Women Accessing Services – A Statutory Perspective

Amy HallClinical Nurse SpecialistHealth Inclusion Team

3 Boroughs Health Inclusion Team

• Homeless, Refugee and Blood Borne virus clinics

• Homeless hostels, day centres and drug and alcohol clinics across Lambeth, Southwark and Lewisham

• 15 nurse specialists, 2 refugee case workers, 1 pain specialist and 1 GP session

• Health assessments, treatment, referrals

2011 - 2012

• 3592 clients seen across the 3 services, 142 clients cases managed

• 13897 face to face contacts• 21.8% were female• 59.2% homeless clients had a mental health

condition, 50.1% were alcohol dependent and 41.3% drug dependent

Cuts to the service

• Reorganisation resulted in move of 2 valued senior caseworkers to the TB team

• Loss of the practice development Nurse post• Lewisham disinvested in the Refugee health

service from April 2012• Southwark disinvested in a 0.5wte Band 6

nurse post from April 2012• A further refugee case worker post was cut

July 2012

Women in our services

Numbers hard to assess due to:• Transient nature• Non- engagement• Often hidden (ie. Sofa surfers and B&Bs)

Homeless link:Approx 11% of rough sleepers in 2010 were women

The nature of the problem

• Research shows that women who are drug or alcohol dependent get significantly more social disapproval than men (Klee, Jackson and Lewis, 2002)

• This gender bias has led to punitive responses and restricted options for treatment and care

• Negative attitudes coupled with discriminatory practice have deterred women from seeking help (Morrison, 1999)

Issues facing our female patients

• Substance misuse• Mental health issues• Domestic violence• Prostitution• Pregnancy • Having children taken away• Partners with multiple issues

Other statutory partners• General practitioners• District and practice nurses• Specialist substance use services• Specialist midwives• Health visitors• Domestic violence services• Lambeth prostitution group• Acute trusts• Social services• Mental health services• Drug and alcohol services• Sexual health services

Organisational difficulties

• No common or shared approach• Poor liaison and communication between

services• Unrealistic expectations / treatment goals• Inconsistent advice given• No ONE professional taking responsibility for

co-ordinating care

Key to moving forward

• Preventing further cuts• Inter-agency communication• Collaboration• Obtain consent to share information

• Some examples of good practice….