Transcript Women Accessing Services – A Statutory Perspective

Women Accessing Services – A
Statutory Perspective
Amy Hall
Clinical Nurse Specialist
Health 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
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Substance misuse
Mental health issues
Domestic violence
Prostitution
Pregnancy
Having children taken away
Partners with multiple issues
Other statutory partners
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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
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Preventing further cuts
Inter-agency communication
Collaboration
Obtain consent to share information
• Some examples of good practice….