Inclusion Health is Everyone’s Business

Recently, QICN’s Homeless and Inclusion Health Network Lead Kirit Sehmbi met Consultant Nurse Anne McBrearty to explore her journey from a curious A&E nurse to a frontline leader and lecturer, now sharing her expertise with nurses and healthcare professionals across mainstream services.

Anne has developed a level 7 CPD module on Inclusion Health at London South Bank University. It’s a one-of-its-kind type of course and Kirit sat down with Anne to learn more about it.

Why do we need specialist courses on Inclusion Health?

What was Anne’s why? Why did she feel that in 2024 a course like this was needed when there seems to be a lot of awareness and media coverage about health inequalities?

The truth is that Anne was and is still witnessing negative staff attitudes about people experiencing homelessness:

“Because I still see and I still hear healthcare professionals talk in such a derogatory way about people experiencing homelessness”

She also saw how this then impacts accessibility to healthcare services – this is why this course was aimed at all healthcare professionals, working in all specialities.

Changing Hearts and Minds

Anne saw that some health professionals still judged from a place of blame, asking questions such as “Why can’t they just…?” or “If they just stopped drinking…”. As Anne puts it, professionals often do not stop to reflect “Why is it that this person is unable to imagine their life without alcohol etc?”

This reminds me of an important distinction that I heard a therapist talk about recently:

Instead of asking “What’s wrong with you?”, we need to ask “What happened to you?”. Changing the question changes our lens and approach to caring for people.

And this is where the idea of professional curiosity comes in – a value that Anne believes is key to providing meaningful care. When someone says something or doesn’t say something, is there an opportunity to explore more or do we stick to the script of the assessment form in front of us?

Subtle Skills – Immeasurable Impact

Skills such as advanced assessment techniques and non-medical prescribing contribute greatly to nurse autonomy. While Anne recognises the important role of a clinical eye and experience – she herself is a Consultant Nurse in this field, able to fully assess, treat and prescribe if necessary – she reminds us of the importance of core skills that we all need to continue to nurture. It’s these subtler skills that we often overlook that are key to meaningful patient engagement and outcomes:

• Communication skills
• Professional curiosity
• Non-verbal cues
• Knowledge of local support services (non-clinical)

These skills are what can make the difference between whether a person hangs around long enough in an appointment, lets you take their blood pressure reading or ask them personal questions. They also deliver joined-up care rather than siloed care that focuses on the clinical aspect alone.

Creating Curriculums for Change

With this in mind, Anne set to design a course for students that offered something totally different. It was important to Anne to have a curriculum that was co-produced by those with lived experience and those delivering frontline services.

With her wealth of experience in the industry (16 years in Inclusion Health), working in partnership with key agencies, and really listening to what the population want from their healthcare service interactions, Anne developed a curriculum:

• Co-designed and co-produced by those with lived experience
• Guest lectures from people working in the industry and with lived experience
• Assessments based on real tangible shifts students can make in the workplace
• Challenges underlying views, beliefs, stigmas
• Assessments marked by those with lived experience

Confident Carers

Practicality, not just theory was another component that Anne wanted to offer on this course. She noticed that many courses are built on theoretical insights, models, and hearing the patient voice through case studies. But few offer skills that are actionable in the workplace.

With the support from the course team, students are expected to create a Quality Improvement project or change proposal in their workplace. This build confidence in real-world problem-solving. It also encourages nurses as agents for change/advocates.

And the student feedback speaks for itself, appreciating these features. Anne tells me that students shared they’d never had teaching like this before.

Having experts by experience lead lectures and talks helped to break down barriers. Students were told “Don’t be afraid to say anything to me” – allowing for honest and open dialogue which increased their insight into real life experiences and developing real empathy.

For Anne, having frontline staff lead on teaching also meant that the students were receiving information that was up-to-date and relevant in a field where policies and pathways can often shift frequently.

Making Multi-disciplinary Teams the Norm

The effect of having a variety of specialists come in to speak on their roles in a person’s life shows the value of partnership-working and that it should be our default position. Anne was keen to focus on the “Team around me” approach.

Outreach workers talked through a day in their life and the processes and hoops that people might have to go through to secure a safe place to stay.

Psychologists talked of the impact of past and ongoing trauma for people experiencing homelessness, refugees, or other marginalised groups such as sex workers. It is one thing to talk about trauma-informed care which Anne says many people are now well-versed in, but to put it into practice is something else. This is where having experts by experience really bring to life the lived experience of someone walking through a system that we as professionals can often become blind to.

It is easy to write down “DNA” (did not attend) in someone’s notes. But do we take the time to ask why the person missed their appointment again? Anne urges us to remember the impact of the very places we work in on a person’s mind:

“Hospitals are absolutely terrifying places”

So, it makes sense why a person may avoid appointments and forces us to think outside the box in how best to engage them.

Inclusion Health is Everyone’s Business

An ongoing debate in the Inclusion Health sector is that the risk of having specialist services can lead to other services not appreciating their own role in delivering equitable care.

People with lived experience share being told: “There’s a service for people like you…”

Not only does this put extra pressure on specialist services, but it washes services of their own duty of care to everyone who attends and threatens a two-tier system. When the NHS was built in 1948, it was proud to service everyone regardless of their background or ability to pay.

Anne’s wish:

“I really want the NHS to be more person-friendly”

And through this endeavour, creating an Inclusion Health module open to nurses and AHPs across all fields, we can get closer to this shared goal.

If you’d like to find out more about the course at LSBU, get in contact with Anne at anne.mcbrearty@nhs.net.

About Anne McBrearty

Anne McBrearty completed her nursing training in 1997 in New Zealand, and moved to London in 2001. She immediately fell in love with London – the people, the diversity and the fun. Anne’s first nursing job was working in a busy central London hospital on an admissions unit, and her first time working with people experiencing homelessness. It was during this time Anne found the role models she needed to become an advocate for people experiencing homelessness and the want to improve care.

In 2009, Anne moved into the community and joined the Homeless Health Service which provided healthcare to people experiencing homelessness in day centres in Westminster. In 2018, the Chief Nurse of Central London Community Health, Charlie Sheldon, wanted to create a Nurse Consultant role to lead the Homeless Health Service. Anne felt she was in the right place at the right time to take on this role.

Anne says, “it is an absolute pleasure and honour to lead such a fantastic team through all of the changes and developments that have occurred in Homeless Health since I started as Nurse Consultant.”

In 2023, Anne was invited by the London North West ICB to join the Homeless Health Programme to provide clinical support and leadership to wider NWLondon community.