I was proud to be a runner-up in the Nurse of the Year category in the BJN Awards 2021.
By background I am an adult registered nurse (qualified in 1996), specialist practitioner (in practice nursing, qualified in 2003), and nurse prescriber (qualified in 2005). I also have various additional qualifications, including a postgraduate diploma in research methods, a diploma in tropical nursing, and a minor injuries practitioner qualification.
I started my career in general medicine and emergency medicine, and spent time working among aboriginal communities in Australia, and in Nepal, but I have been working with people experiencing homelessness and other inclusion health groups in the UK since 2004.
I currently work full time as a Nursing Fellow for the Pathway charity, but am also a Specialist Advisor for the Queen's Nursing Institute (QNI) Homeless and Inclusion Health Programme. I also volunteer for Doctors of the World, undertaking medical outreach in the City of London. I am also the Secretary and a Trustee of the London Network of Nurses and Midwives Homelessness Group.
Pathway role
Pathway (https://www.pathway.org.uk/) sets up and supports homeless hospital discharge teams around the country.
I came into the Pathway role having previously worked in, and then managed, the health inclusion team—a nurse outreach team working in homeless and vulnerable migrant hostels and day centres in Lambeth, Southwark and Lewisham in London (Dorney-Smith, 2007). I then set up the ‘Pathway’ inpatient services for homeless people in Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust and South London and Maudsley NHS Foundation Trust in 2014-2015 (Dorney-Smith et al, 2016a). I am now the clinical lead nurse, and currently support 17 teams nationally, five of which have started in the past 6 months. Setting up many of the Pathway teams, and watching them flourish and go on to support many vulnerable people, has been a great feeling.
As part of this leadership role for Pathway, I delivered a Community of Practice programme for all nurses working in this role during 2018, and developed a framework around this nursing role (Dorney-Smith, 2019). This work was funded by a Burdett Trust for Nurses leadership grant. I also lead on various projects for Pathway. For example, in 2019 I completed a stream of work developing a homeless health clinical assessment template, which is now available nationally (Pathway, 2021a).
I have also become one of the Pathway experts on step-down care from hospital, and have undertaken considerable data analysis evidencing the need for such services, and written journal articles in this area. This evidence is now being used to advocate for such services nationally (Dorney-Smith, 2011; Dorney-Smith et al, 2016b; Dorney-Smith et al, 2019).
I work closely with Experts by Experience (people with a history of homelessness) to get their voices heard in this role (Dorney-Smith and Gill, 2017), and developed training for GP receptionists with them in 2017 (Pathway, 2021b).
Recently, I carried out work on promoting the statutory Duty to Refer to hospital trusts around the country (Dorney-Smith, 2018).
Queen's Nursing Institute role
The QNI Homeless and Inclusion Health programme (https://tinyurl.com/mr3e3dpy) supports nurses and allied professionals working in inclusion health in the community around the country. Currently there are 1400 people signed up to the bi-monthly newsletter—700 are nurses, 300 are allied health professionals, and others are health support workers, policy makers, commissioners and health managers.
I support new nurses coming into this area wherever I can, giving them one-to-one support, and I recently wrote a ‘Get started in homeless and inclusion health nursing’ guide (QNI, 2021). I invite and post best practice case studies from established services on the QNI website. In addition, I have set up a number of clinical networking groups, for example, a group for health visitors working with homeless families. I supported this group to write to government ministers about the plight of homeless families during COVID-19 (QNI, 2020), started a Medact petition (Guest Author, Medact, 2020), and lobbied for a session of the Ending Homelessness All-Party Parliamentary Group (APPG), focused on homeless children (which took place in July 2021).
I have written a journal article profiling the work of these health visitors alongside one of the health visitors and the Magpie Project—a project supporting homeless families in Newham (Dorney-Smith et al, 2020a). Another of the groups supports nurses working with Gypsy, Roma, Traveller and boater communities, and we are currently focused on improving mental health services for men in these communities. Finally, I have updated the Homeless and Inclusion Health Programme guidance available on the network web pages, and invite new guidance where this is appropriate.
Doctors of the World role
On Tuesday evenings I do street outreach work in the City of London for Doctors of the World (https://www.doctorsoftheworld.org.uk/) alongside the Thamesreach outreach team. We work to persuade clients to come in to accommodation. When they agree, I undertake a clinical triage and observations before they come in, and ensure they understand current lockdown rules. Once in, as in more usual times, I help them register with a GP, where needed, and link them in for mental health care, addictions support and substitute prescribing, dentistry, vaccination and screening, among other things—whatever is needed. I also give out phones, socks, and other small sundries where this is relevant. Where people need social care/safeguarding referrals for issues such as self-neglect, domestic violence or lack of mental capacity I arrange this, and I attend numerous case conferences or prompt them if needed.
However, many clients refuse to come in, and these are the clients I am particularly interested in, and focus most on. In this role, I have further developed my knowledge and expertise in the management of self-neglect as a safeguarding issue, and complex mental capacity assessments. As a result of my interest, the City of London is now taking part in a 3-year National Institute for Health Research (NIHR) study, looking a the management of self-neglect in people experiencing homelessness.
