“Getting access to a dentist when you’re homeless can be hard. Tooth pain is pushing homeless people to desperate measures, like trying to pull out their own teeth. Nobody should suffer this way. Today will help dentists across the Midlands to develop skills to help the people who need it most”
Homeless health charity Pathway ran a pilot project, restoring smiles to homeless people. Stan Burridge was homeless for many years, he developed, managed and participated in the scheme, which he described as ‘life changing’.
“The biggest difference for me has been food. I had to cut it into small pieces that I could swallow whole, it’s embarrassing, and not being able to chew impacts on the taste. Now I have a full set of dentures. Having false teeth isn’t perfect, but as least I can enjoy eating, and I can chew most things.”
Stan will be presenting at the conference, presenting his work on supporting homeless people who are frightened of dentists. The day also includes sessions on helping people who have been sexually abused, and chance to meet former British Dental Association Chair, Janet Clarke MBE to discuss starting new services.
‘Homeless and Inclusion Oral Health’ takes place on 23 November 2018.
Researchers have launched an online toolkit to help hostel staff identify and support homeless people who are facing death.
www.homelesspalliativecare.com will give hostel staff caring for terminally ill homeless patients high quality information and advice with guides, tools and activities to help plan care and provide support.
The free resource was created by a partnership between Pathway, Marie Curie Palliative Care Research department (UCL), St Mungo’s and Coordinate My Care.
The group’s previous report, published in Palliative Medicine, revealed that hostel staff often care for homeless people with terminal conditions and complex needs, despite not having palliative care training. They face huge emotional and physical burdens with minimal support and limited resources.
In response, the team developed a two-day training course for hostel staff, recently published in Nurse Education Today. The course was tested with staff at London homeless hostels, and improved their confidence and knowledge.
However, the team’s work has shown that training sessions aren’t enough, the next stage of the project will explore new models of training and support.
Dr Briony Hudson, Marie Curie Palliative Care Research Department at UCL, said:
“The deaths of homeless people are often perceived as sudden, untimely and undignified. This can be very traumatic for everyone involved, especially hostel staff, as they are often left to support people who are very unwell, even when they have high care needs, due to a lack of suitable alternative places to live.”
“One of the reasons homeless people are dying without support is that they are not recognised as having a terminal illness. Throughout this toolkit we suggest that concern about a client’s deteriorating health should act as a trigger for action, rather than waiting for a palliative or terminal diagnosis. We hope this resource will be helpful in supporting homeless people.”
Alex Bax, Chief Executive, Pathway, said:
“Pathway is delighted to have hosted this hugely important work, helping to improve care for seriously ill homeless people facing the end of life. We hope this new toolkit will help the many services that work with homeless people to at least improve the quality of care and support provided to people who have had faced a traumatic and often foreshortened life. At the very least a civilised society should seek to provide dignity in end of life for people who have had so little before.”
Professor Bee Wee, Consultant in palliative medicine at Oxford University, commented:
“I’m absolutely delighted to welcome this online resource, which supports staff working to support people who are homeless who are entering the last stages of their lives. It is a truly valuable contribution to our collective efforts to improve palliative and end of life care for all.”
The research was funded by The Oak Foundation and hosted by Pathway, with support from Marie Curie, St Mungo’s and Coordinate My Care. The online toolkit was funded by a grant from UCL Innovation and Enterprise.
Simon Jones, Director of Policy and Public Affairs at Marie Curie, said: “Dying in familiar surroundings, in comfort, with dignity and with those we love and who love us is what we want for our own deaths and those close to us. Sadly, very rarely is this something that someone who is homeless will experience. There is no reason why a homeless person should not have compassionate care at the end of their lives and a dignified death – this resource brings us one step closer to making this happen.”
Howard Sinclair, St Mungo’s Chief Executive, said: “It’s now a decade since St Mungo’s began the first palliative care service in the homelessness sector, working alongside Marie Curie. We recognised a need to support clients to make informed choices about their care, as well as supporting staff and other clients affected by someone close to them approaching the end of their life.
“This new toolkit brings together essential expertise from across the homelessness and health sectors, ensuring people approaching the end of their life will be treated with the dignity and respect they are due. I hope this resource is in itself a legacy to those who have died, and to what we have learnt from them about loss, bereavement and improving our care for the future.”
Notes to Editor
About the research
The objective of the research was to pilot and evaluate the impact of a two-day training course for hostel staff around supporting homeless people with palliative care needs.
21 frontline staff from two London homeless hostels took part in the training – pre and post training data was collected.
