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The street outreach nurses who bring on-the-spot care to people sleeping rough

Westminster Street Nurse project has opened up access to care for this hard-to-reach group

Nursing team actively seeks out individuals whose needs have been missed by other clinical services

  • Advanced nurse practitioner developed a service that makes a measurable difference to people living on the streets in the heart of London
  • How the pandemic forced the project team to innovate ways to keep service users safe and informed about COVID-19
  • Advanced nurse practitioner Rosa Ungpakorn won the Advanced Nursing Practice category of the RCNi Nurse Awards 2020 for her work
Rosa Ungpakorn with Groundswell case worker Dennis Rogers MBE Picture: Groundswell/Twitter

A nurse has devised an innovative outreach project to help homeless people sleeping rough on the streets of central London.

Rosa Ungpakorn, an advanced nurse practitioner (ANP),

Nursing team actively seeks out individuals whose needs have been missed by other clinical services

  • Advanced nurse practitioner developed a service that makes a measurable difference to people living on the streets in the heart of London
  • How the pandemic forced the project team to innovate ways to keep service users safe and informed about COVID-19
  • Advanced nurse practitioner Rosa Ungpakorn won the Advanced Nursing Practice category of the RCNi Nurse Awards 2020 for her work
Rosa Unpakorn with Groundswell case worker Dennis Rogers MBE
Rosa Ungpakorn with Groundswell case worker Dennis Rogers MBE Picture: Groundswell/Twitter

A nurse has devised an innovative outreach project to help homeless people sleeping rough on the streets of central London.

Rosa Ungpakorn, an advanced nurse practitioner (ANP), has won the Advanced Nursing Practice category of the RCNi Nurse Awards 2020 for her Westminster Street Nurse project.

On-the-spot diagnosis and treatment

Based at Central London Community Healthcare NHS Trust, Ms Ungpakorn devised Westminster Street Nurse to deliver on-the-spot clinical assessments, diagnosis and treatment.

Previously, street outreach had been limited to providing a once-weekly shift of street outreach.

Now thanks to the Westminster Street Nurse project, nurses assess a range of issues including infections, musculoskeletal pain and respiratory issues throughout the week.

Rosa Ungpakorn, winner of the Advanced Nursing Practice category of the RCNi Nurse Awards
Rosa Ungpakorn, winner of the Advanced Nursing Practice category of the RCNi Nurse Awards

Recognition for improving care of an excluded, ignored group of individuals

Ms Ungpakorn says she is ‘shocked but ecstatic’ to win the RCN-sponsored award, especially in the International Year of the Nurse and Midwife.

‘The other ANP finalists have made huge impacts on nursing practice,’ she says.

‘Rosa overcame multiple barriers, established referral pathways and regular contact across agencies, and adjusted the project to maintain its work during the pandemic’

Janice Waters, RCN Nurse Awards 2020 judge

‘This recognition is for all the nurses in my service. I am so pleased a project that aims to improve the care of patients who are often excluded and ignored has been given such a prestigious national award.’

An evidence-based, barrier-breaking service

Awards judge Janice Waters, RCN eastern region council member and independent safeguarding consultant, says all five finalists in the Advanced Nursing Practice Award category presented worthy projects to prove the value of advanced level nursing practice in patient care and nursing practice.

Dr Waters adds: ‘Using research as an essential element of her role, Rosa overcame multiple and difficult barriers, established and maintained regular contact across agencies, established referral pathways and adjusted the project to maintain its work during the pandemic.’

Intersection of homelessness and poor physical and mental health

Some 44% of homeless people have a mental health diagnosis, compared with 23% of the general population, according to an audit by Homeless Link, a national membership charity for organisations working directly with people who become homeless in England.

The organisations also found 78% of homeless people report having a physical health condition, compared with 37% of the general population.

‘Many people sleeping rough were not only excluded from mainstream services but effectively from our clinics. Now, nurse practitioners proactively seek people out’

Rosa Ungpakorn, winner of the Advanced Nursing Practice category of the RCNi Nurse Awards 2020

An England-wide snapshot showed that Westminster was the local authority area with the highest number of people sleeping rough on a single night in autumn 2019, when 333 people were estimated to be on the streets in the borough.

Westminster Street Nurse brings care and treatment direct to patients
Westminster Street Nurse brings care and treatment direct to patients Picture: Kate Stanworth

Striving for a truly inclusive service

In the past, Ms Ungpakorn’s trust’s homeless health service tried to tackle health inequalities by providing clinics in day centres.

‘However, many people sleeping rough were not only excluded from mainstream services but effectively from our clinics,’ she says.

