Shift interviews Katie Carter about her role in a homeless health inclusion team in Brighton as part of The Sussex Community Foundation Trust. They talk about the importance of her role and team, supportive relationships and safe discharges from hospitals for people experiencing homelessness.
[00:00:00.990] – Shift
Hello, listeners. I’m back. This is Shift. And today, I’m going to be talking with Katie Carter, who is part of the multidisciplinary team of committed professionals at the County Hospital of Sussex. They support the long term needs of homeless patients and hopefully stop them needing to come back into hospital. It is part of the Pathway Partnership Programme. Pathway is a National Homeless Inclusion Health Charity. Pathway supports the inclusion health community with the intention to improve the experiences and health outcomes of people who are homeless in hospital.
[00:00:51.170] – Shift
Hi, Katie.
[00:00:52.920] – Katie
Hi, nice to meet you.
[00:00:53.810] – Shift
Nice to meet you. How are you today?
[00:00:55.700] – Katie
I’m okay, yeah. It’s Monday. All right for a Monday. Yeah.
[00:00:59.640] – Shift
Could you tell us a little bit about your job role and maybe some background?
[00:01:04.950] – Katie
Yeah, of course. My role has organically changed quite a bit. So pathway teams across the country have all set up a little bit differently. We were the second one out of London. We started 12 years ago now, April just gone. It started just with a GP lead and a nurse. Usually, you have a nurse that leads the team, if you like, operationally and clinically. In our team, it’s changed quite a lot. We started with a small team, just me and a nurse. Then Chris would be our clinical lead as a doctor at Arch one day a week. Then as people left and the team grew to now just nine, including the weekend worker, I’ve now taken over that operational side, which is not actually normal. My background more housing and housing law, making sure that I can appeal decisions and make sure that no one’s discharged. The idea is no one’s discharged to the street that’s admitted to a ward. Organically, it’s just been that I’ve been there longer. Now I organise if you like, or coordinate the team. Then alongside myself, I’ve got nurses. There’s four nurses, two from March, practise nurses that do part-time, and then one full-time role, which is covered by Sussex Community Foundation Trust, who are also outreach nurses for people who are vulnerably housed or on the street.
[00:02:34.110] – Katie
It all works really well. Then we’ve got a specialist, rough sleeping A&E worker as well, who helps anyone who comes into A&E because we can’t cover that. The wards, because it’s just too busy now. That’s what I do now, just like day to, lots of different things. But still see patients, but do a lot of other stuff behind the scenes to help with evidence so that if in the future we needed help with funding, we had proof of why we needed and what that looks like and what our outcomes look like, where people go and who we get involved in the hospital and how our advocacy works for our patients and things like that.
[00:03:14.040] – Shift
Okay. Interesting. So you do a bit of research?
[00:03:17.500] – Katie
I do as much research as is possible because I’m still patient-facing. So I’ve got an unusual role in that. I do half the day doing patient-facing and then half the day doing all of the things you need to do for that, but also then doing a bit of data on the side. And then so I can participate in conferences across the country and also in Brighton, just to raise awareness that we need these health inclusion services. And that they are actually, they should be, in my opinion, considered a speciality alongside any of the specialities you would think of. So that’s the idea. That’s why I’m still here six and a half years later.
[00:03:58.990] – Shift
Six and a half years? yeah. Okay, nice.
[00:04:01.420] – Katie
Same hospital, but yeah.
[00:04:03.780] – Shift
Well, that’s good because you get to know how it all works, I suppose.
[00:04:06.860] – Katie
Yeah, it’s like continuity. So you build up and relate. Look, it’s a beast. You’re never going to get your word across to everyone because there’s thousands of people in that trust. But we work so closely with the wards that they do get us. And I think they understand mostly why we’re there. And I think that relationship takes time to build. So if your face is changing all the time, that’s quite hard to then be able to advocate for your patients because you’re also almost advocating for yourself first, being like, this is why I’m here, justifying why you’re here. We’ve been able to stop all that by having for a long time now, Chris has been in the team for twelve years and then Greg’s actually come back. So you can’t get rid of us. We always come back.
[00:04:52.030] – Shift
It’s nice to have a friendly face and someone that you can recognise rather than having different faces each time you go in.
[00:04:59.220] – Katie
Absolutely. And the patients, not all of them, we have lots of patients that have never been homeless before. But some of the patients, sadly, that do come back in, they recognise the nurses and the doctors and myself from previous admissions or when they see them in the community. There’s that continuity of care. You’re able to give collateral and be able to advocate much better for patients because you know them and they know you. Because the trust is there, I think it makes such a huge difference to our patients. Definitely. You persuade, to a point, persuade them or to stay on the ward for a test or just build that relationship, which is sometimes hard when they’re being treated the way they are sometimes. Yeah. Really hard.
