St Giles Trust's roots are in helping vulnerable homeless people. Today, this is realised through our partnership work with the Kings Health Partners Pathways Team at St Thomas’ Hospital in Waterloo, London. The team help homeless patients into accommodation and accessing any additional support.
Embedded in the hospital working alongside clinical staff, they are a multidisciplinary team comprising housing caseworkers and health professionals from a range of different agencies. These include Kings College NHS Foundation Trust, Guys and St Thomas’ NHS Foundation Trust, South London and Maudsley, St Giles Trust, The Passage and St Mungo’s. Tyrone Paul and Chanel Young from St Giles Trust work as two of five Housing Caseworkers alongside Nurses, GPs, Occupational Therapists and a Social Worker.
The team start the day with handover and update on state of play with the patients they are supporting. If a patient’s needs are predominantly health-related, one of the clinical team will initially take the lead. If the primary need is housing related, it will be one of the Housing Caseworkers like Tyrone.
The patients' names on the whiteboard are colour-coded according to their housing situation and whether they are linked in with a GP. Tyrone works his way down this board. Discussions involve safeguarding, linking patients up with outreach teams, which night shelters have vacancies and information sharing amongst different agencies.
On the other side of the office are the names of the frequent attendees – those who are not in- patients but adults with complex needs who make repeated and sometimes inappropriate use of A&E. The team work with them intensively, write care plans for A&E staff to follow and support them to engage with community services to reduce their acute attendance and increase their use of scheduled healthcare and community services. With one man his visits have been reduced from 60 every three months to 20.
The team’s main remit is to improve the health outcomes for homeless people in hospital whilst treating their physical, mental and social needs, often caused by or resulting in homelessness. This can involve keeping patients in hospital for a night or two longer so they don’t quickly reappear again. Ensuring someone has a proper support plan in place after they are discharged can take time to arrange. Discharging someone who will simply return to heavy drinking on the streets means a likely return to hospital – sometimes in a matter of hours.
A key part of Tyrone’s work involves gathering information from the patient and professionals then liaising with a maze of support agencies which a vulnerable person would not be able to negotiate alone. Aside from physical health, their homelessness is usually the tip of the iceberg with a whole host of other issues emerging once work with the patient gets underway. These include problems with immigration, estrangement from families, sex working, mental health and substance misuse problems.
“Leaving hospital can be a really difficult time for the patients we support,” says Tyrone. “We are the glue that sticks things together inside and outside.”
Sometimes Tyrone needs to visit a patient's bedside several times as it can take a while for these often very vulnerable patients to open up. “I need personal information to give them the support they need and they don’t know me from Adam,” he says. But his background in working with vulnerable homeless people at St Giles Trust has equipped him with the right skills to do this.
The support he provides is cross cutting and covers pretty much any issue. The period of engagement that Tyrone has with the patient is brief – sometimes only for a couple of days – but intensive. “Some patients are from outside London and so it could be a case of connecting them with support back in their home area – or home country if from abroad. Some people want to be left alone once they’ve been linked in with the right services whereas others are a little more vulnerable and need longer-term support after they’ve been discharged.”
Some of the patients are nearing the end of their lives and want to be reconnected with their loved ones. Sadly, given the nature of the work these are sometimes young people who have led highly chaotic, dangerous and tragically short lives on the streets.
The team’s collective efforts and wide range of expertise means they are effective in helping the 1,200 patients they support each year through Guys and St Thomas’ alone. They close the gaps in support services and help vulnerable patients engage with them. This means future savings in resources through helping prevent re-admissions and minimising the pressure on other frontline services. Equally as important, it means the individuals helped through Pathway have a better quality of life and the misery of being caught in a downward spiral of homelessness and disadvantage is halted.