St Ann’s Hospice wanted to change how they and other organisations support people experiencing homelessness (PEH) who also have advanced, deteriorating health.
They began a scoping project in 2020, which gave them greater insight into the health needs of PEH in Greater Manchester and what was needed to improve equitable access to palliative care. They identified a 'best fit' service model consisting of tailored interventions that would be accessible across the 10 boroughs of Greater Manchester.
The project employed a Homeless Palliative Care Co-ordinator tasked with:
building relationships between the hospices, hostels, inpatient and outpatient services and frontline organisations working with PEH
delivering tailored education and training to staff in cross sector services to improve their knowledge, confidence and understanding of palliative care and homelessness
giving emotional support to staff working closely with PEH who have advanced, deteriorating ill health, including bereavement sessions following a death
advocating for PEH to have improved access to advance care planning and opportunities to participate in conversations about what matters to them
advocating for a holistic approach to care for PEH, utilising multi-disciplinary teams to ensure all aspects of care are considered (not just symptoms or disease).
The project was developed over five years, using a ‘test and learn’ approach.
Outcomes
The project delivered four key outcomes:
The Co-ordinator used a range of interventions and approaches to improve access to palliative care services for people experiencing homelessness (PEH). They:
delivered flexible in-reach and outreach into hospitals, hostels and a variety of other community-based settings
provided tailored training and education sessions to over 2,000 frontline professionals employed in cross-sector roles providing support to PEH
developed a flexible referral criteria to make it easier for staff in homelessness services to refer someone to the hospice without the requirement of a formal diagnosis
advocated for appropriate and adequate responses from healthcare providers, so that PEH with palliative care needs would be identified earlier, have improved outcomes and receive continuity of care.
Multi-disciplinary team meetings were held for 71% of patients referred to the service. The remaining 29% of patients were either sign-posted to more appropriate services or died soon after their referral was received. Find out more about the case management outcomes in the full evaluation report.
Frontline staff supporting PEH with advanced ill health can experience higher levels of stress, compassion fatigue and vicarious trauma. The Homeless Palliative Care Service provided partner organisations with access to bespoke training and support, focusing on self-care, emotional wellbeing and bereavement support.
The Homeless Palliative Care Co-ordinator used trauma informed and strengths based approached when supporting PEH. This provided opportunities for PEH to explore their wishes and priorities. The Care Co-ordinator was able to facilitate access to specialist support and help ensure the individual felt heard and involved in their care.
The Care Co-ordinator received monthly clinical supervision sessions that followed trauma informed principles. Find out more about the psychological and emotional support outcomes in the full evaluation report.
The Homeless Palliative Care Service trained and supported over 2,000 health and social care professionals. The training improved their knowledge, confidence and understanding of homelessness and palliative care and helped them recognise when PEH could benefit from palliative care support.
At the end of the five-year project, referrals had increased by 250%. PEH with advanced ill health were being identified earlier and referred for support sooner.
Find out more about the education and training outcomes in the full evaluation report.
Networking and partnership working has been a key factor in the success of the project.
During year four of the project, the Homeless Palliative Care Service developed a partnership with the Inpatient Palliative Care team at Manchester Royal Infirmary. They attended weekly ward rounds, jointly reviewed inpatients, coordinated MDT meetings and delivered tailored training and education sessions for the staff team.
In year five the service began a weekly community outreach in collaboration with a Consultant in palliative medicine. This gave them a unique opportunity to work flexibly across geographical and cross sector boundaries. It created opportunities for earlier identification of PEH with advanced ill health, whilst strengthening relationships with complex needs hostels, day centres and other community services.
All of this resulted in improved outcomes and experiences for PEH.
Find out more about the networks and partnerships outcomes in the full evaluation report.
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“You’re alright, you lot. You help me get my mind calm about what’s coming. I feel in control and I’ve not had that before.”
John, client aged 69
Cost benefits
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Through the evaluation of the programme, St Ann’s has been able to estimate the cost savings of the Homeless Palliative Care Service’s interventions.
St Ann’s secured a five-year grant from the Big Lottery Fund’s ‘Reaching Communities’ programme, which enabled them to deliver the project.
The programme resulted in an increased number of PEH being admitted to the in-patient unit at the hospice. To help build staff members' capacity to work with PEH, the hospice delivered an internal ‘Homeless Campaign’. This improved teams’ knowledge, confidence and understanding of the needs of PEH. It promoted the benefits of a trauma informed approach to delivering care to PEH with complex needs.
During year four of the project, the team developed a job share model for two Care Co-ordinators working 1.4 FTE. This proved to be invaluable and increased the impact of the project.
Challenges
Just six weeks after the project began in 2020, the COVID-19 pandemic resulted in lockdown. he team adapted service delivery to fit the new virtual approach to working, developing partnerships with key stakeholders by providing online training.
There is a relatively high staff turnover within homelessness support services and this can limit the impact of training and education for frontline staff. The Homeless Palliative Care Service has worked to increase the likelihood of good practice continuing by developing and maintaining strong relationships with services. They have also integrated into existing community based ‘hubs’.
Tips and advice
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The Care Co-ordinator role is highly specialised. The post holders need expertise and experience with both homelessness and healthcare. It’s essential to provide the people in this role with trauma-informed clinical supervision.
Use innovative and flexible personalised approaches when working with PEH who have palliative care needs. Treat people differently to ensure they are treated equally.
Future development
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The service was originally funded as a five-year scoping project. St Ann’s is now seeking funding to continue the Homeless Palliative Care Service in the future.