[00:05:44.550] – Shift
Just for the viewer listening, could we maybe explore what the Pathway programme is exactly?
[00:05:52.500] – Katie
Yeah, of course. It’s very simple in that we make it as simple as possible. A client, a patient will come in through A&E. They’ll either go or be admitted. If they’re admitted, they come to the main team, so not Simon, who’s the A&E worker, and then we will do whatever we can with that patient. They might be housed, but insecurely housed. We’ll support them with advocating for, say, brain scans if we’re worried that there’s some alcohol-related brain injury, or we might try and see if a deep clean can be done their room, or it might just be general day-to-day support to help them stay in for their tests and to tolerate the admissions. Then half of our work is starting from scratch, getting people housed. So whilst they’re going through treatment, we’re applying for housing, we’re appealing housing decisions, we’re getting addresses, doing the logistics of discharge. And all people need to do in the hospital is refer, name, where’s the patient? And we’ll go and see them. We make sure we see them within 24 hours. It’s a bit It’s a bit more difficult for Simon because not everyone that comes in A&E is what they call priority need, which for listeners is a bit confusing, but it’s a housing term.
[00:07:09.540] – Katie
So not everyone in the UK gets housed. And so he deals with a lot more people. Unfortunately, he can’t get housed because they’re not being admitted and the turnover is a lot quicker. But what he does do is put things in place to at least safeguard them, it’s better than nothing, and does duty to refer us, which is really critical. And then our team, we get into a lot more complexity. So So involving other specialisms, adult social care, advocating for different discharge destinations. If we don’t think that emergency accommodation is suitable for someone, we will advocate if they want that for care homes and assessments under the Care Act, which is a bit difficult at the moment, but we do our best. And then just general day-to-day chats so that they have someone to talk to that’s not from the hospital. So we are on an honorary contract. We’re not employed by the hospital. I think that makes quite a difference because it keeps us separate. Not because we don’t want to work together, but it’s just I think it’s nice that they see us as someone that’s there just to listen to them. I think it makes a huge difference.
[00:08:14.300] – Shift
You’re a specialised team? Yes. You specifically work with- Only people. People who are homeless that come into the hospital?
[00:08:21.930] – Katie
Yeah.
[00:08:22.610] – Shift
Okay, so that’s really nice because I think you have so many different problems when you’re homeless, don’t you? It’s not just about why you come to hospital. That could just be a bad back or whatever problem that you might have. We also were coming in with all these other issues that you possibly might have.
[00:08:43.500] – Katie
We’re thinking, yeah, a bit outside the box a bit.
[00:08:46.100] – Shift
Obviously, if you don’t have anywhere to live, then you’re not going to have that continual care. Usually, you’ll probably just get thrown back out on the street, right? Normally before this service.
[00:08:57.650] – Katie
We get asked that a lot. We get asked what happens when there aren’t teams like this? The truth is, adult social care will pick up some of the ones that are particularly vulnerable, but absolutely all right. I’ll be discharged to the street because the acute can’t keep people in beds waiting for housing. No one understands housing. It is a specialism in itself. What we’re seeing more and more of are people that have never been homeless before. I have a real drive to ensure that we get people out of homelessness and not into it. It’s for me, people that have, say, been in private, rented at 70, have found themselves losing their leg, can’t go back home, have never been in emergency accommodation before. For me, it’s like, what can we do here? Can I advocate for the most appropriate placement? It’s really difficult because we have such limited pathways out. We’ve got emergency accommodation. That’s it. We don’t have access to rehabs, which is something that I think we desperately need to have. People come into hospital and do so well. They often have done drugs for a couple of months if it’s a long admission, and they’ve had a full detox, but then they just get put in emergency accommodation.
[00:10:12.520] – Katie
We just really make sure that there’s the wrap-around support to try and get that moved on as quickly as possible, that they’re not just forgotten about. Because as we know in homelessness now, people are stuck in temporary and emergency accommodation for far, far too long. So that’s another thing we do, is make sure we do appropriate referrals. We don’t just get an address and that’s it. We do whatever we can.
[00:10:38.350] – Shift
I’m guessing, obviously, for that to be able to happen, then I’m guessing that you’ve got connections with all the other services available in Brighton?
[00:10:48.750] – Katie
Yeah.
[00:10:49.430] – Shift
I’m guessing. How does that work?
