Teamwork and forging positive relationships, fully focused on better patient care

Our Homeless Health Team works alongside agencies, charities and the Nottingham and Nottinghamshire health and care system to provide triage, treatment and support directly to homeless people.

Over the past ten years we have developed partnerships to address health inequalities and improve access to care for some of the most vulnerable people in society, often with multiple conditions and complex medical histories.

Partnerships have been forged with Changing Futures, Framework, Nottinghamshire Healthcare Trust, Emmanuel House, The Friary, POW Nottingham, GPs and hospitals, Nottingham and Nottinghamshire Integrated Care Board, Nottinghamshire Police, local councils, Public Health and many more, to deliver assertive street outreach with a health specialism – delivering clinical care on the streets of Nottingham.

Lessons learned from this were fundamental to the care we were able to deliver during the Covid pandemic and more recently we have contributed to the Centre for Homelessness Impact Study Test and Learn: Outreach with a health specialism.

This England-wide research programme will evaluate the impact of having primary care nurses attached to street outreach teams with the creation of teams similar to Nottingham’s in eight towns and cities across England.

Evaluation demonstrates impact of early support for new parents and young families

Children in Nottingham’s most disadvantaged areas are happier, healthier and more confident, thanks to a ten-year programme of help and support for them and their parents.

They now have better speech, language and communication skills, improved literacy and maths scores, and are more socially and emotionally developed, after accessing services and activities from the city’s Small Steps Big Changes (SSBC) Programme.

SSBC has been funded through the National Lottery Community Fund’s A Better Start Programme and hosted by Nottingham CityCare. Children in Aspley, Bulwell, Hyson Green and Arboretum, and St Ann’s, show improved Early Years Foundation Stage test results that measure early development, from birth up to their fifth birthdays,

There were increases in communication and language skills, literacy, and maths, which were larger than in other parts of the city.

Evaluation by Nottingham Trent University also shows children whose parents had Family Mentors scored higher in the Ages and Stages Questionnaire (used to measure development in under-5s), particularly in communication, gross motor skills (physical activity), fine motor skills (such as writing, buttoning up clothes, etc), and personal and social skills.

The programme is coming to an end in 2025 but partners are continuing with many initiatives, including Family Mentors, Healthy Lifestyle Pathway and the Healthy Little Minds Programme.

 Funded by The National Lottery Community Fundand hosted by Nottingham CityCare, Nottingham’s largest provider of NHS community health services, SSBC has been helping parents and children under four since 2015.

Click here to find out more about SSBC.

Targeted Healthy Lifestyles – support and guidance relevant to our patients’ cultures and lifestyles

Two thirds of the families in the Aspley, Bulwell, Hyson Green and Arboretum, and St Ann’s neighbourhoods referred to us through our Targeted Healthy Lifestyles programme identified as non-white.

As a result, we developed the Eat Well Tool used by CityCare colleagues to make it more relevant to specific communities.

Lynn McGuinness, Clinical Service Manager at Nottingham’s Children’s Public Health 0-19 Nursing Service said: “We use the Eat Well Tool to support under-fours and their families to understand what makes up a healthy diet.

“For many families, however, the foods being suggested were not as relevant as they should be so we created different versions for different cultures and backgrounds, featuring foods they would be more likely to eat. For example, West African, Bengali, Polish and Caribbean.

“These culturally appropriate guides are now being embedded into our practice.”

Speaking to patients in their own languages

Pain management programmes are often based on clinical studies using patient data from western, white English-speaking populations. This can lead to assumptions about pain perception, treatment preferences, and health beliefs that may not apply across all cultural backgrounds, leading to disengagement, lower adherence rates, less effective pain management, and, ultimately, poorer outcomes for patients.

Using interpreters with lived experience
of persistent pain and clinicians who
could communicate directly with patients to build trust, we ran a programme covering pain neuroscience, exercise and pacing, mental health, medications, sleep, diet and flare-up management for two groups, our South Asian 

Ladies Pain Management Group and our Polish Pain Management Group.

