Not just saying it but really doing it

John Patterson, RCGP Clinical Champion for Health Inequalities

The following case study is one in a series, highlighting the work our members are doing to address specific health inequalities. The Health Inequalities Clinical Priority aims to share learning, and support members and their teams to deliver the best possible care.


Behind this unassuming, and lets be honest, uninviting door lies a hugely warm welcome. This is the home of Brighton Homeless Healthcare.

Serving a population of homeless and temporary housed people in Brighton & Hove, this small group of dedicated staff are more than happy to show me around. The tour doesn’t take long. There are a few consulting rooms, a small waiting area, a slightly decrepit toilet and... well that’s it really. Like most successful teams tackling the ‘wicked issues’ of health inequalities this project's richness is in the personnel of the team and their relationships with service users.

Dr Tim Worthley has been lead clinician for the past four years and talks with consideration about his patients. They are, as you would expect, chaotic, unpredictable and inconsistent. They are patients who have multiple conditions, multiple diagnosis and the classic triad of physical, mental and addiction issues. They are a nightmare on any QOF/KPI system, hit all the criteria for frequent flyers, and are very likely to fly off the handle at those trying to help. They are also though some of the bravest, funniest, stoic, creative, and ‘human’ people you could meet and Tim talks about them fondly, with warmth and with huge depth of compassion.

Over the past two years Tim has led the practice into new territory. Partnering with the UCLH Pathway project set up by Professor Aidan Halligan and with Justlife, a local third sector organisation, The Brighton Homeless Project has developed the Discharge from Hospital Service.

The pathway project supports clinical teams in treating homeless patients in hospitals. GPs  and consultants, together with specialist nurses, deliver care whilst the patient is in hospital. The pathway has now been rolled out to ten acute trusts and delivers the elusive combination of improved patient care and reduced bed days. The discharge service, developed in Brighton, extends this model further still.

This initiative ensures that patients leaving hospital are:

  1. Registered with the homeless GP service;
  2. transported from hospital to safe accommodation;
  3. have medication issued and know how to take it;
  4. are taken to follow up appointments at the hospital and;
  5. are linked in with a plethora of charity activities. 

The result is fewer admissions, greater integration of care, and fewer mistakes. The project has seen the building of relationships across the health economy, friendships and trust between secondary, primary and social care professionals and most importantly improved outcomes for the patients.

Hannah Bishop the practice nurse smiles when I ask her about her job and tells me how much she loves it: loves the patients, the variety, the challenge, the unpredictability. It is a job of huge highs and huge lows but she wouldn’t work anywhere else.

The dedication, commitment and hope of the staff working here is clear to me and to those they look after. In the words of one patient, ‘Yeah you know at this place, someone actually cares, not just saying it, but actually doing it.’

I think that says it all really.


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