[00:10:51.750] – Katie
We did a full pathway, the conference that they do yearly, the two-day that they do, is really great. They have speakers from all over the world, actually, in Europe, but also mainly the UK. We did a presentation about what happens in Brighton shouldn’t stay in Brighton, because we are lucky in that we have, lucky and unlucky, I suppose, we have a huge demand for housing, so it’s not so great. But we’ve got such good networks here, so all of the teams work together. I think that’s where it works really well. We’ve got CGL workers in the hospitals, then that links in with the community. We’ve got Just Life to help people in emergency accommodation. We’ve got nurses in our team that are also the outreach nurses. Then I and a couple of the nurses and Chris work for ARCH, which is a specialist GP surgery. See, then we can register people there very easily with no restrictions. Absolutely, it’s brilliant. To be fair, we do probably half our caseload is out of area applications. We help anyone that’s homeless, not just Brighton & Hove residents, anyone that’s in the Royal Sussex that is faced with homelessness on discharge, we get them housed.
[00:12:13.950] – Katie
We’re lucky. We’ve just got housing officer for Brighton & Hove that’s actually in our team, co-located, which is working really, really well. But that, again, is just for Brighton & Hove residents. We still need to do the legwork for all of the Out-of-Area applications, which logistically It can be a bit trickier just because it’s just very difficult if they need follow up and all of that business. It’s a bit more difficult to know what services are in each area. As you can imagine, it’s like a beast in London. It depends what area you’re in and then you go to a different city. But Brighton, yes.
[00:12:48.850] – Shift
Brighton has got quite a lot of services here. I got more than most places, I assume.
[00:12:54.840] – Katie
No, it does. I think the pros and cons to that are it draws a lot of people that need support down here, which, of course, makes you pressure on them. I know. I’ll come to Brighton. You always say like, Oh, what made you come here? It was just the last stop on the train or whatever. I get that. Also, why would you not come to a city where you’re going to potentially get help. The difficulty, obviously, with that is the demand for the help is so much higher. It doesn’t seem to be, from my perspective at the hospital, I can’t speak for everyone in the community, but it’s certainly not getting quieter. People becoming homeless through marital disputes is becoming more and more common. Just different types of homelessness, which is quite interesting to see the trends in the six and a half years that I’ve been there. But it’s all the same work to me. It’s just, let’s get this, let’s get people out of homelessness as quickly as possible.
[00:13:55.340] – Shift
So you’re working for Arch?
[00:14:00.660] – Katie
I work with all of our team in reach on a recontracted. The Trust, except they acknowledge we exist, we’re allowed to be there. We have passes and all of that. We’ve got our own office there, but we’re not employed by the trust. I’m employed by Arch. I’m a full-time employee of Arch. I was Just Life when I first started. Then it was moved over. Chris, the clinical lead, he is Arch employed, and so are two of the practise nurses that come in two mornings a week. They’re all Arch The two, the main nurse role is Sussex Community Foundation Trust. Then we’ve got our Amy worker is a Just Life worker. We really are. Then, of course, the housing officer is from Brighton & Homes City Council. We really are an MDT team in the sense of clinical housing expertise, advocacy, but also the benefits of coming from different organisations is that you work so well together. Things like referrals, it’s just automatically done. It’s great. That’s great.
[00:15:03.600] – Shift
Because you can talk to each other. You’re all in the same room as well.
[00:15:08.080] – Katie
Exactly. It’s not without its problems, of course.
[00:15:11.160] – Shift
No. I was going to ask about the challenges. But firstly, I was going to ask about how did you manage to actually… Because Arch has obviously gone with the Pathway programme.
[00:15:25.080] – Katie
So, originally, when Chris set it up, Pathway helped out, we still call ourselves Pathway because we are still very much involved with them. We are not technically a Pathway team anymore. I don’t know exactly, so I don’t want to give incorrect information, but if you’re under Pathway team, there’s some involvement with money and stuff that is separate from that now because we’re established. Pathway tend to set teams up rather than continually hold them. That’s good. Because we’ve been funded for so long, so our funding is secured for periods of time that are longer than some Pathway teams have to fight at the beginning to find out where’s their money going to come from. We’re well established now, so it’s a bit easier. It doesn’t mean that at the end of this six years, we’re guaranteed the money, but That’s why it’s so important to just make sure you’ve got as much intel as possible. Because I don’t like to talk about stats because I’m still very much about the patient. But the fact is the NHS want to know the stats. I’m also mindful that in order to help my patients, I do need to know what the demand is.
[00:16:37.460] – Shift
Because you need to get the money, right?
[00:16:40.160] – Katie
Yeah. Well, luckily, I don’t have to.
[00:16:42.510] – Shift
No, you don’t. But I mean, to put it all to work.
[00:16:45.770] – Katie
Absolutely.
