Case Studies

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Barry

Barry is a 42-year-old man living in temporary accommodation but who also spends some nights rough sleeping. He was referred to the Health Inclusion Team by his Street Outreach worker due to a wound on his foot and a wound on his hand. 

The Health Inclusion Team worked with Barry over a number of months to identify and overcome barriers he was experiencing in accessing healthcare. These included a mistrust of new people and organisations, a chaotic lifestyle involving daily begging and daily heroin and excess alcohol use. He was neglecting himself and his health needs were no longer a priority.

Our actions included:

• Initially conducting joint visits with his trusted street outreach worker.  
• Taking time to build trust and an effective working relationship.
• We cleaned and dressed his wounds and arranged antibiotics via our Health Inclusion GP Lead.  We regularly monitored him for signs of sepsis and liaised with his GP Practice. 
• We assisted with general hygiene and nutrition advice and provided clean socks, gloves, a hat and boots. 
• The Care Navigation team have provided information and advice about wider services available both in consideration of health and psychosocial needs. 
• We maintained a resilient approach to limited engagement with our team. Quite often Barry could not be found or refused to talk to us. Over a period of time, we reached a point where he would always engage with us if we found him. 
• We brought his case to our Health Inclusion weekly MDT to make sure Barry didn’t slip through gaps in services. 
• We helped arrange visits from the Health Inclusion Clinical Psychologist as there were concerns about Barry’s mental health.

We still work with Barry in relation to his longer-term engagement with his GP practice and drug and alcohol reduction services. We have established a solid working relationship and he has since trusted us to assist with minor ailments. Both his wounds have completely healed and he is maintaining an improved level of self-care in relation to hygiene and nutrition. The outreach treatment of the infected foot wound was particularly important as this may well have developed into severe sepsis which would have required a lengthy hospital admission. 

John

John is a 49-year-old homeless Polish man currently staying in temporary accommodation. He was referred to the Health Inclusion Team due to concerns about a wound on his ankle and a reluctance to seek medical assistance. John had been hit by a car and fractured his elbow and ankle and had missed recent hospital follow up appointments.

The HHHIT visited John on outreach shifts over a period of several weeks. During this time we used Language Line to listen to him and identify the barriers to accessing healthcare that he was experiencing. These included language barriers, a sense of isolation, a lack of knowledge about available services, and sometimes excess alcohol intake leading to missed appointments. 

Our actions included:

• Building rapport and trust with John and his project worker.
• Using a Polish interpreter via Language Line.
• Informing the GP Practice of the barriers that John was experiencing 
• Assessing his wound and liaising with the Nurse Practitioner at the GP practice to make sure the correct dressings were ordered and then assisting John to attend his dressings clinic appointments. This involved regularly checking that John was aware of his appointments and on one occasion when he was feeling a little anxious about attending, we accompanied him to the GP practice. 
• Our Health Inclusion GP liaised with the hospital and re-referred John back to fracture clinic and to the community occupational health service.
• Our Care Navigators gave information and advice about wider services available, including an Inclusion dentist and providing a connection a local Polish community group. 
• We helped John start to think about his excess alcohol intake and the possibility of engagement with alcohol reduction services.

By providing consistent, regular visits and support and being resilient to occasional disengagement by John, we successfully helped him access mainstream primary and secondary care services. His wound has responded well to treatment, his mobility has improved and he predominantly attends his walk in and telephone appointments. He is taking a proactive interest in his health and reports a recent improvement in his mood and general wellbeing.