Bolton: A specialist nursing service for rough sleepers

A specialist nursing service for rough sleepers works closely with Bolton Council and local voluntary sector services. It provides support on the streets as well as into hostels and from its town centre base.


The challenge

In 2006, staff at Bolton NHS Foundation Trust were approached by a local church group which was concerned that the health needs of rough sleepers were going unmet.

The trust agreed that two members of staff – a district nurse and health visitor – could devote some of their time to offer them a bespoke treatment service.

One of those was Joanne Dickinson. She said: “We were only meant to be doing two hours a week but it quickly started being much more. We were working extra hours on top of the jobs we were doing. It was clear there was a need for this kind of help – they had significant health problems.”

The solution

In 2009 the trust agreed to fund a whole post, which was split between Ms Dickinson and her colleague Julie Draper. They started running a regular health clinic.

Over the years, the team expanded and now has five staff, including a staff nurse, junior sister and nursing associate. As well as providing support to rough sleepers, the Homeless and Vulnerable Adults Service also works with asylum seekers.

It has recently being given a permanent base in the centre of Bolton. Clinics are run from there four days a week. The team also provide in-reach into three hostels and run a clinic at the council’s drug and alcohol service headquarters as well as one at the Urban Outreach Centre, a charity commissioned by the council to work with homeless people.

Ms Dickinson said: “They have a wide variety of health needs – leg ulcers, abscesses where they have been injecting drugs, wounds and chest infections. A lot of the treatment is ongoing so we work hard to encourage them to come back regularly. Many do, but some don’t. When we are really worried we will go out and look for them, visiting guest houses and going out on the streets.”

The impact

Every week the team provides care to around 50 homeless people. The team also provides a service to asylum seekers.

One person who was helped was a man called Brian, who the team first came into contact with in June 2017. He has extensive leg ulcers and an open wound on his heel. He spent some time in and out of hospital and kept losing places in hostels because of drug taking, forcing him on to the streets. At one point he was found with frostbite. The team managed to save his foot working with other NHS teams, including the tissue viability service.

The team continued working with him and by the summer of 2018 his situation had improved. He is now in settled accommodation and receiving treatment for his drug addiction.

Lessons learned

Ms Dickinson said one of the challenges they have faced is getting GP involvement. “This client group often won’t register with a GP and we have not been able to get funding to pay for one, instead myself and Julie undertook advanced practitioner training. That has meant we have been able to diagnose and treat on the scene.”

Ms Dickinson said another development has been the launch of an outreach street engagement by the team. “A few years ago we realised we were not reaching some of the rough sleepers who were most difficult to engage so we have started doing walks around town with the drug and alcohol team and a council homeless outreach team.

“We just get chatting, have a cup of tea and try to get them to come to one of our clinics or offer them treatment there and then if it is possible. It is beginning to make a difference.”

How is the approach being sustained?

Ms Dickinson said: “We’re always looking to innovate and expand. We went into a camp the other day where there were needles and all sorts of risks. We could not treat the clients in that situation.

“If we had an ambulance or some kind of mobile health facility we could have done something. We are looking to see if we could work with St John Ambulance to address that sort of challenge.

“And of course there is always more we could do with extra staff. We have grown over the years, but there is always demand for our help. This is such a vulnerable client group.”


Contact details

Joanne Dickinson
Team Lead
Homeless and Vulnerable Adults Service
Bolton NHS Foundation Trust