Job description
To develop therapeutic alliances with people experiencing homelessness using the principles of trauma informed care, as a way forward to enabling relationship building, assessment and treatment for people experiencing homelessness To undertake specialist homeless health care at an advanced level. The post holder will be able to make high-level clinical decisions, and initiate and carry out complex interventions based on their own interpretation of the clinical situation. To act as a health case manager for individuals identified with high levels of unmet health need, and work towards individual health outcomes as defined by the project goals To undertake holistic physical and psychosocial health assessments on the street for people experiencing homelessness, in order to identify unmet physical, mental health, addictions, safeguarding, housing and social care needs. This includes the need for screening, health promotion and harm reduction work.

To carry relevant equipment on street shifts which enables the assessment of clinical risk, and can be used to provide immediate and necessary care e.g. thermometer, sphygmomanometer, oxygen saturation monitor, basic 3 resuscitation equipment e.g. a pocket mask resuscitator, basic dressings and first aid equipment etc To proactively identify immediate clinical risks to life and limb when seeing individuals on the street (e.g. related to possible infection, chest pain, abdominal pain, neurological concerns etc), and take appropriate action to enable the individual to access appropriate and timely care e.g.

calling an ambulance, or taking senior advice, nurse prescribing etc. To independently undertake mental capacity assessments if an individual refuses necessary care, and to make consequent, best judgment decisions on whether someone has mental capacity to refuse. To understand what action to take in these circumstances (in line with organisational policy), and to deliver this. To provide immediately necessary clinical / therapeutic primary care treatments on the street if needed (based on best possible evidence) that will improve health outcomes for people experiencing homelessness where relevant e.g.

wound dressings, nurse prescriptions / Patient Group Directions etc, but to work to signpost mainstream health services, and work to support patients into safe and effective treatment pathways where possible To offer immediate wound care assessment and basic wound dressing as needed. To ensure that there is good communication of any treatments offered, treatment progress and outcome of any investigations to other healthcare agencies, including GPs. To proactively identify when individuals are not in contact with relevant primary health care services e.g. GPs, community inclusion health nursing, mental health services, addictions support and dentists, and to advocate for and support individuals to access these services appropriately To identify when individuals are frequently attending at emergency services, to understand the nature of this, and to take steps to resolve this (enabling admission or primary care access whichever is more appropriate) To identify all ongoing safeguarding concerns around abuse, neglect and self neglect.

To refer to safeguarding appropriately and contribute to developing safeguarding plans. To understand the barriers to housing, and work to get people into housing solutions alongside outreach workers. This might include providing evidence that a person is priority need for housing, challenging an intentionally homeless decision, or referring for / enabling a Care Act Assessment for someone with care and support needs. To proactively develop and maintain close working relationships with and link in with homeless and inclusion health services, GPs Practices, dentists, Ambulance Service, mental health services, additions services, district nurses, community 4 matrons and acute Trusts in order to enable positive joint working, and the seamless delivery of coordinated care to the homeless population To call and lead case conferences with partner agencies for case managed individuals as necessary, involving the individuals themselves wherever possible To provide screening e.g.

verbal TB screening, or blood spot screening for blood borne viruses (BBV) or diabetes where appropriate To deliver vaccinations on the street e.g. flu, Covid, Pneumovax, Hepatitis A and or B vaccinations when indicated if safe and appropriate to do this To work within and consolidate integrated care and treatment pathways for individuals who are identified as being infected with BBVs (Hepatitis B, Hepatitis C and/or HIV), TB if they are unable to be housed To undertake phlebotomy, if required and safety can be maintained, ensuring adherence to identified pathways for blood sample labelling, collection, obtaining results and signposting. To use blood results to support the assessment the current health status of individuals, and refer for onward care as needed To deliver harm reduction initiatives e.g. brief intervention advice, vitamins, safer injecting advice etc Where indicated, to refer for specialist inpatient services (including detoxification) and liaise with hospital and inpatient unit staff.

To contribute to CGL Naloxone Strategy by training staff and individuals who use our services in the use of naloxone. Ensuring naloxone is distributed to individuals who use our services at every opportunity. To act as an advocate for people experiencing homelessness, supporting the individuals own choices regarding their care and promoting independence and self-care whilst at the same time being able to identify when a person is self neglecting To consistently champion the principles of patient empowerment To actively seek patient feedback on the service, and enable peer and patient involvement in service planning and delivery wherever possible To document all clinical activity thoroughly and contemporaneously, including outlining any perceived risks and mitigations it is recognised that this might not be easy when a shift ends late in the evening and safe procedures should be developed for specific situations. To document activity in line with project guidance in a way that enables health needs and project outcomes to be easily identified and understood.

To attend meetings that are appropriate to the development and maintenance of the role in agreement with and under the direction of the lead nurse To engage with training and clinical networks as required by the manager To manage own workload in such a way as to ensure there is enough time to undertake clinical work, reporting data and commitments and project meetings