The training was found to be useful for improving knowledge, confidence, openness and work-related stress. However, one-off training isn’t enough.
In response, the team developed an online toolkit to share resources and information which can be accessed at homelesspallaitivecare.com
Next steps of the project include building communities of support for frontline homelessness and health staff – exploring ways to embed training into routine practice for staff by developing links between local palliative care, primary care and homelessness services to better support staff consistently and promote multi-disciplinary working.
Pathway works to improve healthcare for homeless people. The charity has helped the NHS to create 11 homelessness teams in hospitals across England, supporting over 3000 patients every year. Pathway also develops models to facilitate improvements in patient care, carries out research in new and developing areas, provides training for healthcare professionals and supports specialist commissioning. Pathway also hosts The Faculty for Homeless and Inclusion Health, a network of over 900 health and social care professionals providing support for homeless people, vulnerable migrants, gypsy and traveller communities and people in the sex industry.
About St Mungo’s
St Mungo’s provides a bed and support to more than 2,600 people each night who are either homeless or at risk of homelessness. As a charity and housing association, we work to prevent homelessness, through more than 250 projects including emergency services, supported housing, specialist physical and mental health services and advice, skills and work services. We believe everyone should have a place to call home and be able to fulfil their hopes and ambitions.
About Marie Curie
Marie Curie is the UK’s leading charity for people with any terminal illness. The charity helps people living with a terminal illness and their families make the most of the time they have together by delivering expert hands-on care, emotional support, research and guidance.
Marie Curie employs more than 2,700 nurses, doctors and other healthcare professionals, and with its nine hospices around the UK, is the largest provider of hospice beds outside the NHS.
The Marie Curie Palliative Care Research Department at UCL is an internationally recognised centre of research with a team of over 20 full-time researchers. The department receives core funding from Marie Curie and also undertakes research funded by the National Institute for Health Research (NIHR), the Alzheimer’s Society and other research funders. The department has particular research strengths in the areas of palliative care for people with dementia, prognostication in advanced cancer and the management of cancer-related fatigue.
Pathway has introduced the first dedicated digital health-screening template to help health services supporting homeless people.
Following two years of development with EMIS Health, the template is now available free of charge to organisations using the EMIS Web clinical system. It was supported by 11 specialist homeless healthcare services for use by 200 staff.
Developers aim to roll the template out across the UK, and hopes it will ultimately relieve pressure on hard-pressed hospital departments.
The template enables doctors and health workers to create and maintain a detailed picture of a homeless person’s health, capturing vital information including clinical history, mental health and addiction issues, as well as details on housing and financial status. The template utilises national clinical coding and is ‘SNOMED CT ready’.
In the past hospitals were using different codes and record systems, resulting in inconsistent record-keeping, that meant some homeless people were not receiving the best treatment.
“Homeless people are five times more likely to attend A&E and four times more likely to be admitted to hospital than the housed population. The template will enable doctors to see patients’ health priorities, provide more effective treatment and help relieve pressure on the NHS by reducing bed days and treatment costs”
She says it will also enable the NHS to accurately track and analyse illness and infection rates amongst the homeless population: “The template will make it much easier to commission large-scale health services, treating patients who are homeless more effectively, economically and on a much larger scale. It has the potential to be a real game changer.”
Mo became homeless after being seriously injured in an accident. A year on, he is safely housed and helped Pathway with developing the template. He said:
“Comorbidities hurt patients and cost the NHS a great deal of money, so it’s important that we capture and use data in ways that really help people. Having my health record follow me would have made diagnosis and treatment quicker, and it probably would have saved the NHS money too.”
Dr Shaun O’Hanlon, Chief Medical Officer at EMIS Group said:
“We have a long-standing relationship with Pathway and were pleased to offer our expertise free of charge to help create this vital template. With homeless people statistically 10 times more likely to die early than the rest of the population, there is a real need for this vulnerable group to receive specialist help, and this template will assist clinicians in driving up standards of care.”
A collaboration of dentists, dental organisations and homelessness charities (including Pathway, Groundswell, Streets Kitchen, Den-Tech and Dentaid) have published a response to an article in the Guardian in which people experiencing homelessness were described by Mick Armstrong, who chairs the British Dental Association as “no hopers” in the context of the current NHS contract.
The letter is a reassurance to both the public and people experiencing homelessness that despite frustrations about the current dental contract there is hope and that good work is taking place across the country through a range of innovative initiatives to provide accessible care for vulnerable people.
