Lucy Carew is a Clinical Nurse Specialist with the Camden Adult Pathway Partnership (CAPP) Team who have been specially commended in this years’ London Homelessness Awards. The team specialise in providing healthcare for people experiencing homelessness who live across 21 sites in Camden, including hostels, shared houses, and women’s refuges, collectively known as the ‘Adult Pathway’. The service is jointly funded by North Central London Integrated Care Board and Camden Council and delivered by University College London Hospitals NHS Foundation Trusts (UCLH). The work of the team was fully rolled out in the spring 2022 and already we have seen improvements in the health and wellbeing of residents, many have had basic check-ups and referrals for untreated conditions.
In the first six months of service rollout, the CAPP team saw a third of the clients in the Adult Pathway, receiving an average satisfaction rating of 9.7 out of 10 from service users, with 80% reporting that their health and wellbeing had improved as a result of the outreach nurse clinics.
The CAPP team currently consists of an operational manager, three nurses, a linked social worker and an administrator, who work with partners in community and acute settings to deliver flexible, client-centred outreach clinics to clients experiencing multiple disadvantage and significant health inequalities. The team aims to facilitate higher levels of engagement with planned care, improve health outcomes and quality of life and reduce Emergency Department attendances and premature mortality.
We asked Lucy to tell us a bit more about her role.
It is important that we meet people in the hostels where they live, as the clients we see often struggle to engage with typical healthcare structures that are not designed for their needs. Many feel more comfortable interacting with a healthcare professional they know and trust, in an environment they are familiar with. We join up the care as we have teams based in the local hospital so we know when someone is about to be discharged and their housing status and can provide help and support right from the start.
So, what happens when we meet clients?
I am employed by UCLH but based in supported accommodation. Clients can come to us and are welcome to discuss anything that concerns them. We end up addressing a wide range of presenting issues, such as mental health, skin complaints, infections, gastrointestinal problems, and dental health, and referring on if necessary. There is no limit on the time we spend with people and our aim is to meet every resident of every house or hostel we work in. People can come back to see us as often as they want to, and we try to operate an open-door policy. Even if people do not have an obvious presenting need, we can talk to them and find out how best we can help them. If we can’t help directly, we usually know who can.
When I meet people for the first time, I explain the service and ask if there are any health concerns. I spend time talking to people and reassuring them; some people feel that they have been let down by services in the past, even excluded.
A good outcome is to get people thinking about their health again and get back into services. One man I met had epilepsy and his seizures were uncontrolled. We got him more support, reached out to the GP and neurologist, and managed to link up the services. As a result, the client felt comfortable talking about his health and is back on his medications. He is now controlling his health and in touch with the neurology team again.
Our clients can come and talk to us about anything and everything. If our clients are known to a service but maybe haven’t engaged, we will contact the particular service and their key worker. We also do a lot of referrals to drug and alcohol services and for mental health support.
Another woman I met was a known diabetic and IV drug user. She had a diabetic seizure in the hostel which triggered a referral. I spoke to her, then she worked with us, and we got her in with the diabetic team, who provided a device to put on her arm which gives a blood sugar level. This allowed her to be more in control. This was a joint effort of CAPP, the hostel team and the diabetes team resulting in a good outcome for the client and allowing us to learn a lot more about diabetes, which can help other clients.
Our role is varied: direct care, sign posting, referrals, coordination, case management. For one client I took photos of a rash and sent them to the GP and consultant. Sometimes it works better coming from us as many clients need additional support to access services – they sometimes don’t have the technology or the confidence.
I think one of the biggest factors for clients is attending external appointments; there can be a lot of fear and anxiety. We talk with them about ways to help reduce the fear. At the same time, we make sure we’re not trying to give expectations that they don’t feel that they would be able to fulfil. Our goal is to get clients happy and healthy and addressing their health and wellbeing.
We also give general advice – breast and testicle checking, contraception, public health. And helping with general life skills where we can, for example changing addresses, or managing their bills. Although not our key role, anything that reduces stress can benefit a client.
What I love about my role
It is a unique and amazing service. I am extremely excited and passionate about this service. It can be draining mentally and physically however we have a great team, and we regularly discuss our days so we can manage these stressful days together.
I absolutely love my job. I’m excited to go in every morning as we make a difference. It is a team effort throughout and we try to be very relaxed, very client centred, very flexible. People who have been homeless can find it difficult to get to services, but CAPP is able to see them and accept them without any judgement. CAPP makes a difference and is an amazing service.
The London Homelessness Awards 2022 took place earlier this month at the Union Chapel in Islington. For more information go to www.lhawards.org.uk