A nurse prescriber from the drug and alcohol service has started doing outreach work with the homeless support team. The work has focused on one particular town centre in the district after concerns were raised about a core group of rough sleepers who were not engaged with treatment.
The challenge
Sefton Council is a metropolitan borough in Merseyside.
Its housing support team commissions the voluntary sector group, Light for Life, to provide a range of services for homeless people.
Meanwhile, the drugs and alcohol treatment service is commissioned by public health and provided by Mersey Care NHS Trust.
Rough sleepers using Light for Life services are regularly referred into the drug and alcohol service, while in-reach services are provided into hostels.
But during 2018 Light for Life staff began to notice there was a core group of rough sleepers in Southport, in the north of the borough, who were clearly struggling with drug and alcohol issues and were unengaged with treatment services.
Greta Fenney, Chief Executive of Light for Life, said: “We opened a winter night shelter for rough sleepers. Over the first weekend we engaged with 13 rough sleepers, 11 of whom appeared to have significant addiction issues which would prevent them from securing and keeping accommodation. On weekends we saw them seeking significant funds from street begging, particularly over Christmas. This was unlikely to change while their addiction issues were not being addressed.”
The solution
The council’s public health and housing support teams decided the solution lay in doing some integrated outreach work. The housing support team secured funding from the government’s Rough Sleepers Initiative to pay for the equivalent of a day’s work from a clinical nurse prescriber.
This allowed them to get a Mersey Care nurse to work directly with the Light for Life outreach service. The nurse started accompanying the homeless service on its rounds in the town centre in early 2019. The funding covered the backfill for the nurse.
The nurse, Lyndsey Davies, carries out assessments, books the clients in for appointments and has even been able to hand out anti-overdose drug treatment naloxone.
She does the outreach work on a Thursday morning and is then available at a nearby clinic in the afternoon for the clients to drop-in for further advice, organise access to service and hand out any prescriptions they may need.
Sefton Council Executive Director Andrea Watts said: “It was clear to us that collaboration was going to be essential if we were going to engage this group. The two services already worked together, referring clients on for help, but we had never worked side-by-side like this on the streets before.”
The impact
Ms Davies has been able to engage a group of around 12 rough sleepers since the project started in January 2019. Half of them are now actively involved with treatment.
She said: “I approach them on the streets and just try to engage them in conversation. I can offer advice and let them know what services are available to them.
“I then let them know I will be in the clinic in the afternoon. They can then come in and get prescriptions there and then, such as an opiate substitute medication. I can also organise admission into inpatient care if needed or organise referral on to our services.”
Ms Davies said another part of her job is to liaise with the key workers of those who are getting treatment. “It is quite common to find someone who engages for a while and then stops. I can provide that link and explain what the key worker wants from them. It helps to re-engage them. It is working really well so far.”
Lessons learned
Ms Davies said it is important to make sure you can provide a full range of advice and support to these clients when the outreach work is being done.
“I go round with a member of staff from Light for Life. It means between us we can answer any questions the client may have – whether it is housing-related, benefits or health.
“You have to take your opportunities when you have engaged with them. By working together we are able to do that.”
How is the approach being sustained?
The new arrangements have been funded for three months.
Councillor Trish Hardy, Cabinet Member for Communities and Housing, said: “Given the success we have had so far we would hope that we will be able to secure funding for it to continue.
“It has been an effective way of engaging these people who for one reason or another just were not actively involved in treatment.
“There is also interest that the approach could be adopted on a wider regional level around Merseyside.”
Contact details
Alan McGee
Substance Use Public Health Lead
Sefton Council
[email protected]