Changing the conversation about health

P.A.T.H.S – Promoting Access To Health Services

CoM Tags:

community health, connecting communities, College of Medicine, C2, food, anti-social behaviour

 RLHIMconsultation400x PATHS (Promoting Access To Health Services) aims to improve attendance rates for homeless patients at any appointment deemed helpful to their overall sense of well-being.
This may include a hospital based appointment, a mental health or addiction, social or spiritual appointment. It does this by providing volunteers to accompany the patient to and from the appointment. Volunteers may accompany the patient into the consulting room if this is what the patient wants and they may also advocate, again if this is something the patient wants.
Year established
Number of staff
1 full time and 28 volunteers
Number of users
300 plus each year
Is there a charge to users?
No charge to users
What makes your project sustainable?
Initial start-up funding was accessed through the department of Health’s Innovation Fund. On going funding for the project is provided via Oxford Homeless Medical Fund which has a healthy, growing base of kind donors. In the vast majority of cases public transport is used, not only to maintain the projects environmental sustainability but also to ground its users in the real world.
User demographics
All project users are somewhere on the homelessness spectrum, between rough sleeping, sofa surfing, living in a hostel or tentatively beginning an initial tenancy.
The project helps to cope with the large number of health related appointments that people experiencing homelessness find difficult to prioritise. So far it has improved attendance rates at hospital based appointments by almost 100%. Challenges have included finding, training and supervising appropriate volunteers.A long, initial start up period was needed to ensure a safe and secure referral system and database was in place. The overall system is working well although training for the volunteers has had to be adjusted now that the project has expanded into PATHSPLUS.Where patients are too chaotic or violent to safely use PATHS volunteers, the surgery support worker may be used to accompany the person to their appointment. There have been some difficulties in this area when the surgery has not updated the patients records to indicate their unsuitability and referral has then occurred through locum GPs who don’t know the patient well. Serious incident reviews have been undertaken to get to the bottom of this and improvements to how data is recorded have been made.

PATHSPLUS work includes: assisting clients with CSCS cards, accessing Personalisation budgets, First aid training, Ultimate Frisbee sessions, Creative writing sessions, a hairdresser coming into cutting clients hair, Cookery classes, Clay modelling classes, Art therapy sessions, Maths sessions, Mindfulness/relaxation and Yoga, A debating club/session and creating posters with clients for all these activities. Finally one of the volunteers has also become an ambassador for OxHop.

Patient-centred, whole person, preventative approach
Attending health related appointments is preventative.Our volunteer matching system for health related appointments now includes those that are not hospital based such as mental health or addictions appointments. It also now includes social and spiritual aspects, such as church services and going to the cinema or just going out for a coffee. This widening of the remit acknowledges the validity of a whole-person approach. Patients choose whether or not a volunteer is matched to them and the volunteer adjusts and adapts their approach and contact according to the expressed needs of the patient.The volunteer may feedback relevant information to the surgery which has come from the patient with their permission. The project and the surgery believe in making patients views count as this is seen as being of highest importance.The surgery now also has a Patient Participation Group that gathers views and suggestions on how we can improve what we do.
Evidence-informed, practice and evaluation
These are regularly reviewed by the director of OXHOP which funds the project.Ongoing evaluation occurs through the regular meetings of the PATHS steering group attended by the volunteer coordinator, the practice manager, the surgery support worker, the lead GP and surgery admin and reception staff. The steering group meets every four months. Since the PATHS project was initiated:• 616.5 hours have been given by the volunteers to take clients to hospital appointments since May 2010
• 1088 hours have been given since PATHSPLUS started in December 2012 Volunteers have so far helped 331 clients attend hospital appointments (up to June 2013)
Multi-disciplinary collaboration, communication and professional practice
The surgery is an NHS surgery within the specialist division of Oxford Health NHS Foundation Trust. It has a team of experienced doctors, nurses, mental health practitioners (AMPs), addiction nurse specialists and visiting consultants and psychiatrists.This multi-disciplinary team, which includes the support worker, all undertake continuing professional development, supervision and appraisal and the team understand the importance of this for maintaining professional integrity. Formal multi-disciplinary collaboration takes place daily at the surgeries half hour lunchtime meeting. Informal multi-disciplinary collaboration takes place on an as needed basis, usually led by the volunteer coordinator however not always.The volunteer coordinator ensures that training for the volunteers is kept up to date and additional training sessions are provided when necessary. These additional sessions have included specialist, more in-depth training on mental health issues and on boundary keeping. All the volunteers are now also trained in basic first aid.
Awards and quotes from users
‘You really helped me, I wouldn’t have made it there without you and you were so friendly and patient with me’. ‘All the volunteers that have helped me are always so friendly and never make me feel like a burden, they never rush me’. PATHS won the Big Society Award in June 2013 – this is an extract from the related government press release:”PATHS was initially established to help reduce the significant non-attendance rates of hospital appointments by homeless and vulnerably housed people in Oxfordshire. The trained volunteers at PATHS assist those patients who need extra help in attending to their specific healthcare needs – for example accompanying them to appointments so that they get the best out of them, taking notes, or helping them with housing or job centre appointments. PATHS has proved so successful in Oxford, which is ranked as one of the cities with the highest number of people experiencing homelessness per capita outside of London, that the programme has been expanded to include additional support. The extended servi
ce PATHSPLUS now includes assistance for patients to attend appointments deemed to improve their overall sense of well-being”.
Contact details
Richard Lohman or Helen WrightPATHS. and PATHSPLUS
c/o Oxford Homeless Medical Centre
P O Box 7
St Aldates
OX1 1TDt: 01865 726008