In a recent article published in the Guardian, the head of the British Dental Association referred to people experiencing homelessness as “no hopers” in the context of current dental commissioning. We—a coalition of members of the dental profession, dental charities and homelessness outreach organisations—strongly reject the message that this article is sending to vulnerable individuals and the wider public.
The chaotic and dangerous nature of homelessness can make it difficult for individuals to be at a certain place at a certain time. This is not a failing to be condemned, but a challenge to be met: it is our professional responsibility to make services more easily accessible to the growing number of vulnerable people in our society.
Commissioning models need to be sufficiently flexible to embrace innovative approaches to providing high quality care to those most at need. Good examples include Community Dental Services who provide dental care for homeless people at multiple locations across the country.Based in Plymouth, Peninsula Dental School offers free dental care at four locations, and supports dental students to provide outreach advice at local homeless shelters. Den-Tech provides same-day denture services for people experiencing homelessness. In Manchester, Revive Dental Care offers drop-in dental clinics for vulnerable people. Dentaid holds free monthly clinics in Southampton and their ‘mobile dental unit’ visits night shelters and soup kitchens around the country.
Instead, we should marry lessons learned in these contexts to resources available within the NHS, and push for greater inclusion at all levels: policy, commissioning, education, training, service design, and inter-professional collaboration.
Until then, we will continue to share experience and resources, establish new partnerships, and innovate in delivering services to members of our society whose requirements are not easily met by existing structures. We believe strongly that there is hope.
Janine Doughty, University College London / Pathway Homeless Healthcare Charity / Crisis at Christmas Dental Service Deputy Service Organiser
Jon Glackin, Streets Kitchen
Matt Downie, Director of Policy and Social Affairs, Crisis
Professor Andrew Hayward, University College London / Pathway Homeless Healthcare Charity
Professor Ruth Freeman, University of Dundee
Vanessa Muirhead, Clinical Senior Lecturer, Barts and the Royal London School of Medicine and Dentistry
Jack Monroe, Author
Martin Burrows, Groundswell
Al Story, UCLH Find and Treat Service Lead
Natalie Bradley, Community Dental Service
Ben Atkins, Revive Dental Care
Janine Brooks, Director of the Dental Coaching Academy
Stan Burridge, Pathway Experts by Experience Lead
Fiona Ellwood, Patron of Society for British Dental Nurses
Nicholas Ransford, Clinical Director of Birmingham Community Dental Service
Jill Harding, Dentaid
Laura Daly, DCT2 in dental public health
Professor Christophe Bedos , McGill University, Montreal
Frances O’Leary, DCT3 Paediatric dentistry
Pippasha Khan, Dental student, Kings College London
Andreas Johnson, Chair of Den-Tech Denture Charity
Professor Blanaid Daly, Professor in Special Care Dentistry, Trinity College Dublin
Renato Venturelli Garay, Research Assistant UCL
Sara Harford, Clinical Fellow
Nadia Khalique, Dental Hygienist / therapist
Holly Bretel, StR in Special Care Dentistry
Mehdi Yazdi, Principal dentist Crown Bank Dental practice
Jo Dick, Registrar in Special Care Dentistry
Deborah Manger, Deputy Medical Director & Specialist in Special Care Dentistry for NHFT
Zana Khan, GP in homeless and inclusion health
David Conway, Professor of Dental Public Health, University of Glasgow
Caoimhin MacGiolla Phadraig, Special Care Dentist, Dublin Dental University Hospital
Esther Stephenson, Dental Core Trainee in Oral and Maxillofacial Surgery
Neil Martin, Specialist in Special Care Dentistry/DCT East Anglia Training Programme Advisor
Samina Nayani, StR Special Care Dentistry, Kings College Hospital
Alexander Holden, University of Sydney
Nahush Shah, Senior Registrar in Orthodontics / Service Lead for Crisis at Christmas
Dorothea Hackman, Euston Foodbank
David Croser, General Dental Practitioner
Rob Whitton, Peninsula Dental School
Martha Paisi, Peninsula Dental School
Serena Luchenski, NIHR/HEE Clinical Research Fellow and Honorary Public Health Consultant
Mili Doshi, Consultant in Special Care Dentistry
Laura Gartshore, Senior Lecturer and Honorary Consultant in Paediatric Dentistry
Maryam Ahmadyar, Community Dental Officer
Councillor Ruth Rosenau, Stoke
Matthew Turtle, Museum of Homelessness
Art Hindocha, Senior Registrar in Orthodontics
Jessica Turtle, Chair of Trustees, Simon Community
Gabriel Galia, Wellcome Clinical Research Career Development Fellow
Daniel Stone, Labour Councillor for Stroud Green, Haringey
Jackie Bird, Director of Joanna Project
Andrea Rodriguez, Senior Research Fellow – Homelessness (Advocacy and Policy) Smile4life Programme
Norma Smart, Specialist in Special Care Dentistry
Sam Joseph, Street Vet co-founder
Jade Statt, Street Vet co-founder
Melissa Scott, Service Lead, Homeless Health Service, Bournemouth
Rachel Cullen, Simon Community
Bhavik Patel, Integrated Clinical Fellow, Northamptonshire Healthcare NHS Foundation Trust
Brooke Zaidman, SpR in Special Care Denistry
Jenny Lawson and others, Nag’s Head Solidarity Centre Womens Group
Garima Arora, Research Assistant, University of Dundee
Paul Jackman, Still Human Outreach
Nikki Kenyon, Manchester: Life On The Streets
Louise McTernan, Outreach worker Manchester
Derek Richards, President British Association for the Study of Community Dentistry
It’s a lucky day for three homeless health services, who have been shortlisted for prestigious Nursing Times Awards.