[00:16:46.060] – Katie
Just life and ARCH senior managers have to do all that fighting for us.
[00:16:52.310] – Shift
So did you have to do specific training at all? Because with the pathway, because you’re obviously specific team at the hospital. I was thinking whether you were using the pathway because apparently the pathway training model was coproduced with people who experienced lived experience with homelessness. I think their model was developed using lived experience of homelessness.
[00:17:22.720] – Katie
Yeah. I mean, again, because we were so long ago, it’s evolved probably differently to how they Describe it now, how they use it now, lived experience has been pulled in more and more and more, which is quite right. We do have training on homelessness and how people experience it. I’ve always met people and made an effort to speak to people about what it is that they actually feel they need when they come into hospital. From a training point of view, it’s very It’s a very difficult environment, the hospital. You have to be both understanding that you need to get people out of beds, but more importantly, you want a safer discharge as possible. That’s the side we’re leading towards. But the training has to be with the patient in mind. My training is very specifically around… We’ve done trauma and forward training, of course, and substance misuse training, but it’s more for me, it’s about making sure I always get people housed. I did a qualification in housing because I wanted to understand the housing, the wider housing sector, not just the Homelessness Reduction Act. I wanted to understand it better so that I could advocate better and not blindly.
[00:18:44.940] – Katie
Then the nurses in our team have had to pick up housing because they don’t do hands-on clinical work. We all do the same job, really. We all chip in, do housing forms. We all send housing forms off. We all say, No, come on, we need to get this person placed. The training that you’re probably referring to, we won’t have been a party to because it’s developed as Pathway has developed.
[00:19:11.230] – Shift
They would have been there initially, though, right?
[00:19:14.450] – Katie
They would be. I think it’s… Yes, absolutely. There’s initial training, but there’s not specific training. When you join, it’s a case of there is no one situation. Every situation is completely different. If I’m honest, there is what I always say when I start, when you’ve got a new person starting, there is no way that you can train someone until you’ve gone across a few different scenarios because you think you know something and you absolutely don’t because your mind’s got such different lives. Yeah, no, totally. You You think you’ve heard all the stories, and then you absolutely haven’t because everyone is a different person. We are in the team, let alone all of our patients experiencing this. It’s a case of living it and breathing it and then just going right, oh, okay. So now we’ve got this one. We’ve got such experienced people in our team and we still go to the office and go, You’re not going to believe this story. Right. How can we help this person because I’m stumped? And that’s where you put your heads together and there’s no real answer sometimes.
[00:20:19.810] – Shift
Would you be able to give us any examples? I know you can’t use actual events or patient’s names, but a general overview of what has worked using the pathway model or any challenges that you’re coming across?
[00:20:34.310] – Katie
Yeah. I mean, do you know what? We’ve seen about this the other day. We don’t focus enough on how many amazing things happen as a result of us working with our patients and our patients working with us because you’re just onto the next challenge. So you sit down and reflect sometimes and you’re like, My goodness, it’s so amazing, some of the feedback we’ve had. I think the biggest thing for me, and I can’t speak for the rest of my team, but in recent years, is just advocating for people to have things that a normal person in existence gets, because that doesn’t happen. You get an 83 A year-old woman that’s housed, will get lots of neurological exams, no questions asked. But if it’s a homeless man who drinks lots of alcohol, won’t get the same treatment. One of the things that we’ve had a lot of success, and Emily, our lead nurses, trying to start a pathway, but it’s a bit of a beast of a job, is to get people diagnosed with alcohol-related brain injuries that are substantial, so that we are getting the neurological exams to prove that they haven’t got the executive functioning in areas so that they’re not just bummed into EA because we get referred people that, quite honestly, are absolutely not appropriate for our pathway and absolutely not going to be able to manage.
[00:21:56.970] – Katie
We’ve had some successes with people who wanted to, some people that haven’t had, sadly, capacity, but getting people into care homes as a result of us pushing for neurology to be involved and OTs to do assessments. What’s OT? Occupational therapy. They actually take patients out and do what’s called a multiple errands test. And it’s just things like, can you go to the shop and buy a crisp, some crisps, a chocolate bar, and pay for it, and let me know how much the change is, things like that. And that’s It has to prove that some people might present in a hospital, okay, because they’ve been bought their food three times a day. They’ve been given their medicine. They’ve got level access bathrooms that are fully adapted. But when they go out, they’re not coping, and they’re coming into hospital multiple times, and that we need to treat something like what they call it ARBI, the alcoholic related brain injury, as a dementia. We need to treat it with the same respect we would a dementia. And it’s still a brain disease. It doesn’t matter how they acquired it. It doesn’t matter that it’s because of alcohol.
