Opening Doors – Improving lives Jo Fitzpatrick Project Manager 15.11.11

1. Opening Doors – Improving livesJo FitzpatrickProject Manager 15.11.11 www.qni.org.uk

2. Background of the project • Follows on from Homeless Health Initiative • Homeless families and homeless people with focus on substance misuse • Aim: to improve health, care and experience for the client www.qni.org.uk

3. How aims will be achieved • Network of nurses and health professionals working with this client group • Monthly newsletter • Workshops • Practical guidance notes • Case studies of new working practices • Dissemination of best practice www.qni.org.uk

4. Progress so far: • Newsletters – monthly e-newsletter • Q&A • ‘Focus on’ • Project news • General news articles • Resources – new documents, training opportunities etc www.qni.org.uk

5. Q&A: Questions have been diverse: • Students looking for placements • Sources of information on international homelessness • Job descriptions and service specifications • IVDU’s and leg ulcers research • Issues around clients with no recourse to public funds • How to increase uptake of BBV services • Hospital discharge • A10 community increases and issues • Community care grants for families • Electronic patient records This allows people to exchange information, gain help or advice and swap stories. Also posted up on the website. www.qni.org.uk

6. Progress so far: Workshops 2011: • London – From the Cradle to the Grave • Newcastle – linking statutory and voluntary agencies in the North East • TB master class • Workshop on Criminal Justice and MCA • 2012- Birmingham – Safeguarding (March) • Manchester – Mental Health (June) www.qni.org.uk

7. Workshops: “Sharing what I’ve learnt today with my team to influence the way we work with substance misuse clients” ‘will make a difference gave me a boost. Always loved this work but today has reactivated my enthusiasm and given me lots of ideas for further reading and discussion with colleagues’. ‘to be realists and listen to what the service user wants. Be positive no matter how small the change, be realistic and don't give up’ “I will work with (various partners) to implement Hepatitis B vaccination in all babies born to mothers with substance misuse issues” www.qni.org.uk

8. Progress so far: 2011: • Safeguarding homeless families • Nutrition toolkit 2012: • Mental health All toolkits aim to give basic information along with practical tools and information to improve service user health and wellbeing www.qni.org.uk

9. What nurses said: • It is very comprehensive and has pulled together a number of strands, some of which I was already aware of, in a clear and easy to use format for practice, so that my assessment is also as comprehensive as it can be. • I always find the information and guidance produced by QNI to be helpful to improve practice and of a very high standard (whilst being very 'user friendly' and easy to digest) • ‘I am going to be moving to another trust at the end of the week and I will be taking it with me. I am a Health Visitor who will be working with very vulnerable families and I feel this model will work extremely well in the assessment process’ www.qni.org.uk

10. Outcomes from year 1: • New Hepatitis C clinics for pregnant women/blood borne virus testing resulting in improved uptake • New Nurse Liaison role developed at Newcastle Royal Victoria Infirmary • Specialised podiatry services for homeless and vulnerably housed people developed • On site flu vaccinations developed www.qni.org.uk

11. Outcomes from year 1: • Input into reports and consultations, including NICE and Department of Health • 77% of network members report improved knowledge and practice • 89% of network members reported that the information from the project and newsletter was very useful • Network growth of over 100 – now 693

12. IVDU and leg ulcers – the issues • I see approx. 12 individuals per who have existing or past leg ulcers as a result of IVDU- in the 4 customers I have on the books presently they have an average of 4 attendances per year to A&E due to leg ulcers in the 12 months prior to being taken onto my case load. Since being on the caseload 2 of them have had 1 admission each both of which were on my advice. All of the customers with leg ulcers are between 25-35; 3 male 1 female and have had ulcer for 3-7 years • Individuals lead very chaotic lifestyles and as such find it difficult to keep to appointments for dressings etc. one way I have found to address this is by holding “drop-in” clinics either at the hostels or the “soup kitchens”- often I will txt message patients to remind them to come and see me. I have also discussed with drug services as to holding sessions at their premises when patients attend for methadone scripts, unfortunately I do not have capacity for this. • Pain control is very difficult as there is often a tolerance to opioid medication, there is often a very low pain threshold. If someone is on testing through drug services they have to be notified as some medications will give false positives which can cause issues if they are on probation. • Due to chaotic lifestyles prescribing can cause problems they will forget to bring their dressings with them – so I tend to store dressings myself • There is often poor compliance with antibiotics etc again I resort to txt msg reminders    www.qni.org.uk

13. IVDU and leg ulcers – the issues • Stigma. This is a huge issue, much of my work surrounds gaining the trust of individuals. Many have had previous poor experience in encounters with health care providers. There are many reasons for this – poor compliance, view that damage is “self –inflicted” criminal records h/o violence ex-offenders all of which serve to increase stigma and reduce rate of engagement with services. The attitudes of some health care staff can be very paternalistic and derogatory towards this disenfranchised group which causes them to disengage from services • Lack of continuity of care- this is a very mobile group of individuals – therefore outpatient appoints can be lost, may move addresses frequently. They may receive a custodial sentence. If I do find out where they are serving their sentence I have tried to fax care plans etc to prison health care services. Unfortunately it does not appear that there is much expertise in wound care management especially compression therapy within prison services. As I have received some incorrectly applied dressings back into the hostels on release from prison. www.qni.org.uk

14. Jo.fitzpatrick@qni.org.uk 020 7549 1402 www.qni.org.uk