Pathway homeless hospital teams at Bristol Royal Infirmary and Bevan Healthcare CiC in Bradford will be going head to head in the HRH Prince of Wales Nursing category, whilst Pathway’s Nursing Fellow is up for the Technology and Data in Nursing award.
People experiencing homelessness often have serious physical and mental health problems and are more likely to face difficult and sometimes life-threatening illnesses such as tuberculosis, Hepatitis, epilepsy, heart disease, stroke and asthma.
Pathway helps hospitals to set up teams to support homeless patients during their admission, and make sure they have somewhere safe to sleep when they are discharged, help with financial and legal issues, links to day centres and support services and clean clothes and toiletries.
Dr Nigel Hewett, Medical Director of Pathway said:
“Nurses play a key role in homelessness teams and change the lives of patients who are homeless with their compassionate care and clinical excellence. We’re incredibly proud of the teams who have been shortlisted and look forward to some friendly rivalry on the night.”
The team braved one of the hottest days of the year and took to the streets of east London, finishing the challenge and raising a whopping £765 to help seriously ill homeless people.
Pictured here with Pathway CEO Alex Bax (who met them at the finish line!), the team has raised enough to provide 50 homeless hospital patients with ‘dignity in care’ kits, including toiletries and pyjamas for their hospital admission, travel tickets to a safe bed once a Pathway team has arranged one, and a duvet and pillows to help them set up in a new home.
Stan was homeless for 20 years, and now helps formerly homeless people to be part of Pathway’s work. Stan said:
“Being ill, alone and in hospital was one of the scariest experiences I faced when I was homeless. Knowing that someone cares really helps. This donation will make such a difference to so many people. Well done, and a huge thank-you to all of the runners and donors who took part and made this an amazing event.
Ruth Carnall, Chair at Carnall Farrar said:
“We are very proud of all our runners for completing the gruelling race and absolutely delighted that the money raised by their efforts will be going to such an important and worthy cause.”
Pathway calls on Brighton shoppers to help homeless patients
Pathway, a small charity helping seriously ill homeless people, has been shortlisted for a supermarket charity scheme across Brighton and Hove. Tesco ‘Bags of Help’ gives money raised from carrier bag sales to community projects. Pathway is one of three groups that has been shortlisted for a grant of up to £4000.
The Pathway team at Brighton and Sussex University Hospital helps homeless patients to:
Sort out financial problems,
Register with a GP,
Reconnect with lost family and loved ones.
Without help from Pathway teams, many hospitals would be forced to discharge homeless patients to sleep rough after treatment, running the risk of their illness returning. Brighton and Sussex University Hospital is one of only 11 hospitals across England to offer this specialist support.
During May and June Tesco shoppers in Brighton will be able to vote for Pathway and other shortlisted charities using a token given to them at the checkout each time they shop.Alex Bax, Chief Executive of Pathway said:
“Your token in the box can make a real difference to homeless people. A little bit of help from a Pathway team can help people get life back on track.”
Bags of Help has already given over £36 million to nearly 8000 projects across the UK. Alec Brown, Head of Community at Tesco, said:
“We are absolutely delighted to open the voting for May and June. There are some fantastic projects on the shortlists and we can’t wait to see these come to life in hundreds of communities.”
