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A day in the life of Ollalo House and the UCLH Find & Treat team

Earlier this year, on the Homeless Health (HH) team, we were given the opportunity to visit two award winning health and care services aimed at supporting individuals experiencing homelessness. Here is how we got on and what we learned during the visit.

We spent the morning learning about the incredible support that is offered at Ollalo House and what a day in the life of a resident looks like. In the afternoon, we heard from the UCLH Find & Treat team about their invaluable work screening and treating residents across London. Seeing first-hand the day to day running of this one-stop-shop health service opened our eyes to what makes a service truly accessible and inclusive for people experiencing homelessness.

When the day drew to a close, we all reflected on the phenomenal impact that can be achieved with a huge amount of passion and a thoughtful approach. The two services offer lessons on how to successfully tailor health and care services to the needs of those using them. Key ingredients to the services’ successes included:

  • The physical accessibility of their services e.g., ramps, lifts
  • The language and cultural accessibility of the service e.g., translators, staff speaking multiple languages, or being from a range of backgrounds and cultures
  • Providing a one-stop-shop so users can access multiple services or have multiple needs met at the same time and location
  • Open, safe and non-judgmental environment e.g., staff trained in how to approach service user conversations
  • Meaningfully involving service users or those with lived experience in the design and delivery of the service

 

Ollalo House – residential and holistic support for people who are vulnerable and in need

The Ollalo House team in Euston is an intermediate care service which was founded in 2008. The service offers accommodation and holistic wrap-around support to those who are vulnerable and in need. The charity supports individuals with a variety of different health and care issues, including – but not limited to:

  • Homeless people who have experienced trauma and face multiple disadvantages
  • Migrants facing homelessness
  • Victims of human trafficking
  • Individuals who have been diagnosed with tuberculosis and are experiencing homelessness

We were warmly welcomed by Pawel the Service Manager of Ollalo House and taken on a tour of the house. Colourful artwork created by residents hung on the walls, offering pops of colour and highlighting residents’ creativity as we walked from reception to bedrooms and communal spaces upstairs.

Homeless health team and Ollallo House staff sitting around table eating soup

A delicious lunch in Ollalo House’s dining room, if you look closely, you can see residents’ artwork featured on the wall behind us.

 

Speaking with Pawel it was clear how all-encompassing the support they offer is. Individuals referred to Ollalo House are given a place to call home, with their own room, bathroom, as well as multiple living rooms and kitchens and a computer room to get online.  Residents are given three meals a day, cooked from scratch on site and can also snack on food stored in the kitchen in between meals. Typically, those accessing the service are individuals who would otherwise be homeless or sleeping rough, sorting out their accommodation is one of the first and important steps to beginning their journey to a stable healthy life. Having regular meals and getting the right nutrients also forms part of that important journey.

Each individual is assigned a support worker. The most multi-lingual amongst them speak 12 languages, which Pawel highlighted was important for building relationships with clients and making them feel at ease. Cantonese and Mandarin are the two latest languages that his team can speak, and he plans to expand the team by adding Russian, Ukrainian, and Romanian speakers in the near future.

Support required varies from person to person. For instance, one resident may benefit from help navigating public transport when getting to a new job, others could need help reading documents, another signing up to a GP practice or attending an alcohol detoxification appointment. The support can also include helping residents to set up daily routines, create a healthy structure of friends and family around them, sort referrals to services, or create an action plan for anything from health, to career and finances.

If you would like to know more about the amazing work, visit the Ollalo House website.

Double door into x-ray room of Find & Treat mobile health unit, x-ray image displays on right-hand side screen

Double doors leading to the Find&Treat mobile chest X-ray machine. On the right is the screen where the X ray images are generated and then read by the clinical team.

 

UCLH Find & Treat Team – bringing health services directly to those in need

The second service we visited was the UCLH Find & Treat service. This ground-breaking service has been working on the streets of London since 2008, offering care for people experiencing homelessness and other vulnerable adults. The team have taken their mobile clinic all over the UK and Ireland, with their two Find and Treat vans. The mobile units visit a wide range of sites including street kitchens, homeless hostels and prisons, or anywhere where marginalised adults who may struggle to access mainstream healthcare live or will frequently visit.

Once set up on site, the service offers screening, diagnosis and treatment for a range of conditions such as tuberculosis, Hepatitis B and C, HIV, cardiovascular diseases, STIs and COVID-19. No appointment is needed, you simply knock on the door of the van for an opportunity to get a comprehensive health check. If any of the above conditions are identified, then the treatment process can also be started. Much of the screening done can be interpreted and the results given on the same day. The appointment is also an opportunity to connect individuals with other health and care services they need but may not have accessed otherwise.

It’s clear from our visit how effective the mobile clinic approach is – bringing health services to individuals, rather than asking those same people to visit a fixed NHS site. The numbers they can reach daily using this approach are impressive. In the two hours while we were there, they screened 37 individuals.

