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CONCLUSION Homelessness is increasing and with this comes an increasing risk of health issues. These can also be exacerbated by substance misuse and mental health issues. There are teams of specialist nurses and health visitors working across the country in specialist drop in centres and also doing outreach work. Many of these nurses feel isolated in their work. The Opening Doors project is briefly described and an example given of how this can help to link nurses and good practice and the improved outcomes for the patient.


‘Health issues can be both a cause and a consequence of homelessness’


REFERENCES 1. Crisis. Homelessness, a silent killer. Crisis; 2011. Available at: www. crisis.org.uk/data/files/publications/Homelessness%20-%20a%20 silent%20killer.pdf


2. Department of Communities and Local Government. Rough Sleeping Statistics England –Autumn 2011 Experimental Statistics. Available at: www.communities.gov.uk/documents/statistics/pdf/2093657.pdf


3. Department of Communities and Local Government. Live tables on homelessness. Available at: www.communities.gov.uk/housing/ housingresearch/housingstatistics/housingstatisticsby/homeless- nessstatistics/livetables


questioned had at least one problem that was either due to a mental or physical health problem, or caused by substance misuse.5 Healthcare provision varies throughout the country, as does the


incidence of homelessness. In some places there are practices that deal specifically with this client group and have many different services under one roof, such as podiatry, drug and alcohol workers, mental health specialists, specialist GPs as well as primary care and specialist nurses. Many of these run on a ‘drop-in’ basis, as fixed appointments can often be missed. If people can access all these services together, there is a greater likelihood that treatment can take place. Other areas operate outreach services, either street or hostel-based, so the services are going directly to the people that need them. Many of the nurses, health visitors and other health professionals


that work with this group can feel isolated in their work. The on-going changes to the NHS can result in teams being broken up and moved around, leading to further feelings of isolation for staff that are dealing with a very challenging client group. The Opening Doors project that is being delivered by the Queens


Nursing Institute (QNI) is going some way to alleviate this and also provides practical solutions to improve the situation. The project has a network of over 650 nurses and other health professionals that work with this client group. They all receive a monthly e-newsletter that contains information and resources. The project also runs workshops and produces practical guidance notes to improve best practice and therefore patient services. See Box 1 for an example of how the project engages with nurses and enables them to share knowledge and experiences. This has proved to be very popular. The project aims to improve the lives, experience and outcomes of homeless people and families by means of information, engagement and sharing of best practice within the nursing community working with this client group.


4. Department of Health. Healthcare for Single Homeless People. Office of the Chief Analyst; 2010.


5. St Mungos. Homelessness; it makes you sick. 2008. Available at: www. mungos.org/campaigns/homelessness_it_makes_you_sick


RESOURCES QNI Opening Doors Project www.qni.org.uk/for_nurses/opening_doors Homeless Link homeless.org.uk Crisis www.crisis.org.uk Department of Communities and Local Government Homelessness Statistics www.communities.gov.uk/housing/housingresearch/housingstatistics housingstatisticsby/homelessnessstatistics/publicationshomelessness


BOX 1. HOW THE OPENING DOORS PROJECT ENGAGES WITH NURSES


One example is a popular feature of the newsletter which takes the form of a ‘Q&A’ section. Anyone from the network can send in a question, and then replies come in from other members and are posted in the next edition. Previous questions are also posted up on the project website. The sorts of things that have been covered are: The use of naloxone in opiate overdoses in hostels. Intravenous drug users and leg ulcerations. Health trainers working with the homeless/vulnerably housed. How to increase the uptake of blood-borne virus testing in a Harm Reduction Service. Hospital discharge of homeless people.


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Nursing in Practice March/April 2012 21


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