[00:23:02.000] – Katie
It’s irrelevant. I think, our biggest win is just helping so many people. And we spend longer with them. So we find a doctor will be like, oh, they’re fine. And we see them and issue go, They seem really great. Then we sit with them 20 minutes. We’re like, Oh, no, there’s something not right here. I feel like I want to know more because I don’t feel comfortable. I think that’s really great that that’s happening. But the issue we’ve got is it’s not easy. We’re not getting the support because of the pressures that adult social care are under. We aren’t getting all of the support from all the parties. There is a gap in the service provision for people that don’t quite need a care home, but definitely aren’t suitable for emergency accommodation. That’s a real obstacle for us. But that doesn’t mean that are getting those exams, start any examination done or tests done or scans done isn’t worth it. I think that’s our biggest win. The sad thing is it’s becoming more and more frequent, which I think is why we’re focusing on it.
[00:24:13.080] – Shift
What’s coming more frequent? Sorry.
[00:24:14.260] – Katie
People presenting with alcohol-related brain injury. But so severe that it’s… Because sometimes if you stop drinking, but again, the support isn’t there for that often. If you stop drinking, sometimes it can be reversible if it’s in the early stages, but we’re finding people have substantial deficits. I think that’s what I’m proudest of, is the team really fighting because it’s not easy to get specialists like neurology or neuropsych And I think that’s what we’re doing now. We’re really involved because they are so stretched, but they’re listening. I think that’s a really positive thing that it feels like the culture shifting a little bit. Yeah, lovely. I think that’s our proudest thing from the last 12 months. There’s lots of other things that are great. And we hear some wonderful stories of people moving on to sheltered and getting out of homelessness very quickly because of our referrals to support them in the community. But this is big. It could be really big if we get it sorted. It’s really good. That’s, I think, a really positive step.
[00:25:17.970] – Shift
Yeah, nice. The next question was going to be, are you able to use your learning to create a better practise? I guess you’ve answered that in what you’ve just said.
[00:25:30.170] – Katie
Yeah, Yeah, I suppose. It’s a good question though still, because I think also about our practise. I was thinking about that the other day because we should reflect more on how we can be better as a team because we are so busy that I don’t think we spend enough time with our patients as we used to because we’re so busy. I don’t want to become another person that just comes around and does a couple of things and walks away again because we’ve never been, those people. So I really want to take the time.
[00:26:01.590] – Shift
That’s why it works. It’s because you don’t.
[00:26:03.090] – Katie
Take the time. So we’re trying to… We split so much more now. So we used to go around as a team, but we just can’t often because the caseload is too big. And it also means if we only take a couple of people each when we do the ward round, we can actually sit and they can actually offload and open up a bit.
[00:26:21.100] – Shift
And you can see more, obviously as well, because like you say, after five minutes to 20 minutes or an hour, it’s a lot different to five minutes, isn’t it? Sitting with someone an hour to 20 minutes or five minutes.
[00:26:32.920] – Katie
It’s respecting the fact as well that they might not want our involvement as well. What I do find happens a lot in this sector, and it’s something that within this team, I try and emphasise that the importance of not doing is I think professionals sometimes think they know what’s best for the patient because they’re anxious and they’re worried about them and they think that they need to go this direction. They need to go into care home because we want them to die with dignity. Absolutely, of course, that’s all any of us want. But if we’ve got a patient that has capacity and they do not want that, we do have to respect their wishes. I think sometimes that doesn’t happen. There’s a lot of forced, this is what we think they need. I think we try and make sure they’re very much a part of the conversation, even though sometimes that can be hard when we have the dialogue with the community workers who we get on extremely well with. But sometimes what the patient wants, what we think and what they think can It might not be the same thing. I always think the patient’s voice should be absolutely the first thing you’re listening to.
[00:27:38.250] – Katie
Definitely. However hard it might be to hear, it might not be what you think is safe. It’s the most important voice.
[00:27:44.750] – Shift
Do you think that the way that you work, which I think is great, by the way, I’ve been part of Common Ambition, Brighton & Hove Common Ambition for a while, a couple of years now. The main things that we came up with that was causing problems was stigma, judgement, and person-centred. Lots of these things that you’re covering as your team. I think it would be really good if it was everywhere. Everybody thought like that. I’m just thinking, do you think just the way that you work? You learn by example and someone might see you doing something and they’re like, oh, actually, yeah, I think I would like to do that next time. I think that’s a better way of doing something. Do you think your team influencing other people around you who are working around you? You can see how you’re working. Do you think that might help with influencing how they’re working?
[00:28:50.540] – Katie
Yeah.
