The Arch Healthcare surgery serves approximately 1400 homeless and vulnerably housed patients – the vast majority of them have multiple and complex needs. We set up Arch Health CIC as a social enterprise at the beginning of last year and we were awarded the contract to run the surgery at Morley Street in the autumn. We opened at the start of February.
Working with purpose
I love the vision of creating more possibilities for care in every moment. We are committed to excellent clinical care but also take a very broad view of the health and wellbeing of our patients. As well as our nurses and GPs, working in the surgery, Royal Sussex County Hospital and Mill View, there are a team of five non-clinical engagement workers working across the city with our patients. They work particularly with patients who are being discharged from Royal Sussex County and Mill View Hospitals. They help with things like getting them to the GP surgery, getting them registered with relevant service and taking them to drug and alcohol services. They really do get involved in all kinds of things from benefits to housing issues to general sorting out and social problems, just keeping an eye out for people.
We’re also helping other surgeries in the city, sharing our knowledge and expertise and supporting them to help with some of the more complex patients.
And then we’re also working with lots of other community agencies – charities and people working across the city in the area of homelessness. We’re pulling down the barriers because in some ways GP surgeries can traditionally be a bit of a fortress.
We want agencies who are working in Brighton and Hove to support the health and wellbeing of homeless people to come and talk to us so we can support and encourage them in the valuable services which they provide. So for example, a nurse from our practice has been running a clinic at BHT’s First Base Day Centre running and a drop-in at Just Life. This will be a growing area for us.
And we were talking to a team from a BHT hostel in a meeting recently and they told us about taking a group of their residents camping for two or three days last year. It’s not a clinical intervention, no medication involved, but actually this sort of work makes a massive difference in so many ways.
So those organisations play a massive role in the health and wellbeing of our patients. It’s not all about prescriptions. There’s such a lot that can be done.
How Here’s Start-up fund helped
The money we’ve borrowed from Here’s Start-up fund has meant that we have enough working capital to mitigate some of the financial risk at the start of our journey. It is a working capital loan. Without it we would have been carrying a very high risk in terms of cash-flow if we hadn’t had this money. It sounds like it’s not important. But it’s really, really important – if you have it, you can do things. If you don’t have it, you can’t even get started.
We might have been able to get a loan had we gone to the bank after being given the commission – but we had 10 weeks to mobilise from the time we knew we had the commission which probably isn’t long enough to get a bank on board. Also if we had borrowed from a bank we’d be paying a high interest rate. That is money that could be spent on doing something good.
Inclusion health innovation
There are some flagship GP surgeries in homeless healthcare. We’ve partnered with one of them – Inclusion Healthcare – in Leicester because of their specialism in homelessness. We are really keen to learn from them.
What we’re doing is connected to work at a national level around ‘inclusion health’ – deprivation healthcare essentially. There is a well-researched model for supporting homeless people in hospital through to their discharge. This is work that’s led by Pathway. So there are around a dozen teams around the country in hospitals supporting homeless people when they’re in hospital. In Brighton we have ‘Pathway Plus’, which means we also support people in the community once they come out of hospital. I don’t think that’s happening anywhere else in the UK at the moment. That’s a new innovation.
If we can do a better job in primary care and the community then we can help the whole system. If we can help people to get well, through excellent clinical care and connection with the services that are there to support them we can help to alleviate the pressure on other services – for example A&E and the ambulance service. That would be good news for everyone.