Kia ora koutou. It’s wonderful to join other Churchill Fellows this evening. Sharing what we have learned – and what we have done with that learning is a very satisfying aspect of the Fellowship – and I am looking forward to comparing notes with some of you tonight.
When I took up the Fellowship, I was a GP at Auckland City Mission’s Calder Medical Centre, where approximately ten percent of the patients were rough sleepers. Many of them were suffering from mental illness, addictions and poorly managed chronic illness.
The more I worked with these people, the more I became aware that child poverty and domestic violence are fundamental causes of homelessness – but of course that’s another story.
As you can imagine, this population presents particular challenges to primary healthcare providers. Most long-term rough sleepers have suffered childhood abuse and trauma, with long-term impacts on their personalities, behaviour and wellbeing. They feel the system has let them down, they lead chaotic lives, and they don’t have addresses for hospital appointments or interactions with Government agencies.
I wanted to understand how primary healthcare could be better provided to homeless people, so that they could receive the same service other New Zealanders receive and expect.
Over a period of four weeks I visited Dublin, Oxford, Bradford and London to see primary care and street outreach services, hostels, Detox and Rehabilitation Centres, Hepatitis C Services and homeless teams in hospitals.
I wanted practical ideas I could bring back and adopt at the Calder Medical Centre – and which might also inform the development of Home Ground, an Auckland housing development for 80 tenants, complete with various wraparound services.
During my four weeks, I was impressed to see initiatives that were improving co-ordination between primary care, secondary care and social services – at the Department of Inclusion Health at St James’ Hospital in Dublin – and also operating in Pathway teams in the UK, where a team comprising a part-time GP, an experienced hospital nurse, a social worker and care support workers help patients with issues such as housing and benefits advice, recovery of important documents, community services, and addictions support.
On my return, I brought the most relevant ideas based to a review of the Calder Medical Centre’s health services, with a view of improving our outcomes for homeless people.
And we did make changes. These included training our staff to create a safe environment for people who have experienced trauma; outreach or street medicine; flexible appointment times; helping people attend specialist out-patient clinics; identifying at-risk families and individuals for additional support; and exposing medical and nursing students to this type of practice and population.
We improved co-ordination of primary care, secondary care and social services (for example to reduce what we term 'failed' discharges – where patients are unable to care for themselves and end up being re-admitted).
I hoped the Fellowship would be an opportunity to bring about effective change in my practice, and I also hoped that I would be energised and stimulated by the experience.
I can say both outcomes were achieved, and I am deeply grateful to have had this opportunity to develop greater understanding of the healthcare needs of homeless people and to introduce measures that will hopefully deliver better outcomes for them.
Although many of the initiatives I saw are operating in a different system to what we have in New Zealand, it was very satisfying to be able to adapt them to a New Zealand context and get some wins for some of the most vulnerable people in Auckland.