[00:28:50.860] – Katie
I mean, one thing I would say is on, I’m losing my days. Friday, we do quite a lot of training at the Trust and we’re actually getting asked to do it alongside CGL, which is the Change, Grow, Live, the Substance, This, Use Service for people that don’t know who’s listening in Brighton & Hove. We did a training session with them on the Infectious Diseases Wards. We did get a lot of people on there for a variety of reasons. Yes, I do. In answer to your question, it might be that they write a better discharge summary so that it helps them get housed, or they might understand where Where we’re coming from with regards to let’s just do this test while they’re in because they’re not going to come back in three days because they’re going to have a lot going on. That thing listening. It’s funny because probably from a community point of view, I understand why sometimes we actually can come across as quite cutthroat because we have to work so fast. We don’t get the luxury of a long period of working because we have to discharge people ultimately. We’re very to the point, what can we do?
[00:30:00.470] – Katie
What can we achieve? It’s still being kind. What’s realistic? One thing we never do is ever over inflate or give any false allusion to something that’s an option. We’re very, very honest with our patients. However hard it’s to hear, I think it’s much more important to say this is going to be really crap, but we can get you through this because we’re going to refer you to people, we’ll move you through. Because I think the worst thing you can do, and I don’t know-
[00:30:35.620] – Shift
Expectations.
[00:30:35.710] – Katie
Absolutely. Because when I first started this job, I’ve had to learn so much through error. When I first started, I used to take people to the emergency accommodation, make their bed, and all of that stuff. I do, if I can. Covid changed a lot of that and my roles changed. But one time, I wasn’t involved with managing their expectations. I took that person to that accommodation, and they broke down in tears at how bad it was and why did no one warn me how bad this was going to be? I, from that moment on, was like, without being too pessimistic, but I do make sure they’re aware that it’s going to potentially be because we, of course, don’t know the address straight away.
[00:31:16.060] – Katie
Then we get the address and then we know even more. But as a general blanket, I always say this is going to be tough and we’ll get you through it with the help of the community workers and that we’re here for you and that if you stay as much as you can do, engage with professionals, you can get you through this. But I just don’t think it’s helpful.
[00:31:38.500] – Shift
No, I totally agree because if you know where you stand, then you can get and then you know what to expect. Then you know, okay, so she told me this, so she’s also given me these options and these solutions, and I can go here now. So they have that in their mind because it’s very much when you’re homeless and someone offers She’d like somewhere to stay, it’s very much like, it can be like, oh, wow, I’m going to get housed. And then they put you in this place where you’re like, oh, okay, I don’t really want to be here. And that’s like It makes it even more devastating because you either staying in there uncomfortably or you just leave and you’re back on the street. Exactly.
[00:32:20.800] – Katie
My point is, what’s the point? If it’s going to break down, we’ve not done our job. I think that especially as half our caseloader, people that have not experienced homelessness before, of course, we see a lot of people that have been in and out of it, but we see a lot of people that have never been homeless before. Therefore, you have got to be honest with them because it’s going to be one hell of a shock for them to walk into to Some of the emergency accommodations in this city when they’ve never been in anything like that before. They’ve never rough slept, for example. They’ve never been in temporary accommodation. I think it’s incredibly important part is to be very honest.
[00:32:58.940] – Shift
I’m guessing What about this? Do you know anything about the step-down bed? I do. Yeah, because that’s another new thing that I think is helping or not helping. You tell me.
[00:33:12.590] – Katie
No, of course. I mean, it’s a resource that I would never want to go without. Again, with any new project, which it still really is, because it’s now in a new phase. It’s recommissioned in a different way. You wouldn’t want to be without it. The pros of it are, of course, the amazing clinical and support teams there. You couldn’t ask for better. They have literally saved lives. A particular patient that went in there would not be here if it wasn’t for them. The downsides, of course, are where it’s situated. It’s in a high support hostel around lots of drugs and alcohol.
[00:33:53.710] – Shift
Oh, okay.
[00:33:54.080] – Katie
I didn’t know that. Which is not great for some people. It’s a bit more simple. There’s a few things that come across. Don’t get me wrong, it’s full and move on. The other thing is moving the clients on from there can be tricky because often there’s a complex history attached. The housing, therefore, is more complex Their needs can be compound. What options from there are more difficult. The movement’s a bit slow, but absolutely fantastic resource. The downside is that half the people that have mobility needs that we meet are people that have not been homeless before. We will always offer it because that is absolutely the right thing to do because it’s an option. Again, we will say all the pros because there’s many. You get food twice a day, you get nurse going in every day if you need them. You’ve just come out of hospital. It gives you some more time to recuperate. However, it’s a high support hospital. You share facilities and avoiding drugs and alcohol is impossible. Not taking them, but as in you’re aware they’re all around you.
