their healthcare.
Part of Rebecca’s day to day is getting out and seeing her patients. She does health checks and changes dressings to make sure her patients are keeping well. Her first visit was to Jane, who was experiencing some health issues that needed addressing right away.
Rebecca worked with Jane to assess her needs and got in touch with her GP to ensure that Jane was provided with the right prescriptions to help her get her health in order. Rebecca also arranged for a follow up call from Jane’s GP to ensure she was staying on track with her medication.
“Many of our patients avoid contacting their doctors or going to the hospital as they are often afraid of being judged as a result of their living situation,” said Rebecca.
“What we try to provide is the health care they need free of judgement, a friendly ear to hear their concerns and support to access the services that will help them to stay well.”
Heather, one of the team’s regular patients is so grateful for their service, “I’ve been visiting the clinic for a few months now. It was quite daunting the first time I went as I don’t go out much, maybe once a fortnight due to my anxiety and stress.”
I wasn’t sure what to expect, and thought when I first got there ‘should I do a runner?’ but I’m glad I didn’t. As soon as I met the nurses that were on that day, they made me feel at ease, they didn’t judge me or look down their nose at me. They’re brilliant and I’ll be gutted when I don’t need them anymore.”
“Our patient group can be a very complex and chaotic group who require a lot of input, not just from our service, but from our wider multidisciplinary team including Bolton Council, the drug and alcohol services, mental health and local charities,” said Joanne.
“We always strive to look after our homeless and vulnerable population as best as we can. While it’s not always easy, we are all very passionate about our work and wanting to ensure that our patients aren’t overlooked and are receiving the health and care services that they need.”
One of the service’s patients that Rebecca paid a visit to that day recently had news that there might be a spot available for her in a detox programme. Both she and Rebecca were overjoyed at the possibility of the patient being able to have a chance at no longer being drug dependent, as they have worked so hard to get to this place. She said,
“These nurses have been a lifeline to me, not only have they helped to save my legs, but they help me by being there for me when I need to talk to someone,”
As part of Andy Burnham’s initiative to tackle homelessness and rough sleeping, there are a number of funded guest houses across Bolton that are available for the most vulnerable. People can stay in the guest houses under the agreement that they engage with the housing and nursing professionals.
We joined Ava as she visited the guest houses, alongside Alan from the council. Ava typically knocks on every door to check in with the patients and see if they have any healthcare needs, or need any support from other agencies.
The needs of each individual is so complex and varies from person to person. It’s clear that our team know each person’s story and background inside out, so they understand exactly what is required to help them.
This extends to advice about how they spend their day when they are not in the guest houses.
“It’s important that our patients understand that we are here to help and support them to get back on their feet, in a safe space.
We typically see the same patients, so we know what they are up to and how we can help. Any new faces soon get to know us and understand why we are here.”
The patients we met couldn’t praise the team highly enough, they have a huge amount of appreciation and respect for them.
One patient told us “Ava is the best of the best. She is amazing.”
The team attend the street kitchen fortnightly, on a Tuesday evening to offer advice and signpost to other agencies. If St John Ambulance are there, they can also offer consultations and change dressings.
The street kitchen is run by Homeless Aid UK, which is a charity that provides food, clothes and much more to the homeless people within not only the Bolton area but also, Wigan, Manchester, Liverpool, London and more recently Glasgow.
Within Bolton the street kitchen is on a Tuesday, Friday, Saturday and Sunday, this is run between 7-8pm on the outdoor market, people can go for a hot meal and usually a packed lunch for the following day.
Thank you to our amazing Homeless and Vulnerable Adult Nursing Team, who play a life changing role in the lives of their patients and it’s great to be able to shine a light on the fantastic work they do.
Rebecca’s patient today told us how excited she was for the future, she had her bags packed up and ready to go in to detox. This was thanks to the support, encouragement and understanding of our team and the other professionals involved in her care.
Unsurprisingly, our team were highly commended by the HSJ in 2020 for the work they do with the wider collaborative team in order to meet the needs of this client group.
“We can’t help everyone but everyone can help someone and so long as we are there for those who need us the most, we know that we’re doing a good job.”