Side of Find & Treat mobile health unit with illustration of houses and NHS logo

The Find&Treat van with artwork adorning the body of the vehicle – the van is painted with different locations that the team visit regularly, including their home site of UCLH and HMP Pentonville.

 

Inside the mobile clinics

When you step onboard the larger of the two vans, service users enter a reception area for pre-screening conversations. Once the screening is complete, they walk to the end of the vehicle nearest the driving cabin and enter a room that houses the chest X-ray machine. Once finished with the scan, they step back outside and walk around to the back of the van and up the stairs to a consultation room with further diagnostic equipment, where clinical staff will test for further conditions and also deliver vaccines if needed.

On board the second van, users immediately step into the consultation room where individuals they’re met by a friendly face who asks pre-screening questions for a liver health check. Once complete, they step through a doorway to the back of the van and lie down ready for the liver scan. The liver scanner is one of multiple tests done for patients at this one-stop-show and assesses for instance identifies conditions such as cirrhosis and hepatitis.

One of the secrets to the service’s incredible success is the specialist outreach team members with lived experience of homelessness or health conditions that the service treat. As we ourselves witnessed, these individuals help put people at ease during screenings. We saw this firsthand when a woman hovers at the entrance to the van where X-rays are carried out. Uncertain about whether she wants to step on-board, she holds back and warily observes others stepping forward. George, one of the team, approaches her and begins talking, gently outlining the screening process and explaining the support that is available both on-board and after the van has left for the day. Buoyed by his assurances, she seems calmer and climbs the stairs to begin the Tuberculosis screening happening on board the larger X-Ray bus. It’s clear that the warmth and friendliness of the team help alleviate worries about the process.

Homeless health team members with face masks outside the Find & Treat mobile health unit.

A photo pit stop from our tour with UCLH Find & Treat team member George.

 

An inclusive approach

The Find & Treat service is such an important service for London because it allows vulnerable populations to receive the care they need without discrimination and judgement. Having a warm approachable team member who is focused on encouraging someone to begin their screening and treatment journey is key, talking them through what is involved and making sure they feel safe and comfortable. The Find & Treat Team actively encourage you to step onboard and are keen to help answer questions or calm any concerns.

Thanks to the hard work of the team who are continually highlighting the needs of their patients and advocating for further funding for this overlooked population, the service has grown both in the number of conditions it can screen and treat. As we move through 2022, the team aims to continue the wide range of diagnostic tests available with visits planned across the country and even overseas in Dublin.

 

Taking Learnings Forward

We would like to thank the amazing generosity and kindness of both Ollalo House and UCLH Find & Treat teams in welcoming us to their services and sharing their experiences of supporting individuals who are experiencing homelessness.

The visits were invaluable for deepening our understanding of just how important these services are. Going forward when we work with health and care commissioners this knowledge will be key and mean we can draw attention to the importance of maintaining and expanding these invaluable services.

Interested in finding out more? Visit the Find&Treat website and Ollalo House website.

For more information, or resources for people experiencing homelessness, see our resources page.here.


London Health Podcast

The London Health Podcast looks to tackle specific issues affecting health and care, so that we can make London the world’s healthiest city.

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  1. Homeless health
  2. Personality disorders
  3. Good Thinking
  4. #AskAboutAsthma

Homeless health

People experiencing homelessness are among the most vulnerable and isolated in our society, with the poorest health outcomes. Traditional systems of health and care often struggle to meet their needs. Consequently, they are more likely to die young, with an average age of death of 45 for men and 43 for women (ONS, 2019).

Healthy London Partnership works with our regional partners with the aim of improving access to healthcare and the capacity and capability of the system to respond to the needs of people who are homeless, to improve their health and reduce their hospital admissions.

Browse this playlist of podcast episodes exploring homelessness and health, produced by the Healthy London Partnership Homeless Health programme team.

Personality disorders

Personality disorders have been called the most misunderstood mental health condition. They have a legacy of confusion and controversy around diagnosis, language, what it means and how it impacts on individuals, even what they should be called.

Yet it is estimated that worldwide, around 8% of the general population report having complex emotional needs These figures rise to around 25% of people accessing primary care services and 50% accessing community mental health services will experience symptoms or behaviours related to the formally diagnosed.

This podcast series talks to people living with them – aiming to raise hope and understanding.

Good Thinking

Good Thinking supports Londoners to look after their mental health and wellbeing in a way that works for them. Since its launch in 2017, more than half a million people have used our digital service to tackle anxiety, stress, low mood, sleep problems and other concerns.

Their podcast series captures the thoughts, feelings, and experiences of Londoners directly or indirectly affected by coronavirus. They ask them about the approaches they are taking to stay mentally well and share with you top tips on what you can do to stay mentally healthy.