[00:35:01.530] – Shift
The environment, possibly not so… No.
[00:35:05.090] – Katie
Well, it’s like we’ve had quite a few older men and women who don’t do substances.
[00:35:09.260] – Shift
Yeah, and even who people who do substances and don’t want to be around it as well. But it was a nice idea I mean, maybe maybe that could- It still works. That could be improved as well. You could always get another place, like a building, possibly.
[00:35:24.150] – Katie
So a couple of people have gone in. This is what I mean about giving people options. We’ve offered it to a couple of people who have gone in there that weren’t using substances, and they actually excelled and did really well. You can’t tell. No. I’m just saying that it’s obviously got its challenges because of where it is. The ideal would be, but then it is… Having more options. Is to have more options. It’s to have more options. It’s to have a care home, really, but that’s not a full-blown care home. That’s neutral, that’s bit clinical, but homely as well. Because it’s also a working hospital, so it’s not just step-down bed. It would be great to have a step-down bed that’s completely separate, like a health bed. But having said that, you get what you’re given. It’s really hard to find properties, and this is available, and the staff there are fantastic. Some of the patients have done phenomenally well. Also Some clients and patients haven’t had any other options because of the history with housing and just in general. It’s a fantastic resource. I just think we need a couple of them for different Situations?
[00:36:31.430] – Katie
Yeah.
[00:36:32.000] – Shift
Obviously, like you say, the resources are not nonexistent, but they’re lacking.
[00:36:38.270] – Katie
Yeah, of course, especially in this city where, look how tough it is just to rent if you’ve got money. Let alone if you’re someone homeless or you’re trying to set up a service where you find a block of… And it needs to be level access. That’s the other problem, because the whole point in it is that we’ve got a lot of people coming out of hospital that need somewhere that’s level access, that the council just do not have stock in the city. So a lot of our patients end up in Eastbourne. If they’ve got loads of wound care needs, step down is phenomenal for that. I definitely say it’s far more positive thing, but it’s not without its challenges.
[00:37:14.260] – Shift
I mean, it’s a It’s in it as well, isn’t it? How long has it been?
[00:37:17.970] – Katie
No, it’s been. That’s what I mean. It was for… You’re testing me. I’m pretty sure.
[00:37:24.300] – Shift
It’s not your department, really, is it?
[00:37:26.940] – Katie
Well, it is because we’re there from the beginning.
[00:37:29.580] – Katie
We were the only refer us in. It’s like three years old.
[00:37:32.600] – Shift
Okay, but that’s not much.
[00:37:34.040] – Katie
That’s new. But it is new and it’s changed because it was split between two sites. So two high school hotels, one across the city at St. Pat’s, which closed, and then it’s all been decanted over to New Street so it’s a great service, but it’s just, yeah, see where it goes. Okay.
[00:37:51.060] – Shift
Well, I was going to say about Arch. Just for the people listening, I just wanted to say that Arch Healthcare was set up a community interest company to address the health needs of people experiencing homelessness and housing insecurity in the city. The service includes a GP surgery and in-reach service to Royal Sussex County Hospital. Hospital, a health engagement team, an outreach team, and you work closely with other healthcare providers. I just wanted you to say that in case people who are listening did know who ARCH was in Brighton. Yeah, that’s us. I don’t know. I’ve just been looking at their service and I just think they’re great. They do really a lot of good work. I have nice people in there. I just wanted to ask you, Emilia, do you enjoy working with ARCH?
[00:38:40.620] – Katie
I do, yeah. I love it. I wouldn’t be here if it wasn’t for the support. I think you join, and the same for when I work for Just Life. I think if their values match your own and they actually live them instead of saying, because every company has values right because it’s part of what they strategies. But it’s different with Arch because they do really live and breathe it. The patients mean everything to them and everything is about making things better for people. I, personally, I can’t speak for everyone. It is a hard sector to work in. It has its effects on your mental health. It can have effects on your personal life. You do have to look after yourself, and they do things to look after you, which is the point. So we have counselling optional, but we have private counselling we can have once a month, which was offered here at Just Life, and they offer it, too. I’ve had that for four and a half years, and I’d never change it. And then, reflective practise on top of that. But So when you are there and you really are living and breathing their values, I do think that they look after you, and I think that’s really important.
[00:39:53.950] – Katie
You’ve got to be in it for the right reasons because you wouldn’t last five seconds, I don’t think otherwise. No. Otherwise, Yeah.
