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Camden: Holistic health care services for rough sleepers

The council and its partners in the borough have designed a range of dedicated health services to homeless people, covering everything from GP care and psychological support to dietary advice.

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The challenge

Camden’s position as a national transport hub, situated in the heart of London, draws rough sleepers from other parts of the UK and from overseas. By taking an approach centred on intervention, the council saw a significant reduction in the number of rough sleepers in the borough from 2000 to 2010. However, the problem has since been on the rise.

Camden Council’s commissioned outreach services to engage with around 700 rough sleepers over the year. These are a rather transient population with complex needs, many of whom have disconnected from support services in their home area. Around 60 per cent of rough sleepers in Camden are known to have significant issues relating to substance misuse and mental illness, requiring a range of additional support to enable them to rebuild their lives away from the streets.

In 2016, the council and its partners set out a new vision, ‘Routes off the Street’, to tackle the changing nature of rough sleeping head on. Addressing the health needs of rough sleepers was identified as a key priority.

The solution

Soon after the Routes off the Street approach was launched, the council and clinical commissioning group (CCG) set up a Homeless Health and Care Network. The network includes representatives from community safety, public health and adult social care as well as colleagues from the CCG, voluntary sector and local NHS services.

The network oversees health-related work and brings partners together around funding opportunities. A key objective of the network is to help break down the barriers rough sleepers face when accessing mainstream services.

Recognising these barriers, Camden provides specialist health services for rough sleepers, including a homeless GP practice situated close to Euston train station and an enhanced service for homeless people across the borough’s 35 GP surgeries enabling them to access support.

This has been built on by the CCG which has created a psychological and psychiatric counselling service at the dedicated GP surgery.

To ensure that rough sleepers are supported to navigate the health system, a peer advocacy service is provided by Groundswell, which uses volunteers to accompany and represent rough sleepers to appointments and clinics.

Meanwhile, the street outreach service – known as the Safer Streets Team – is supported by both mental health staff and drug and alcohol workers. Specialist mental health input is provided by Focus Homeless Outreach Service, which is jointly commissioned by the council and CCG.

The impact

As services have expanded, the number of people being helped has grown. Groundswell’s peer advocates carry out more than 200 engagements each year, while the specialist GP surgery has a caseload of more than 600. Brief interventions, from dietary advice to GP registration, are regularly taking place.

Those who are in urgent need of acute medical attention are often taken to University College London Hospital, where they get support from a dedicated team for rough sleepers.

Dr Tim Robson, who leads the UCLH team, described the support provided as “fantastic”.

Lessons learned

The Routes off the Street approach has meant there has been a real focus on some of the most difficult to engage homeless people. This has required the council and its partners to adjust the way they work and continually learn from best practice.

Routes off the Street Coordinator Emily Rainbow said: “The psychology service at our specialist homeless GP surgery is a great example of this. We initially had a standard NHS booking system, but found many patients were failing to turn up to appointments and then being discharged. The service now operates largely on a drop-in basis, allowing people to turn up and receive support and counselling when they are ready, at a pace that suits them.

“We are finding that this is much more effective. With this client group you really have to take services to them as much as possible.

“We now have a GP conducting outreach sessions, including joint shifts with the street outreach team. This has provided essential support to some of our most entrenched rough sleepers with serious health conditions. These individuals could die on the streets without this and other vital services.”

How is the approach being sustained?

Camden’s public health and community safety teams are in the process of creating a jointly commissioned service for rough sleepers. The new arrangements formally start in April and will see a local day centre become much more focussed on assessment and treatment.

Ms Rainbow said: “To date, it has been a rather informal, relaxed environment where rough sleepers can come in and get off the streets. But our vision is to create a hub that acts as a route into services and away from the streets for good.

“There is currently nowhere for the street outreach team to take clients, so they will use the centre to bring people in. Once there, they will be assessed and triaged for appropriate support. The hub will have a clinical room and benefit from a wealth of specialist health in-reach - for example, GP and mental health drop-ins, podiatry and sexual health clinics, and community diabetes and dentist services.”

Contact details

Emily Rainbow

Routes off the Street Coordinator

Camden Council

[email protected]