Hastings, East Sussex has a very high concentration of homeless people for the region and remains the most deprived district in the region as well as being among the 40 most deprived in England. The St John Ambulance Homeless Service (SJAHS) Hastings was set up in 2004 to address the inequalities in health care provision faced by these people. Life expectancy of rough sleepers is just 42 years whilst the national average is 74 for men and 79 for women. Many have multiple 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 The priority has been to deliver our unique health care service to those most in need and today we operate four, weekly drop in clinics from the Seaview Project, Hastings, a multi disciplined day facility for the homeless. There has been a regular increase in case load since 2004 when the number of client contacts for the service was 541. By the end of 2009 the number was 1,417, an overall increase in five years of 162%. 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, and the client shown here was treated successfully by the SJAHS podiatrist and nurses. 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 a qualified Nurse Coordinator, 12 trained and skilled volunteers (six of who are health professionals), gave 992 hours of their time during 2009 to provide health and advocacy care. We expect the core number of active volunteers engaged in the service to increase by 3 during this year to support the growing levels of work giving a total of 1050 volunteer hours for 2010. Each clinic session is nurse led and with isolation being an additional major problem that homeless people face, contact with our 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 services 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 during 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 this service from the Seaview Project where we are able to make the most client contacts. Often not aware of the help and support available to them, we will also 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 5,550 clients over the next three years 2010-2012, and support 870 into accessing mainstream health, housing or mental Health services. By providing regular clinics we work to improve the health of homeless people. All consultations are free of charge, no appointments need to be made and there are no time limits. This is especially important for advocacy work. There are a small number of homeless and vulnerably housed people who do not access Seaview Project but do attend some of the other local voluntary services. The SJA Hastings Homeless Service is looking into extending its provision of health care by providing an out of hour’s service to target this group. The additional clinic will be piloted during Spring 2010 at Hope Kitchen, a church based soup kitchen, and results will be assessed to judge its viability. 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. Funding need Hastings Homeless Service has benefitted from Lottery funding which finishes in March this year and we are now working to secure grant donations to help support our work. A proportion of the service costs are met through income generated by our SJAHS commercial training which is delivered to other homeless agencies. We are planning to increase this over the next three years. Projected costs for the service over the next three years are; 2010 £46,660 / 2011 £47,333 / 2012 £48650 A detailed budget is available