[00:40:00.760] – Shift
That pretty much answers my question about whether you feel valued. I’m guessing that’s a yes. And the other question was about self-care, actually. I hope you’re looking after yourself because obviously it’s hard work, like you say. It’s hard sector to work in.
[00:40:18.150] – Katie
I struggled before. Now the team’s got bigger and I’ve started coordinating the team. I feel like more of… I feel that I need to lead a bit by example. Does that make sense? I think when it was just me and Greg and then sometimes it just be me and it just be Greg. I felt like you just got drowned in. I just need to make sure the patients are okay. But as the team’s got bigger, it’s easier because it’s not all on one person. But also I think it’s just encouraging everyone to take a moment. Don’t get me wrong, we slip, I slip. But we’ve got a sanctuary at the hospital which overlooks the sea. Sometimes If it’s been a really hard war round, something’s happened because lots of things happen. Taking five minutes to just reflect before going on to the next patient because sometimes you can take on that stuff onto the next person without realising. I think I’ve got much better at it, but I’m still working on that.
[00:41:21.780] – Shift
I was thinking it’s important to do self-care and have that time to check in with yourself, like you said.
[00:41:30.170] – Katie
Yeah, I don’t do it enough. No. I definitely don’t.
[00:41:33.690] – Shift
And I’ll be happy to admit that.
[00:41:36.600] – Katie
Is there resources available to you? I mean, you said Arch gives you counselling.
[00:41:42.640] – Katie
Is it counselling, you said? Absolutely, yeah. Counselling once a month. Yeah. Paid. And you go during work time. That’s amazing. That’s just for the -. It doesn’t have to be about work. It’s often not about work. But it’s just there’s resources there if you want them. And sometimes when you’re drowning, you don’t realise you are. Your colleagues are there to say… Because we are about away in the hospital. For a long time, it was not completely nonintentional, but you felt, even though that wasn’t the case, you were forgotten about a little bit. But they’ve integrated the teams through the last few years to make sure and we all much more connected with each other and then also who employ us, which has made a big difference. Because for a while, there was not as many of those meetings to connect and that’s got so much better, which I think is good.
[00:42:34.730] – Shift
I think that’s really important as well. I was thinking, that’s my next question, really was peer support and having someone to offload and have someone to recognise Are you okay? Just ask that question. Are you all right? Do you need me to help you with something? Just give me that peer support where you feel comfortable enough to even say actually to someone, you know what? Do you know what? Can I have… If you like to just give me five minutes?
[00:43:01.920] – Katie
Also, so often, so often it’s my colleagues that have pulled me to one side. I don’t think you’re okay. And then you’re like, oh my God, am I okay? Because it’s heavy. We care. Yeah.
[00:43:17.010] – Shift
That’s nice that you have that support that’s there.
[00:43:19.470] – Katie
Yeah. Amazing. I think, to be honest, in times like that, we all know how that feels. I’m sure you don’t always recognise it in yourself when it’s getting worse. But your friends and your colleagues often are the ones that help you out.
[00:43:33.740] – Shift
Well, I don’t know if you want to say anything else, but it’s nearly 45 minutes.
[00:43:38.590] – Katie
I’m sure I’ve bored everyone today.
[00:43:41.070] – Shift
No, it’s really interesting what you’re saying. It’s really nice to meet someone who’s up there and spending there pretty much your life helping other people. Nice one for your-
[00:43:53.420] – Katie
No, thank you.
[00:43:53.980] – Katie
Thank you for your good work. Thank you for your good work. It’s nice to have an opportunity to talk about it any time. Happy to do.
[00:43:59.900] – Shift
Well, Well, you don’t really realise what other people do for you when you go to the hospital and when you meet the GP and you don’t really see that person, but then everything else as well. I’m doing these interviews to try and highlight people who are doing good work and try and have some understanding of what they’re actually going through and how it’s actually all run just so that other people can understand, have a bit more of a perception on them and us. It’s like all of us are together.
[00:44:37.040] – Katie
One of the biggest things that have come out of Common Ambition, and we knew going into it, and it’s still a problem, is navigating the system and knowing who is there for help and where you go. I think it’s good to do this, and you also get to probably understand what everyone’s doing. So what does that mean? What does that mean?
[00:44:55.040] – Shift
Because it works both ways. Relationships work both ways. Well, it was really nice to meet you today. It was really nice to meet you. Well, that’s it, I think. I hope you all enjoyed the interview. I might do a write-up and I might put a couple of links to Arch and maybe the Pathway team, so you can have a little look on a few things that we’ve spoken about today, if you’re interested. Otherwise, have a nice day and keep smiling and be positive. Bye. Let’s say bye.
[00:45:33.890] – Katie
Bye, everyone.