#AskAboutAsthma

The #AskAboutAsthma campaign encourages children and young people, their families, and those involved in their care, to ensure four simple and effective measures to help them control their asthma.

Their podcast below talks to people about their connection with the condition.


Homeless Health workstream update: primary care – April 2022

Dr Jasmin Malik is chairing the London Homeless Health Primary Care Steering Group, which has been established to bring key partners together at the city level, to oversee the citywide primary care workstream.

Amongst others, the group will work to:

  • develop primary care commissioning around homelessness services and close the gap in GP registration for homeless and other inclusion health groups that overlap the homeless agenda
  • develop minimum standards for homeless health care provision for mainstream GP practices, GP practices that have LCSs in place and specialist GP practices
  • align community mental health, primary care and addiction services to better support people experiencing homelessness.

Membership consists of clinical and commissioning representation from ICSs, Homeless and Inclusion Health, Primary care, NHSE/I, OHID and third-sector partners Pathway and Groundswell, who also provide lived experience expertise.

Members of the steering group are forming smaller Task and Finish groups which will oversee and take ownership of subsects of overall work. Each ICS will hold a sub-group and will project manage it, recognising the limitations but ensuring that there are some actions coming out of this group. Members of the group and project managers are currently allocating themselves to the sub-group where they feel best fitting.

The four Task & Finish sub-groups are:

  • Minimum standards of practice and data gathering
  • Training
  • Digital access and Registration blockers
  • Aligning community mental health, primary care and addiction services

The group is accountable and reports to the London Homeless Health Leadership Group as well as the Pan-London ICS group. Communication links have been established with Primary Care Health Inequalities Partnership group. Initial meetings have held in December 2021 and January, February 2022.

Prior to establishing the steering group, a Community of Practice event was held in September 2021 focusing on the day-to-day barriers to GP registrations for inclusion health groups, including people experiencing homelessness and how they can be overcome to support their entry into primary care.

Discussions, examples of good practice and concerns raised in this event will help inform the work of the steering group over the coming year.

 

Click here to read related content from the London Homeless Health Partner April 2022 newsletter.


Homeless Health clinical leads update – April 2022

Co-Clinical Leads Dr Jasmin Malik and Dr Caroline Shulman joined HLP’s Homeless Health programme in September 2021. Jasmin and Caroline bring valuable skill sets to their joint leadership role having worked with inclusion health groups in primary care across London for a number of years.

Working within the homeless health network, their combined knowledge, experience and understanding of the homeless population, frontline practitioners and the commissioning landscape, enables Caroline and Jasmin to bring their joint clinical voice into the development of pan-London homeless services.

Jasmin’s background includes being a clinical lead for homelessness and mental health in Camden/NCL since 2017. This role has involved working with commissioners at a local level supporting the development of local homeless services, bringing together local networks of clinicians and frontline staff, and providing training and support to local hostels prior to and during the pandemic.

Caroline is a clinician, researcher and trainer and has led a number of projects in homeless and inclusion health. She was also a clinical lead for a multidisciplinary hospital Pathway team for a number of years. Her projects include highlighting unmet palliative care needs and high levels of frailty within the homeless population, and development of interventions to advocate for – and improve access of – high-quality services. She is also developing training resources for inter-professional learning to support localised communities of practice to better address the needs of people with multiple and complex needs.

Through their joint role for the HLP Homeless Health programme, they are supporting a number of areas and contribute to the Homeless Health Leadership Group and ICS meetings. Their work includes building upon and chairing the Homeless Health Clinical Leads Group which is an open forum for clinicians and other frontline practitioners working in homeless services, ensuring the clinical voice is heard. Members can share experiences, discuss problems and potential solutions – where necessary escalating to commissioners and other appropriate bodies, and learn from regular speakers sharing their expertise.

Jasmin has been working with ICSs to conduct a mapping of homelessness provisions across boroughs, and has convened a new steering group to take forward the Primary Care workstream. Caroline is supporting the out of hospital programme and led rapid surveys capturing a snapshot of COVID cases across London between December 2021-January 2022. She also led a subsequent winter snapshot audit to capture a more in-depth picture of hospital inpatients’ needs, helping to identify difficulties in facilitating timely and safe discharges and any gaps in step-down accommodations. Caroline is currently working on developing a survey with St Mungo’s to explore the unmet needs of people with care and support needs living within homeless hostels.

Caroline and Jasmin are also involved in work addressing the health needs of the most vulnerable rough sleepers in London as part of the T1000 project. They are also bringing their clinical voice into the mental health and substance misuse workstreams, as well as highlighting the needs raised by experts and frontline practitioners regarding other areas of need such as women rough sleepers, homeless children and families, and the transitional years between the ages of 16-25.

 

Click here to read related content from the London Homeless Health Partner April 2022 newsletter.