Option 1 - Healthcare needs of the homeless: Profession-led discharge

The fifth theme asks What is patient or person centred care?

Kate Stock opens the session with Can we help address the healthcare needs of people who are homeless? before Sue Hanson and Jane Barnes describe the Green Ward model for profession-led discharge.

Kate currently works as part of Glasgow’s Homeless Assertive Outreach Independent prescriber Link team in conjunction with Hunter Street Homeless practice and the Simon Community. This role acts to remove barriers to healthcare for the homeless person by taking healthcare out from the usual clinical settings to a convenient and comfortable setting either on the street or in temporary/emergency accommodation. The team offer patients a comprehensive health check including assessment, treatment, prescribing and referral with the HAIL team providing follow up at the patient’s pace and place. Areas of particular interest within this role are homelessness & inclusive health, health inequalities, street medicine, non medical prescribing and substance misuse rehabilitation.

‘Can we help address the healthcare needs of people who are homeless?’

The number of people who are destitute and homeless is increasing and their health continues to worsen. An evidence base together with decency and common sense calls for assertive street outreach by clinicians. Traditionally, this role has been delivered by GPs or nurses but, due to shortages of these professionals, there are fewer clinicians going to where homeless patients live. The availability of Pharmacist Independent Prescribers has created an opportunity for a novel, co-ordinated pathway of care for people who are homeless, which aims to sustain engagement and prevent health crises. This presentation will cover evidence of ‘inclusion healthcare’ needs including prescribing, impact on unscheduled care use, interdependency of housing and health, patient centred interventions to address health including pharmacist-led work in Glasgow over the past 5 years, and plans for a parallel health services research programme. The aim of the presentation is to increase participants’ understanding of the problem of homeless health and raise awareness of collaborative opportunities for a new service development within participants’ localities, across the UK.

Jane Barnes

Having worked in hospital pharmacy for a number of years Jane Barnes has a broad range of experience including clinical, aseptic and dispensing services. As department manager for over 15 years she has managed the introduction of automation (department robot and ward vending machines) and the development of patient-centred clinical and medicines management services. Jane is passionate about facilitating staff to work at ‘top of license’ to care for patients at the bedside, explore new innovative ways of working, and embed the pharmacy profession in the multidisciplinary team.

Sue Hanson

Having provided a clinical pharmacy service on a variety of medical wards in hospital over many years and completing the Clinical Diploma and Independent Prescribing qualifications, Sue Hanson has gained knowledge and experience to enable her to be comfortable with caring for the particular cohort of patients in the project to be presented. She also has extensive experience in community pharmacy and understands the needs and demands of this group of professionals. This has contributed to good communication skills, which are vital for the management of this service. Working on different committees within secondary care during her career has enabled Sue to be at ease working within a multidisciplinary team. It is the multidisciplinary team approach that is paramount for the success of the project to be presented.

‘Profession-led discharge: the ‘Green Ward’ model’

In order to improve patient flow and individual patient experience a ward at a community hospital was been designated as a ‘complex discharge’ or ‘green ward’. The patients are medically fit but require additional input to ensure a secure discharge and prevent re-admission. The ward is professionally-led by an advanced nurse practitioner, supported by pharmacy and therapy staff providing an enhanced service. The outcome of this multidisciplinary approach has been an improvement in patient flow and re-admission rates within the Health Board as well as a better patient experience. The pharmacy team are an integral part of the model. The use of independent prescribing skills supports inpatient care and discharge. Robust communication links with colleagues in primary and community settings also supports the patient pathway.