1. Women Accessing Services – A Statutory Perspective Amy Hall Clinical Nurse Specialist Health Inclusion Team

2. 3 Boroughs Health Inclusion Team Homeless, Refugee and Blood Borne virus clinics Homeless hostels, day centres and drug and alcohol clinics across Lambeth, Southwark and Lewisham 15 nurse specialists, 2 refugee case workers, 1 pain specialist and 1 GP session Health assessments, treatment, referrals

3. 2011 - 2012 3592 clients seen across the 3 services, 142 clients cases managed 13897 face to face contacts 21.8% were female 59.2% homeless clients had a mental health condition, 50.1% were alcohol dependent and 41.3% drug dependent

4. Cuts to the service Reorganisation resulted in move of 2 valued senior caseworkers to the TB team Loss of the practice development Nurse post Lewisham disinvested in the Refugee health service from April 2012 Southwark disinvested in a 0.5wte Band 6 nurse post from April 2012 A further refugee case worker post was cut July 2012

5. Women in our services Numbers hard to assess due to: Transient nature Non- engagement Often hidden (ie. Sofa surfers and B&Bs) Homeless link: Approx 11% of rough sleepers in 2010 were women

6. The nature of the problem Research shows that women who are drug or alcohol dependent get significantly more social disapproval than men (Klee, Jackson and Lewis, 2002) This gender bias has led to punitive responses and restricted options for treatment and care Negative attitudes coupled with discriminatory practice have deterred women from seeking help (Morrison, 1999)

7. Issues facing our female patients Substance misuse Mental health issues Domestic violence Prostitution Pregnancy Having children taken away Partners with multiple issues

8. Other statutory partners General practitioners District and practice nurses Specialist substance use services Specialist midwives Health visitors Domestic violence services Lambeth prostitution group Acute trusts Social services Mental health services Drug and alcohol services Sexual health services

9. Organisational difficulties No common or shared approach Poor liaison and communication between services Unrealistic expectations / treatment goals Inconsistent advice given No ONE professional taking responsibility for co-ordinating care

10. Key to moving forward Preventing further cuts Inter-agency communication Collaboration Obtain consent to share information Some examples of good practice….