Voluntary nurse-led street outreach work in Wales

I am a community staff nurse and Queen’s Nurse working with Powys Teaching Health Board. I am also a community nurse prescriber and palliative link nurse.

I qualified as a nurse in 2006. My passion for homeless health stems from my own personal experiences as a rough sleeper. I left home at a young age fleeing abuse, and lived between the streets of London, care homes and secure units for many years.

In September 2018 I joined a 24-hour sleep-out in Cardiff to raise funds for local charity ‘Hope for the Homeless’ to help feed the homeless, alongside fellow District Nurse Eira Evans. Whilst on the sleep-out we met a young rough sleeper whom was in a lot of discomfort with his feet. After much coaxing he let us look. He had awful trench foot, his socks and boots were soaked, and he was very embarrassed. Although Cardiff has services set up to manage homeless health (Butetown Medical Practice and some outreach at the Huggard Centre), we discovered that many rough sleepers were not accessing them. Some spoke of a fear of losing their begging pitches or tents if they were gone too long. Some who had issues around addiction explained that they had no interest in the health services.

My colleague and I then decided to try to take a nursing service to the streets. Hope for the Homeless was already supporting and feeding rough sleepers several times a week, and we linked into their existing service. Our first outing was in Cardiff city. We purchased the items needed for outreach basic foot care – wet wipes, nail clippers and nail file, gloves, apron and hand sanitizer, and off we went. On our first outing the street sleepers were very dubious of us to begin with, and we may have delivered basic foot care to only 2 or 3 people. However, through the rapport already built by ‘Hope for the Homeless’, we began to establish ours, and now treat about 10-20 people each time we go out.

We are now a year on, and advertise what we do as a voluntary nurse-led street clinic. The rough sleepers know when we are coming and look forward to our visit. More staff have joined the service and we have a pharmacy technician, lymphoedema nurses, tissue viability nurses, community nurses, mental health nurses, ITU nurses, a paramedic, ward nurses and a Macmillan nurse who volunteers. We also have student nurses and newly qualified nurses who join us, and many caring members of the public. Days are arranged in advance, and each street clinic normally has a turnout of 10-20 volunteers, shifts permitting.

We have also branched out to set up the service in Newport. On our first visit myself and two other nurses performed basic foot care on 16 rough sleepers, determining there was a need for the service there. In subsequent visits up to 40 individuals have been seen. In Swansea we have joined with the Sameera Foundation to provide a foot health day for rough sleepers, and are trying to encourage other vulnerable groups to participate. The Sameera Foundation (along with other sponsors) provide hot food and beverages, while we perform basic foot care and give out donations of hygiene items and warm clothing. We offer advice and links to other services, and the NHS based homeless nurse has provided a signpost system to ensure we work in unity.

In our work we are aware we work within a voluntary remit, and try to protect ourselves as much as possible, and think about health and safety. For example, we use a kneel pad to kneel down, and always ask rough sleepers to remove their own shoes and socks and roll up trousers to knees. Personal protective equipment is always used. Hand mirrors are used to look under feet and heels. Footcare bags provided to volunteers have wipes, disposable gloves, an apron, dressing sheets, alcohol gel, nail clippers, single-use nail files, talc, barrier cream and a mirror.

We clean feet using hygienic wipes, and then use softening creams for dry calloused feet. If the rough sleeper has wet feet with evidence of trench foot, we clean their feet and use talc to draw out moisture.  We provide them with clean dry socks and dry footwear, and the advice required to maintain healthy feet themselves. If nails require cutting, we seek consent and clip directly across the nail ensuring that nails are not cut in which could cause further discomfort. Any concerns found are highlighted to the rough sleeper and they are encouraged to attend the professional services available. It is important to note that nobody insures this work specifically – nurses are bound by their code, and the limits of their own personal professional insurance.

Besides foot care we offer advice and work alongside other services, by signposting to them. Our group works as an additional set of eyes alongside our already established professional services. We are not there to replace them, but to encourage them to engage with the established services to maintain their health.

Our work currently receives much interest from nurses in other areas, and we have had interest from Aberdeen, Stoke and other areas in Wales – who would like to set up their own voluntary health clinics for the homeless. I would personally like to see the service working in conjunction with our professional services in every city in the United Kingdom.

Volunteers who join me often say they feel humbled to have had the opportunity to help, and that they would never look at a homeless person the same again. As an ex rough sleeper, I understand fully the vulnerability of those whom have nothing. When you join that community you have a feeling of invisibility, and an overwhelming feeling that no one cares about you. This is my chance to do something practical – I personally feel that giving is everything and costs nothing. I would personally encourage anyone thinking of setting up a service like this to just do it. Here in Wales we are in the process of building a constitution as ‘Homeless Hope’ with a view to building our own charity one day.

Click here to find more information about Homeless Hope Foot Health group on Facebook.