Money raised by the scheme will go towards ‘Dignity in Care’ packages, making sure patients have toiletries and pyjamas during their stay, clean warm clothes when they are discharged, and bedding and crockery if they are moving into a home for the first time.
Notes to Editors
The Bags of Help initiative is supported by money raised from carrier bag sales in Tesco stores.
The scheme is administered by Groundwork.
Bags of Help funding is available to community groups and charities looking to fund local projects that bring benefits to communities. Anyone can nominate a project and organisations can apply online. For more information please visit: www.tesco.com/bagsofhelp
Customers can vote for Pathway at the following Tesco stores:
Pathway works to improve healthcare for people who are homeless. We’ve helped the NHS create 11 teams of doctors, nurses and social care professionals work across England, supporting 3500 patients every year.Pathway also develops models to facilitate improvements in patient care, carries out research in new and developing areas, provides training for healthcare professionals and supports specialist commissioning. The charity hosts The Faculty for Homeless and Inclusion Health, a network of over 1000 professionals involved in healthcare for people on the edges of society.
A new MSc module in Inclusion Health will be launching at University College London this spring, in association with The Faculty for Homeless and Inclusion Health. The course, offering 7 days of learning over 7 weeks, includes material on:
Inclusion health populations and their health needs
The social determinants of health
Effective interventions for inclusion health communities
Data collation and statistics for inclusion health services
Teaching staff include leading Inclusion Health experts Dr Chris Sargeant and Dr Caroline Shulman, and chance to learn from people with lived experience of exclusion and ill health. Dr Sargeant said:
“This short course is an opportunity for researchers and people from across the health and social care sectors to formalise and extend their learning at a prestigious academic institution. We look forward to welcoming people at every stage of their career, and supporting the leading lights of inclusion health in the future.”
The course is available as an optional unit on UCL’s Population Health MSc, but can also be taken as a standalone unit with transferable academic credits, or simply for CPD. There are reduced rates for NHS staff, and a limited number of supported places for people with lived experience of homelessness and inclusion.
Pathway has been selected by the Health Foundation, an independent charity, to be part of an innovative programme to improve health and social care by using novel scaling approaches to widen use of successful health and social care interventions.
The Exploring Social Franchising and Licensing programme supports four organisations to replicate interventions that they have already tested and proven to work. The organisations will employ replication techniques, social franchising and licensing, that have not yet been used widely in the UK.
The initiative from Pathway improves healthcare for homeless hospital patients, by creating NHS teams to:
Support and advocate for patients who are homeless in hospital,
Help homeless patients to find accommodation and release NHS beds,
Support people dealing with financial issues
Access help to address personal problems that contribute to their homelessness
Help people reconnect with lost loved ones.
The approach has been proven to improve health and housing outcomes for patients and is currently used in 11 hospitals across England. Chief Executive Officer Alex Bax said:
“We are delighted to have won the chance to participate in this programme. It’s a fantastic opportunity for us to explore, with the experts, whether we can spread our ‘Pathway hospital team’ model more rapidly, to benefit some of the most vulnerable and excluded patients the NHS supports.”
The new programme will run for one year and each project will receive up to £145,000 to develop approaches that will enable the project to spread their successful health and care intervention to other sites across the UK in future. Sarah Henderson, Assistant Director at the Health Foundation said:
“We are very excited to support four outstanding project teams and organisations, selected because of their ambition, experience of spreading successful health and care interventions, and importantly, because we think their interventions have considerable potential to be replicated using social franchising or licensing techniques.
“Working together, as part of the Exploring Social Franchising and Licensing programme, we hope to increase understanding of whether social franchising and licensing can be used to support a more sustainable and systematic approach to replicating proven health and social care interventions and the conditions under which these methods are most useful. We hope that we can enable successful inventions to be used more widely to improve care for patients and service users.”
Notes to editors
The media contact for this story is Sushma Sangyam:
020 7257 2092
About the Health Foundation
The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. www.health.org.uk
Pathway works to improve healthcare for people who are homeless. We’ve helped the NHS create 11 teams of doctors, nurses and social care professionals work across England, supporting 3500 patients every year. Pathway also develops models to facilitate improvements in patient care, carries out research in new and developing areas, provides training for healthcare professionals and supports specialist commissioning.
The charity hosts The Faculty for Homeless and Inclusion Health, a network of over 1000 professionals and people with lived experience of exclusion, including vulnerable migrants, people who are homeless, from gypsy and traveller communities, or who sell sex. www.pathway.org.uk