The St John Ambulance Homeless Service in Brighton was set up in 1998 to address the inequalities in health care provision faced by those people who are homeless or vulnerably housed. Many homeless people have multiple and complex health needs and are unable to find their own way through difficult and exclusive appointment systems to get GP or other consultations. This means that most do not have access to statutory GP services and St John Ambulance Sussex continues to be the only organisation that gives them direct health care treatments at times and locations where they can access it most easily. The people who benefit from our service are individuals who find themselves, through a variety of reasons, alone and homeless, some with absolutely nowhere to go while others are vulnerably housed (living in poor or temporary accommodation). They are people who when we reach them, lead often chaotic lives and have complex histories of health problems both physical and mental, family separations, alcohol and drug abuse or social issues. They are human beings whose lives have little control and so have become marginalised from the mainstream social support systems and society. Current service profile There has been a regular annual increase in case load since 2000 when the number of client contacts for the service was 652. By the end of 2009 the number was 1,592, an increase of 25% in a year from 2008. In response to the growing numbers of homeless and vulnerable people needing its services, we increased the number of outreach clinics provided in Brighton during 2009 by 30% over the provision of 2008. Today we operate four, weekly drop in health clinics using four different venues in Brighton; St Anne’s Day Centre, St Patrick’s Hostel and Night Shelter, First Base Day Centre and through our mobile unit which also delivers outreach health care out onto the streets of the city. Our mobile health unit is a specially adapted ambulance giving all the benefits of an equipped surgery. It is recognisable, water proof and a safe environment to hold confidential consultations. The key issues dealt with during consultations are wound and foot care, drug and alcohol related problems, infestation and skin disorders and skeletal injuries and we offer a significant range of nursing services to satisfy this growing need; wound care, advice, monitoring of ongoing chronic conditions such as diabetes as well as podiatry and dentistry. Foot care is a particular concern as homeless people wear shoes for an average of 22 hours a day and unless wet socks are removed feet are unable to recover and conditions such as Trench Foot occur which can lead to necrosis and ultimately loss of limb. If seen in time however, it can be dealt with easily and effectively. Transient homeless people represent 30% of clients seen, arriving in the town from many other locations without anywhere to go. Having no ‘local’ connection they face particular problems in reaching help and SJAHS provides support to them. Our client demographics show that even though around 97% seen are white British, Irish or other, the remaining figures reflect the diverse ethnicity of clients and for these people language can create a further barrier in accessing services. SJA subscribe nationally to Language Line, an on demand interpretation service and offers this facility to everyone that needs it. Personnel Under the management of the Brighton Homeless Service Coordinator, 29 trained volunteers (thirteen of who are health professionals), gave 2,574 hours of their time during 2009 to provide health care and advocacy support. Each clinic session is nurse led and with isolation being an additional major problem that homeless people face, contact with our skilled volunteers is invaluable in giving them a non judgemental environment in which to talk and express their concerns and problems and build trusting relationships. As well as health care we are able to offer support with a wide range of information and signpost them to other agencies where appropriate. Because of our flexibility we can to work across agency and in partnership to find solutions that no one group could achieve. Future To consolidate and expand our service in existing clinics and outreach for 2010 and beyond is now our focus. The four drop in health and first aid clinics will provide dependable and consistent access to health diagnosis and treatments and we will continue to take the service out to those places where we are able to make the most client contacts. Often not aware of the help and support available to them, we will also be able to assess each person’s need and act as the contact to reach other services. Where appropriate staff or volunteers will accompany people to appointments and housing interviews to help attendance issues and work together toward positive outcomes which will give improved chances of resettlement. Our projection is that we will see and treat at least 4,350 clients over the next three years 2010-2012, and support 930 into accessing mainstream health, housing or mental Health services. Service monitoring Performance indicators are agreed and set for the service and information is collected and shared through an established reporting process to SJA Sussex personnel and management and to other agency stakeholders. SJAHS are rigorous in recording data by client contacts, what type of accommodation they have (e.g. sleeping out, night shelter), ethnicity, support needs, nurse issues, local connection criteria and many case studies to illustrate the impact of our services. This enables us to evaluate and develop the service according to actual need and to assess the best possible methods of doing so. Information has also been collected on the client use of other referral services so that we are able to maintain an overall picture of facilities for the homeless and their use in the city The service relies solely on donations for funding and the projected costs for the next three years are; 2010 £59,339 / 2011 £59,791 / 2012 £61,727 A detailed budget is available.