London Network of Nurses and Midwives Homelessness Group
I am Secretary and Trustee of this charity (https://homelesshealthnetwork.net/), which was registered in 2019. The charity grew out of the original London Network of Nurses and Midwives (LNNM) group. The LNNM was set up in 1999 by Christine Beasley (the Chief Nursing Officer at that time). The purpose of the network was to bring specialist nurses, midwives and health visitors together to influence health policy throughout London. When it was originally set up there were a 17 clinical specialty groups in operation. This wider London Network remained fully active until 2006, but was then run down, and formally ceased to exist in 2015 after funding for the wider network stopped.
Alongside three other key colleagues who have been there since the start, we kept the network going voluntarily, and we have now grown it to where it is today. The group meets up bi-monthly, and has around 250 signed up to its newsletters. It has run five annual conferences from 2014 to 2019, entirely using the volunteer time and skills of the members, with generous support obtained from the London Housing Foundation. The last conference had nearly 300 attendees, was catered by the Marylebone Project (a homeless women's collective), and had entertainment provided by Street Opera. Since registering as a charity, we have obtained grants from NHS England and further funding from the London Housing Federation, and have started to produce our own clinical guidance.
‘During the first wave of COVID-19 … clients came in from the street, night shelters, sofa surfing and past histories of living on buses, at work and, in many cases, living in airports or bus stations’
We have recently bid for funds, and have been able to directly employ a network development manager, who is a nurse by background. The group currently has funding to produce e-learning on street outreach, tissue viability and neurodiversity in the homelessness context. The group has achieved a level of independent influence over the years, and I now tweet on behalf of the LNNM (@lnnmhomeless). Through this I have become a total convert to Twitter as a clinical networking tool! I am proud that I have helped to keep the LNNM going over the years.
COVID-19
During the first wave of COVID-19 I was seconded to work in two Ministry of Housing Communities and Local Government (MHCLG)-funded ‘Everyone In’ hotels for 3 months. I started work at the first hotel that had been secured for this purpose, commencing on Saturday 20 March.
Clients came in from the street, night shelters, sofa surfing and past histories of living on buses, at work, and, in many cases, living in airports or bus stations. The initial estimate was that 1000-2000 people would need to be brought in from across London. In fact, around 7000 were brought in.
When I arrived, the first 37 of the clients to come in were there already, and homeless charity St Mungo's staff had identified three clients immediately that they thought were medically vulnerable. On clinical assessment, two of these had COVID symptoms. Thus started a pretty intensive period of triage and urgent support provided by multiple volunteers and self-redeployed staff lasting several weeks to support getting ‘Everyone In’ safely pan-London, and cohort them effectively.
I then stayed supporting the first 150-bed hotel and then another 200-bed hotel, for 6 weeks. During that time, I directly managed around 25 symptomatic clients who had nowhere else to go, mostly on one floor that we designated for symptomatic clients at one of the hotels. I sourced everything that was needed—staff, clinical equipment, personal protective equipment, locked cabinets etc—over the initial few days, and developed messaging and procedures in the hotels to make them safe from a public health point of view. All clients received a medical triage, and clients with addictions and mental health problems were plugged into emergency support to stabilise them and help them settle and self-isolate. I later moved on to support other hotels.
Throughout this time, I kept all the QNI and LNNM network members up-to-date with policy changes as they happened, and advice about how to develop services in their own areas. I also contributed to the body of work now available on the Homeless Health during COVID-19 response web page (Healthy London Partnership, 2021). I was pleased to have been able to contribute practically on the ground from day one to the COVID-19 response, and also to have helped people across the UK respond effectively in their areas.
Access for all
I know I live and breathe inclusion health, but I love what I do. I firmly believe in equitable access, and the roles I have taken have allowed me to have a national voice to advocate for the most vulnerable people in our society, in a creative and autonomous way.
It's a cliché, but it's a chance to really make a difference, and at the moment, post-COVID, there is a focus on health inequalities that we should be able to capitalise on. My vision is to make inclusion health everyone's business in the NHS, not just a specialist discipline.
I must say that my peers and colleagues are inspiring and brilliant people, as are the clients and Experts by Experience that I work for and alongside, and they keep me going. I also love working closely with a wide variety of partners across health, housing, social care and the fabulous voluntary sector organisations that provide so much support to inclusion health groups.
In the past I was seconded to the Department of Health and Social Care, and now continue to feed into many national policy and practice groups. I have also had a wide variety of reports and journal articles published, including CPD articles (Dorney-Smith et al, 2018; 2020b) in partnership with various colleagues. Most recently, I have contributed to the Royal College of Nursing (RCN) report Leaving No-one Behind (RCN, 2021).
It is nursing that has enabled me to have a national platform to promote inclusion health more widely, and I am proud to be a nurse. And I am very proud to have been runner-up in BJN Awards Nurse of the Year in 2021!