Nurse-led service aims to make sure health for the homeless is not forgotten

Central London Community Healthcare NHS Trust is running an initiative in Hammersmith and Fulham to help homeless people access healthcare. Lead nurse Justine Sanderson explains why it is essential

Central London Community Healthcare NHS Trust is running an initiative in Hammersmith and Fulham to help homeless people access healthcare. Lead nurse Justine Sanderson explains why it is essential

Lead nurse Justine Sanderson launched the service in 2015

More than 300,000 people in the UK are homeless, according to Shelter. As a consequence of the many challenges homeless people face, their health can often be forgotten. Many will ignore nagging pain and worrying symptoms until they require emergency treatment or become fatally unwell.

In Hammersmith and Fulham, Central London Community Healthcare NHS Trust’s homeless health peripatetic nurse service is changing the outlook for this vulnerable community. Lead nurse Justine Sanderson launched the service in the Hammersmith and Fulham borough in November 2015. She provides healthcare across four homeless hostels and a walk-in centre for rough sleepers. 

The service began as an initial 12-month pilot. Main outcomes included: a 30% reduction in ambulance callouts; a 20% reduction in accident and emergency presentations; and a 20% reduction in non-elective hospital admissions. 

‘Prior to the introduction of the service, three hostels had spent £92,000 in the previous financial year on inappropriate London Ambulance Service (LAS) callouts,’ says Ms Sanderson. 

More than 300,000 

people in the UK are homeless

(Source: Shelter)

Overcoming mistrust

‘One of the first things I was told was that homeless people have a real mistrust of healthcare professionals,” she says. 'They do not look after themselves and do not feel worthy of receiving healthcare. 

‘They are also suspicious of strangers going into the hostel environment, so I spent the first three months slowly introducing myself and chatting generally with the residents.

'Gradually people started to tell me about their health issues. From there, I was able to make sure that everyone registered with a GP and was screened for hepatitis C. I also provided flu jabs to those that wanted one.’ 

She sees on average 100 patients a month and works 9am-5pm Monday to Friday across the five locations. Each hostel has residents with varying drug and alcohol support needs. 

‘Most females that I look after will tend to be sex workers to fund their drug habit,’ she says. ‘They will often have abscesses in their groin from where they have been injecting intravenously. In addition to treating their wounds, I will also have a chat about sexual health and we will go along to the local sexual health clinic together.’

No clinic rules

As a nurse prescriber, Ms Sanderson provides around 20 prescriptions a month. 


number of times homeless people are more likely to have hepatitis C 

(Source: The Lancet Infectious Diseases)

‘I have to be quite tough with providing prescriptions as even though I have broken down barriers, I cannot let them walk all over me,’ she says. ‘However, if someone makes an appointment and does not turn up 15 times but then turns up on the 16th occasion, that is fine.

'Nobody gets discharged from the service or penalised for not turning up. Clinics are not strict, there are no rules. I wanted the service to be accessible and available for everyone – flexibility is important with this patient group. 

‘One day a week, I am based in the day centre in Shepherd’s Bush,’ she adds. ‘People I see there tend to come in off the street for medical attention. This patient group is different as people might be living illegally in the country or they may not have a GP. It differs from working in hostels, where I am aware that I am in their home. If they want to drink alcohol when I am seeing them in their home, they have every right to do so. I always feel safe.’

‘Flexibility is important with this patient group’

Usual appointment duration times also do not apply. Each hostel has a diary where appointments with Ms Sanderson can be made during her clinic times. Residents may ask for a general health check, a prescription or seek help with filling in paperwork, such as Personal Independence Payment (PIP) assessment forms. 

Ms Sanderson can also arrange for a peer advocate from Groundswell (a charity that offers a homeless health support service) to attend hospital appointments with residents. 

‘I found that there was a history of ‘did not attends’ (DNA) for secondary care appointments. I have access to SystmOne and can check when appointments are coming up. I will make sure appointments are added to the hostel diary. I also write them on big posters to put in their rooms and I will book a Groundswell advocate to accompany them. This makes sure that people have better attendance.’

A revelation

43 (women) / 47 (men) 

average age of death of homeless people in England

(Source: Crisis)

She finds days when patients do not want to engage, such as refusing to attend appointments, can be challenging. Support from staff in the St Mungo’s charity network helps, as does speaking to the trust’s Westminster homeless health team. She finds the role ‘enormously rewarding’. 

‘I absolutely love it,’ she says. ‘I have nursed in affluent areas of London and there is nothing like the reward you get from doing the simplest things for someone who has absolutely nothing. It is life-changing for these people. 

‘When they realise I am interested in their health, it can be a revelation for them.”

‘It has changed her life’

‘The year before I started the service, one of my female patients had been admitted to hospital four times via the emergency department to treat IV abscesses that had become infected,’ says Ms Sanderson. ‘She would remain in hospital for four or five days every time she was admitted.

'Since I have been in the post, she has never been in hospital. I manage her treatment at the hostel through antibiotics and twice weekly dressing changes. It has changed her life and saved the NHS money.

'Homeless people will often wait until the problem gets so bad that their only option is the emergency department. This is a vital service.’

‘We cannot imagine not having her around’

Picture credit: Alamy

Amy Rice is deputy manager at Hope Gardens, one of the St Mungo’s hostels that Ms Sanderson works at.

‘Having Justine here has been hugely beneficial as most of our residents find it difficult to go to GP practices due to past negative experiences or they may have mental health problems that prevent them from being able to leave the building,’ says Ms Rice. ‘They go to her with health concerns earlier as she is someone they know and trust. We can talk through any concerns with her if we are worried about a resident’s health and she has helped to educate us. She will advise how to manage conditions and what we should look out for that could indicate a person’s health is worsening. 

‘Appointments can be informal and Justine will see patients in their rooms if they would prefer. She has given residents the confidence to go and see health professionals in the community such as a GP or dentist. She has made it easier for residents to access GP services and she will always go along with our clients to register with a new practice. I can remember how difficult it was to access or even speak to GPs about our clients and their health. Getting anyone to their GP was extremely difficult.

'We cannot imagine not having her around. Her role is invaluable.’


For more information on the Hammersmith and Fulham homeless health peripatetic nurse service, contact Justine Sanderson via email.

Julie Penfold is a freelance writer

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