Westminster Homeless Health Action Group Meeting Minutes

Westminster Homeless Health Action Group Meeting Minutes

5thDecember, 10am–12pm

Venue: Francis Street

Apologies:

Attendees:18

Service:

WCC Rough Sleeping Commissioner

St Mungo’s HHCP Coordinator

St Mungo’s HHP Coordinator

SERVICE PRESENTATIONS

Hepatic Encephalopathy (HE) – Jules Moffatt from Norgine Primary Care Representative

In the UK:

-600,000 people have liver disease

-60,000 people have liver cirrhosis

-57,682 hospital admissions

Jules discussed disease background, diagnosis and management. Chronic liver disease develops over time with cirrhosis the outcome of long term liver damage. Causes of chronic liver disease include alcohol use, hepatitis b and c, and fat deposition in the liver. Compensated cirrhosis is stable for the liver whereas decompensated cirrhosis is where the liver no longer maintains its essential functions.

Complications of cirrhosis include ascites, spontaneous bacterial peritentis, variceal bleeding and heptorenal syndrome.

Hepatic Encephalopathy (HE) is subdivided into 3 factors:

1. Gastrointestinal Bleeding – infections, dehydration
2. Constipation – electrolyte imbalance, excess dietary protein
3. Medication – TIPPS

The key message for staff is when noticing differences in clients or they inform staff of problems to encourage clients to go to their GP.

Incontinence – Annamarie McManus from Westminster Continence Services

The definition of incontinence is when you don’t have control of your bladder/anal sphincter (urine/ faecal) In the UK:

-6-7 million people suffer from incontinence

-£800 cost to the NHS in catheters, pads and sheets.

Annamarie explained that incontinence is not a condition but a symptom of a condition. Some of the different types of incontinence including functional (not knowing where the toilet is/can’t see signs), motility problems, physiological (muscles not strong enough) and stress (triggered by anything from coughing to running). Alcohol also triggers incontinence when the bladder relaxes. Incontinence is very embarrassing for patients as it is not socially acceptable.

The Westminster Continence provide floor pelvic and muscle exercises as well as front and back pads (although the last resort) can be delivered. Referrals into the continence service can be made without a GP and the services provide assessments as well as outreach services.

Annamarie discussed the key message as being to encourage people not to go to the toilet on the ‘first urge’ and the importance of eating healthily (especially fiber), drinking lots of fluids and moving about a lot

Stroke Survival – Barry Coppock from Stroke Survivors Service

Strokes are the fourth biggest killer in the UK and Barry explained how to recognise a stroke including:

-Face drooped

-Slurred speech

-Cannot move arm

Barry discussed the causes, particularly lifestyle causes:

-High blood pressure

-Inactivity

-Diet

-Smoking

-Alcohol

The Stroke Survivors Service will go into services and hostels to discuss with clients and staff. Scans can be conducted to detect strokes and mini strokes (less symptoms than strokes).

Barry explained that while strokes cannot be prevented fully the risk of strokes can be reduced.

London Ambulance Service (LAS) Call Outs – Nicky Tanner and Samuel Smith from CLCH

There are frequent LAS callers/A&E attenders much of this relating to mental health issues and alcohol and substance misuse. Often these are related to homelessness.

Frequent LAS Callers/A&E Attenders MDT was organised with Emergency and Urgent Care Units, Central London CCG, LAS, JHT, Homeless GP Practices, Westminster Council and homeless healthcare charities. The aim of the group was to analyse LAS callout data and A&E data to propose and consider actions to reduce LAS/A&E dependency.

Samael and Nicky explained the success of the group so far:

-Organised co-ordination of training between LAS, HHT, JHT and Emergency Departments

-Working on a mechanism whereby patients discussed at HHT’s frequent attenders’ meeting are fed back to the various Emergency Department’s frequent attenders’ meeting and vice versa.

-Discussed several patients (anonymously) who are high users of services (sometimes attending A&E over 200 times a year) and devised plans to help them and be more proactive in managing them, largely by co-ordinating actions between organisations.

Date of next meeting: 6th February 2018

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