‘Now, nurse practitioners proactively seek out people on the street or in charity-run locations.’

How we kept nurse outreach going during the COVID-19 pandemic

 Team member Maria O'Donoghue undertakes outreach work
Team member Maria O'Donoghue undertakes outreach work

Advanced Nursing Practice Award winner Rosa Ungpakorn says COVID-19 presented challenges to providing outreach care through Westminster Street Nurse.

‘Day centres and night shelters suddenly closed and the specialist homeless GP practices switched to working remotely,’ she says.

‘Without access to a TV, computer or smartphone, people on the street were often left with little information. If they were able to access advice, it was impossible to follow – how do you wash your hands regularly when public toilets are closed? How do you self-isolate if you are sleeping rough?’

Rapid adaptations to ensure patients and nurses were safe

The Westminster Street Nurse model had to adapt rapidly in line with UK government and International Street Medicine Institute guidance to ensure patient and nurse safety.

‘At one point, we were the only outreach service still working on the street in the borough’

Ms Ungpakorn created outreach packs with hand wipes, soap, a government leaflet on the virus, foil blankets and a snack bar. They also provided a contact number for people to call if they developed symptoms.

Hand wipes were included in the outreach
packs offered to clients

She says: ‘We had to develop partnerships, including with a church providing food so we could deliver healthcare and advice in the same place.

‘We partnered the local drug support service to facilitate rapid methadone prescribing on the street and assisted drug workers to do telephone assessments.’

Then, the government implemented the Everyone In operation to provide hotel and other emergency accommodation for people experiencing homelessness.

Ms Ungpakorn says emergency accommodation took the strain off so people could think about their health and access healthcare.

‘We saw some very positive outcomes for people with long histories of rough sleeping, whose health significantly improved once they had somewhere to stay and stabilise their drug use.

Foil blankets were distributed, along
with contact information for support

Advocacy and communicating patients’ needs to commissioners

‘Sadly though, this was not the case for everyone rough-sleeping in Westminster, as the funding ran out before there were enough hotel rooms.

‘At one point, Westminster Street Nurse was the only outreach service still working on the street in the borough, so another essential role of ours was to advocate for these people left on the street, to escalate our front-line knowledge – and the experiences patients were reporting to us – up to clinical commissioning group and sustainability and transformation partnership level.’

Healthcare street outreach valued as an opportunity for human contact

When setting up the Westminster Street Nurse project, Ms Ungpakorn wanted to involve the patient group in the design of the service, and her research explored the perceptions of homeless people with experience of sleeping rough.

‘It showed they felt health-related street outreach can offer a human connection that makes them feel less isolated, cared for and able to overcome barriers to healthcare,’ says Ms Ungpakorn.

‘This award will give me a greater platform for homeless and inclusion healthcare and the ANP role within it’

Ms Ungakorn

The project was designed with patients in mind, including a change from early morning to daytime shifts to avoid waking people, and partnership working with housing outreach teams and meal services.

Rosa Ungpakorn with a client. She involved clients in the design of the service from the start
Rosa Ungpakorn involved patients in the design of the service from the start

From pilot project to permanent, patient-centred service

During the pilot, street outreach was increased from one shift a week to one nurse on duty all week, with joint shifts with housing outreach teams, pop-up clinics in charity-run locations and a referral pathway for targeted individual visits.

The pilot was a big success and Westminster Street Nurse is now a permanent service: a review after three months showed a more than 400% increase in the number of people seen via street outreach compared with the same period the previous year. Half of these were not registered with a GP, and 80% were not accessing other clinics.

Rosa Ungpakorn with Westmnster Street Nurse colleague Marie O’Donoghue
Rosa Ungpakorn with Westmnster Street Nurse colleague Marie O’Donoghue

‘Now I want to devise guidance for delivering specialist healthcare outreach services’

Currently, there are no UK guidelines on delivering specialist services via street outreach so Ms Ungakorn intends to publish guidelines endorsed the RCN to help others offer street-based healthcare to people experiencing homelessness.

‘I want to share the knowledge from my research and work on Westminster Street Nurse,’ she says.

‘The nature of homelessness and the demographics of people on the street differ widely across the UK, so rather than a prescriptive one-size-fits-all, they will be designed to be a flexible tool applicable to services nationally.

She is also working with the London Network of Nurses and Midwives Homelessness Group to develop teaching materials and an e-learning module about street outreach.

‘This award will give me a greater platform for homeless and inclusion healthcare and the ANP role within it,’ she says.


Elaine Cole is RCNi special projects editor


The Advanced Nursing Practice Award is sponsored by the RCN

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