Purba Bhattacharjee Clinical Specialist, Physiotherapist Pain Team said  disparities in chronic pain and pain management among minority groups are especially pronounced and  tailoring our approach to specific need would lead to improved quality of life and overall outcomes.”

► Patients who do not have English as their first language were also not easily able to self-refer to our Mosaic musculo-skeletal services. Key languages were identified, and we simplified our communications with patients, creating multiple language versions of letters and template messages on SystmOne.

Giving isolated families the chance to meet and access care

Working with agencies, including Nottingham City Council, midwives, GPs, Serco, Migrant Help, and Nottingham and Nottinghamshire Refugee Forum, we opened a weekly drop-in Stay and Play Clinic.

The clinics aim to:

·Increase access to more children and families without needing to access individual properties

·Offer open access to health information and support

·Increase social activity for both parents and children.

Suzie Keegan, Clinical Service Lead in the Transient Families Team, said: “These families may be vulnerable, have unmet health needs, and may have suffered significant trauma such as torture or sexual abuse.

“It is also often difficult for these families to access standard drop-in clinics due to language barriers, time constraints in current clinics, parental mental health and because they may not know the local area.”

The cross-partner working has also improved information sharing and regular safeguarding meetings are now held with Nottingham City Council.

Peer-to-peer Nordic walking group to improve physical and mental health

Sarah McCracken (pictured), an NHS Parkinson’s Nurse Specialist and British Nordic walking instructor, has been encouraging people with Parkinson’s Disease to join her on Nordic walks to help with their condition. Initially part of a funded research project in 2023, she continues to encourage people living with Parkinson’s,
colleagues, family, and friends to join in at the University of Nottingham every Monday and walks alongside Colwick parkrun most Saturdays.

Numbers are growing and it has sparked interest in our clinical team and among local Parkinson’s groups.

The university walks are supported by Parkinson’s UK and Trent Bridge Rotary Club and run by volunteer instructors.

Two of the instructors are living with Parkinson’s and inspire the group to be active and persevere.

“The benefits are evidence-based and supported by NHS England,” says Sarah.

“My research, which ran from 2021 to 2023, has left a legacy with early results suggesting there are wellbeing benefits in addition to improvements in balance, posture and speed of movement.

"We presented at four conferences during autumn 2024, including an international convention with a global audience.

“Nordic walking uses up to 90% of the big skeletal muscles and is a great all over body workout. It’s suitable  for people of all ages. I have taught more than 100 people with Parkinson’s to Nordic walk.”

Pulmonary Rehabilitation classes

We help and support patients with chronic lung conditions to live better, more fulfilling lives and stay out of hospital, easing pressure on other parts of the health service.

Through rehabilitation and education, patients with COPD (chronic obstructive pulmonary disease) are supported to manage their conditions in the community and at home.

Patients say the team has made a “phenomenal difference” to their lives and that they are “no longer frightened” about how their condition will progress.

National research in 2022 showed that patients diagnosed with COPD accounted for 8% of emergency respiratory admissions*. National figures indicate pulmonary rehabilitation can reduce exacerbations (requiring GP or hospital interventions) by a third**. Patients also welcome the social side of the classes, which gives them the chance to meet people living with similar conditions and experiences.

*Population Health Management – respiratory deep dive Analysis – COPD 2022)

** Chartered Society of Physiotherapy.

Children at the heart, parents leading the way, supported and guided by experts

Small Steps Big Changes, the CityCare-hosted and  National Lottery-funded programme, aims to reduce inequalities in the  key communities of Aspley, Bulwell, Hyson Green and Arboretum, and St Ann’s to give babies and very young children the best possible start.

Elements across the programme were designed to tackle unfair and avoidable differences in outcomes and to make access more equitable, improving experience and outcomes, including:

• A shift towards prevention and early intervention during pregnancy and first four years
• Understanding and working with local communities
• Working with Place-based Partnerships.

Outcomes

Evaluation shows SSBC children:

► Have better language skills with a statistically significant difference in vocabulary scores

► Are happier and more confident than their peers, with healthier diets, sleeping routines and behaviour

► Achieved higher scores in ASQ (Ages and Stages Questionnaire) screening after 18 months or more on the programme.

