Emmanuel House’s partnership with City Care’s Homeless Health Team

Nottingham City Care’s ‘Homeless Health Team’ provides healthcare for those who are street homeless or vulnerably housed in hostels or supported accommodation.

The team is made up of physical and mental health nurses, who provide treatment, advice and support to help patients stay as healthy as possible.

The HHT has been working in partnership with Emmanuel House for over 14 years, offering drop-in appointments at the support centre, as well as flexible appointments for urgent care at various locations, including The Health Shop and The Friary.

With no clinical space of its own, the HHT relies on places like Emmanuel House for it to carry out its clinics.

We spoke to Angela Romain, Nurse Specialist at the Homeless Health Team, about how the service works.

We couldn’t do our work without the Emmanuel House partnership – we need to work with other organisations to have the clinical space.

Angela Romain, Nurse Specialist at the Homeless Health Team

The service provided by the Homeless Health Team is invaluable to vulnerable adults and I am delighted that this service is able to operate out of Emmanuel House as necessary. The team is highly respected by all Emmanuel House staff.

Denis Tully, CEO at Emmanuel House,

The important of partnership working at Emmanuel House

I can’t tell you how much we appreciate Emmanuel House and the support they offer us. Knowing that the centre is available for collaborative working is invaluable. A person’s health can really fall down without both sides of the service.

Someone once said to me, ‘thank you for treating me like a human being’. Sometimes a person with no fixed abode might not approach mainstream healthcare because of their expectation of judgement. The Homeless Health Team provides a non-judgemental alternative.

Angela Romain, Nurse Specialist at the Homeless Health Team

Our outreach services have a long-standing and established relationship with the Homeless Health Team. By working closely together, in a pro-active and person-centred way, we achieve really positive outcomes for homeless people, leading to a marked improvement in their mental health and wellbeing.

Maria King, operations manager at Emmanuel House

How the Homeless Health Team operates at Emmanuel House Support Centre

The HHT enables our beneficiaries to access healthcare while they’re visiting the centre for other services, such as food, showers or support.

If a support worker has any healthcare concerns about a beneficiary, or if a beneficiary mentions that they’re feeling unwell, we’re able to refer them to a Homeless Health Team nurse.

How the HHT can support our beneficiaries:

  • Give a full physical medical assessment, which may include taking a temperature, listening to their chest or dressing wounds.
  • Advocate for a beneficiary and liaise with GPs on their behalf. With a nurse’s medical assessment over the phone, a GP can prescribe medication without needing to physically see the beneficiary. This prevents the beneficiary having to ringing the GP themselves, which can be problematic as often they might not know how to describe their medical symptoms. It also means that they can follow up missed appointments, if letters are sent to old addresses.
  • Work with Emmanuel House support workers to remind clients about appointments or ask support workers to attend.
  • Support a person with multiple needs that might be linked to rough sleeping, by working collaboratively with one of our support workers.
  • Register a person with a GP, using Emmanuel House as their correspondence address.

For a lot of homeless people, health is not a priority and they are unlikely to actively seek out healthcare. Because of their homelessness, their health could rapidly deteriorate.

Emmanuel House is all about meeting the basic needs of homeless people. The HHT enables us to meet the healthcare needs of those who don’t prioritize their own health, or struggle to access a mainstream facility, alongside a hot meal, a shower or a change of clothes. Throughout the years, the HHT has been an invaluable resource – a lifeline to homeless people and a reassurance for staff who are worried about their clients.

Angela

Mental health support for those who are homeless

Alongside the physical health provision, Emmanuel House support workers can also refer their clients to the HHT for a mental health assessment. This could involve:

  • Referring a beneficiary to a community psychiatric nurse (CPN), who will signpost a specific mental health service or recommend alternative treatment such as talking therapy. The beneficiary could then be allocated an ongoing CPN to support them with their mental health needs.
  • Referring a beneficiary to Emmanuel House’s Wellbeing Support Team, which works with homeless people who have mental health support needs and other complex multiple needs.
  • Having clinical supervisions with the Wellbeing Support Team, in which she can offer psychiatric advice for different needs, such as personality disorders.

How does this impact our local community?

The HHT’s work reduces the impact on local healthcare services by tackling health issues before they require further, more intensive treatment. For example, a chest infection can be treated by a HHT nurse, which left untreated, could rapidly deteriorate and develop into pneumonia.

The consequences of someone running out of their daily medication are huge, particularly when it helps with their mental health needs. It could massively impact their relationships, job and accommodation.

Angela

How the Homeless Health Team supported the Night Shelter at the hotel

  • Daily visits to the hotel between March 2020 and June 2021.
  • Worked in partnership with the Night Shelter support staff to register people who are rough sleeping with a GP, within 48 hours of them arriving at the hotel.
  • Acted as part of the Covid-19 response team, assessing if people had Covid-19 symptoms and working with Public Health to respond accordingly.
  • Service users were locatable under one roof, so all of the different services and support staff could work together to deliver wrap-around care.
  • The HHT could easily identify needs and put things in place to meet these needs.
  • On a logistical level, it was easier to fill in medical forms and if people needed to leave in the daytime, the nurses could leave the forms with the support staff.

Some of the rough sleepers we came across believed that because they were street homeless, they couldn’t register for a GP. We explained that Emmanuel House could be the registered correspondence address.

A lot of the people we met, such as migrant workers, thought that because they were transient, they didn’t perceive themselves to be unhealthy or to have a need for a GP. It just hadn’t occurred to them.

Emmanuel House’s model of care at the hotel was of an exceptionally high standard. Emmanuel House support staff were there 24/7 and they were highly skilled workers, providing incredibly good quality support for very vulnerable people.

Angela

Because of the relationship between Emmanuel House and the HHT, support staff could immediately flag any health concerns with the HHT and arrange for an appointment.

The future of the Homeless Health Team

We’re hoping to set up weekly drop-in sessions at the centre, in addition to other flexible appointments for urgent care.