Improving palliative support for people who are homeless

Project overview

Saint Francis Hospice identified the need to improve care and support for people who are sleeping rough or are vulnerably housed, and have a life-limiting condition. With funding from the Masonic Charitable Foundation, through Hospice UK, they worked with local agencies to build relationships and support homeless people to access palliative care services. 

The hospice worked with a range of homelessness organisations in Havering including the Salvation Army, Hope4Havering, Street Pastors and the YMCA. They visited all the homelessness hostels in the local area.

The team built relationships with Havering Housing and the Peabody Trust housing association, joining local Housing Steering Groups that focus on homelessness and rough sleeping. They formed a partnership with the local NHS Trusts and a local GP. 

Outcomes

Through collaborative working, Saint Francis has been able to:

• register homeless patients with a GP
• develop a strategy for homeless patients to be discharged from local hospitals using a ‘step down’ approach
• work with local councils to reduce attendance at Accident and Emergency
• create a referral pathway 
• improved guidance and procedures for hospice staff caring for homeless people
• advised the hospital Alcohol Liaison team about how to recognise and refer rough sleepers
• develop information leaflets about hospice services and advance care planning in an easy read format
• deliver 24 hours of teaching about palliative and end of life care for 20 key workers caring for people experiencing homelessness
• deliver interactive education (both virtually and face-to-face) for hospice staff, including 10 minute ‘tool box’ talks, a quiz about homelessness, sessions with a key workers and a debate about the challenges of admitting someone experiencing homelessness to the hospice in patient unit.

As a result of the project, hostels, housing departments and clinical leads are able to refer patients directly to Saint Francis for assessment and care (including Hospice @ Home care within hostels). Hospice staff are better equipped to care for the needs of homeless people at the end of life. Most importantly, homeless patients are being better provided with the care and support they need.

Key facilitators

The hospice staff were dedicated to understanding the difficulties faced by people who are homeless and rough sleeping and wanted to learn how to support them better. 

During Homeless Person’s Week in October 2021, seven members of hospice staff slept out to raise awareness of the real situation faced by rough sleepers. This generated a lot of interest from hospice staff, local press and Havering Housing Department who also took part in a ‘sleep out’ in a public car park. The local press published a feature supporting the project and highlighting the difficulties faced by homeless people. This resulted in some direct offers of assistance from the local community.

The steering group for the project met on a bi-monthly basis to monitor progress and set goals.

Challenges

Restrictions during the COVID-19 pandemic meant that the team were unable to set up drop-in services at local hostels. However they were still able to build strong and lasting relationships with local hostels.

To begin with, it wasn’t easy for the team to identify the agencies they needed to engage with. However as the project progressed and the hospice gathered more knowledge, Saint Francis became the ‘go to’ agency to ask for information about supporting homeless people.

Due to funding constraints, this was a time-limited project. It was a huge challenge to carry out such a large piece of work in a relatively short period of time and the team has made significant progress.

Saint Francis has not yet been successful in seeking more funding to further develop this work. However support for homeless people at the end of life is now seen as ‘business as usual’ within the hospice, and the project is continuing on a reduced hours basis.