In September last year Birmingham St Mary’s launched a new service to make sure people experiencing homelessness and who have palliative care needs have access to support. Sharon Hudson, Community Development and Partnerships Lead at the hospice, tells us how it works.

Birmingham St Mary’s began planning a service to support the city’s homeless population in 2017, after identifying that people with palliative care needs were only being reached by the time they were very unwell. “They were being missed within systems and were really sick by the time they came to us” Sharon says.

 “We knew that our existing services didn't quite fit with the needs of this group of people because we weren't finding them, so we allocated one of our nurses to work with the existing systems and do a bit of a scoping.”

Gaps in care

Their nurse spent several months in clinics that mostly focused on rehabilitation, identifying people with palliative care needs or at the end of life but who weren’t being recognised as such. “There are already issues for anybody with a condition that isn't cancer to access our services because of illness trajectories being up and down. With people who are homeless, who have comorbidities, addictions, housing problems, poverty and mental health conditions, it just wasn't clear. We knew we'd have to work in a different way because we couldn't wait for somebody to recognise the signs and refer them to us.”

The Homelessness Support Service was modelled on the hospice’s existing care home programme, which has an educational element so that expertise is shared across services. “It’s parallel working, so rather than someone who's got those multiple complex needs having five different health professionals dealing with each of the elements of complexity, we're building a service that sits with and alongside all these other services” Sharon says.

An important aspect of the service is that they will be proactively looking for people who need their care. It’s also tailored to the needs of the patient. “The service has a social worker and a nurse, because we recognise that it's not just about symptom management and clinical input, but actually the housing support, family support and the financial and the social issues around it are as important and need as much of a service offer.”

“The service is provided within our acute hospitals, by Homelessness Pathways Link nurses.  We’ll work alongside them so that when somebody who is experiencing homelessness is admitted to hospital, they are picked up by the nurse. People that are in and out of hospital are often those with complex health needs, so we want to pull them into our systems from a hospital admission if they want to be involved in our care.”

Meeting rising demand

Sharon says the unmet need is huge. During the first lockdown, the Government’s Everyone In programme offered around 15,000 people experiencing homelessness a bed, but since that support ended there has been a huge increase in the number people with no recourse to public funds. She says Brexit will make this worse, with a rise in the numbers of refugees and migrants with no money, and with serious health needs and no access to emergency care.

“The numbers are increasing, and there’s a lot of hidden people that we're not seeing. They’re not coming forward because they are frightened of making themselves aware to healthcare services, because they're frightened of being thrown out of the country. There's a huge untapped area of people who are really vulnerable and who have palliative care needs that we're just not seeing. Part of what we're going to do with this service is try and find them.”

The pandemic has added an additional difficulty to their work, as restrictions mean much of their support must be given remotely. “There's been a lot of work to make sure people have access to phones, wifi and computers so services can reach them. Funding was great for things like this initially, but now local councils are expected to find a lot of the resources for themselves.”

Sustainable hospice care

Birmingham’s service will run for two years initially, and is based on a community development model, funded by the Eveson Charitable Trust and three other funders. Their ambition is that, if funding isn’t possible to extend the project, the training and knowledge sharing taking place over the next two years will leave systems better enabled to recognise and support the end of life, palliative and bereavement care needs of the homeless population.

“A huge component of the programme is education, and we'll be developing communities of practice, working with hostels, shelters, and crisis teams with the health services. We want to train people through direct, regular, sustained education, helping them develop their core skills and then putting in systems that support that. We see this a model for the sustainability of hospice care for the future."