Technological innovation allowing direct communication with our experts

Chat Health allows service users to talk to practitioners live, using text messaging.

We use the platform to deliver Text Health, a texting service providing first-line advice to parents of children aged 0 to19 and young people aged 11 to 19.

It is open each day between 8.30am and 5pm and messages are answered within 24 hours (excluding weekends and bank holidays).

In the past 24 months, 0 to19 practitioners have held 6,019 conversations with parents and young people.

The most common conversations are about appointments and administration, minor illness advice, and advice about infant feeding. They can also offer confidential advice on issues, including domestic abuse, maternal mental health and parenting support.

The main reasons 11 to 19 year olds contact the team include requests for help with emotional health problems, minor illnesses and sexual health advice.

Working with our communities to develop and deliver the workforce they need

With a workforce of more than 1,200, we are a major employer in Nottingham.

Our recruitment teams attend events across the region, raising our profile as an employer of choice, supporting local people into work and collaborating with schools, colleges and universities to develop the skills needed to deliver care in the communities we serve.

In 2024 we attended careers events and  jobs fairs, engaging with hundreds of prospective candidates.

We recruit nurses and allied health professionals at all stages of their careers, from students to mature candidates thinking about a return to work.

We also have many roles in vital support services, including clerical and administration work, HR, training, caretaking, domestic assistants and supervisors.

Click here to find out more about our roles and vacancies.

Apprenticeships: Pursuing a dream career alongside work and family

Stevie Marshall (pictured) joined CityCare ten years ago and worked in administration, as a rehabilitation support worker and a speech therapy assistant before becoming an Occupational Therapy Apprentice.

Based in the Rehabilitation and Falls Service, she likes the way occupational therapists take a holistic approach to patients’ care and use problem-solving skills to seek resolutions. This often means they have to think “outside the box” about how to enable people to regain
independence.

“Full-time university never seemed an option to me. Financially, I didn’t feel it would be possible. The  apprenticeship has allowed me to pursue a dream career alongside working and raising a family.

“It has been brilliant. I have met new people, and I am able to put my learning into practice, often in the same week,” says Stevie.

She has completed her third and final clinical placement (with Sherwood Forest Hospital’s Urgent and  Emergency Therapy Team in the Emergency Department) and is looking forward to completing her studies and starting work as a CityCare Occupational Therapist.

Volunteering: Thanks to CityCare, there’s no stopping me now. I can go anywhere

Our volunteers make a difference to their communities, supporting patients and becoming part of the larger Nottingham CityCare family.

Many simply wish to give something back to the community. For others, becoming a volunteer is a great way to learn new skills, meet people and, potentially, get back into work or try out a new career.

Therese Murley (pictured) volunteered at St Ann’s Health Centre in Nottingham providing administrative  support. She started in the district nursing team in October 2023 and the skills and experience boosted her confidence as she applied for new roles. She now works for Nottingham City Council.

Helping you to make a difference to our communities

We are planning a new charity with a mission to preserve and protect the health of patients in Nottingham.

Through grants, it is our longer-term intention that Nottingham CityCare Community Charity will fund education, practical advice, facilities, support services and equipment not normally commissioned by the NHS or local authorities.

We will consider ideas from colleagues, patients and the public that will make a difference to the communities we serve.

This could range from offering funding to kick-start a peer-to-peer support group for patients undergoing treatment or rehabilitation, to specific support for individual patients and their families.

CityCare colleagues ready to respond

We are proud of CityCare colleagues each time they demonstrate how they are living by our values – kindness, respect, trust and honesty.

This often goes beyond their “day job” to involve fund-raising and collecting vital items needed by members of the communities where they live and work. 

One example is District Nurse Natalie Barnaby, who responded to a call for essential items for women and their families.

She urged CityCare colleagues to donate and acted as a contact point for items, which were needed by people afraid to leave their homes during a period of increased tension and a rise in hate crimes following the Southport attack in the summer of 2024.