A shared, multi-agency, and co-ordinated way of working is vital in making sure clients can access the best possible care. Achieving this will require some creative thinking about how to provide a realistic and flexible approach that clients can relate to and access, as opposed to the one-size-fits-all approach found in many mainstream services. Currently, people experiencing homelessness rarely have access to palliative care, making it even more pressing.

We know that homeless people face particular challenges in accessing health care support. Many people with advanced ill health who are homeless have ongoing complex needs, behaviours and substance use issues, as well as illnesses characterised by a high level of uncertainty, such as liver disease.

Because of these complexities, multidisciplinary teams are needed to share ideas and make realistic plans that fit the needs of the individual within current services. If started early enough multi-agency working can help us to consider current and future care needs, and provide support to clients and staff throughout the client’s illness. We have developed some tools that you might find helpful when working with other services.

A client does not need to be identified as palliative before discussing your concerns with other professionals and services. You and your team’s concerns can be enough to call a meeting. You do not have to wait for others to request a meeting. The multi-agency working activity sheet might help your service or project think about what supports are needed, and the who can support you tool could help identify sources of support.

Consider the value of your project facilitating multi-agency meetings. This may help to ensure meetings take place as and when needed. Facilitating meetings also enables you to have more contact and build relationships with everyone involved. If possible. holding multi-agency meetings at the project could be an opportunity for others to learn more about the client’s living environment.

The multi-agency prompt tool could help in planning for and bringing structure to the meetings. Having a nominated coordinator to promote continuity and attendance can also be useful. This role can be rotated if needed.

Staying true to who we are, and maintaining our intentions to do the best we can with clients and others is perhaps the most important quality we can bring to our interactions with them.

The attitudes we bring are also very important. They are what enable us to focus on what the client wants at any moment in time, rather than what we may want for them, e.g. striving to ensure a client goes to detox when this may not be what they want or able to achieve at this time.

Multi-agency working carries a number of significant benefits, including:

• Bringing together a range of expertise, information and skills to meet clients’ holistic needs, a key factor of palliative and end of life care.
• Opportunities to meet regularly to share ideas, aspirations, plans and concerns about a client’s care, and help with assessments to ensure clients can access everything they are entitled to.
• Opportunities to provide support earlier for you, your team and clients.
• Supports conversations about future wishes and care for clients with advanced ill health (advance care planning).
• Promote a sense of shared responsibility around concerns and risk management. This could include the storage of medication at a project or managing complex symptoms and behaviours.
• A greater chance of providing person centred care that considers what really matters to clients at any stage in their illness trajectory.

Poor communication across services – e.g. a lack of information sharing between hospitals and homeless services around discharge planning, or not knowing who has had what conversations with clients or others.

Availability of services – limited availability of services to provide care in the project.

Decision-making processes – e.g. different viewpoints, interpretations and attitudes among professionals as to what might be in the best interest of a client.

Working within different models of care – there are particular challenges in providing palliative care in systems with a recovery focus.

Working in different settings – the lack of opportunity or time for everyone to meet and share ideas, often due to people’s schedules, work places and limited time.

Leadership – for example a lack of a coordinated response, or nominated person to coordinate meetings and share information.

Case review – discussing one client’s current and future care needs with people from other professions.

Multiple clients meeting – a meeting attended by professionals from a range of services in which you discuss multiple client’s about whose health you are concerned in order to plan for their current and future care and support needs.

Hospital discharge meetings – these are held towards the end of a hospital stay and are attended by a range of professionals. In the meeting, the physical condition of the client (both before and after hospitalisation), the type of support and care they may need and where they will be discharge to should be discussed. It’s an ideal setting to share concerns about the appropriateness of a project as a place of care

There are a number of practical steps and considerations to bear in mind when facilitating a multi-agency meeting. These include:

Setting up meetings

• Arranging dates and venue
• Notifying everyone
• Encouraging attendance
• Nominating a coordinator

Holding meetings

• Nominating a chair
• Discussing previous minutes/actions considered
• Updates and current concerns
• Recording actions
• Taking minutes (shared by everyone)
• Setting a date for the next meeting
• Distributing minutes

• Client’s consent, participation or absence. For instance, respecting a client’s choice to attend or not, supporting them if anxious about attending, and carrying out appropriate follow-ups with clients unable to attend.
• Knowing who to invite and who can support you. This depends on the nature of the meeting, as there may be additional people or specialists you might like to invite. Circulate minutes and action points so that those within the multi-agency team who could not attend are kept up to date.
• Respecting the different viewpoints, interpretations, attitudes, roles, beliefs and values within the team. Exploring these differences is an integral part of any multi-agency meeting, and should be encouraged in a professional manner.
• Language- avoid using complicated medical terms – ask if you are unsure what something means. If clients are present ensure they are included in any discussions. Be particularly aware when English is not their first language.

Allowing things to be just as they are with clients, rather than wanting things to be different.

Often we will struggle to accept things the way they are in our own lives and when supporting clients. We may sometimes want different outcomes from our interactions with them. An example of this is when clients make choices that we feel are not in their best interest.

The more accepting we can be of the way things are, the more able we are to focus on what really matters to clients, and what really matter to us as well. This allows us to consider alternative responses if needed, and it allows clients to feel listened to and respected.

For instance, how might being more accepting of a client who chooses not to engage with services (such as detox) influence the interactions you have with them? The opportunity to explore other options with them can always occur another time.

Allowing things to emerge for clients in their own time.

Our minds have a natural tendency to expect instant results and particular outcomes. When not achieved this can lead to disappointment, frustration, worry, or all three. The more patient we can be with clients, the more at ease we are likely to be in our interactions with them. This can also help clients to feel more in control.

Being patient also encourages clients to work towards their aspirations and concerns at a pace that is comfortable for them. For instance, struggling to get clients to engage with their GP about their poor health.

Regardless of how and when a client may decide to engage with the GP, how might being more patient with the situation influence the ease at which you interact with them in that moment? How might it make them feel?

Not always needing to strive for particular outcomes, or to make things right.

Striving for outcomes can be a positive thing, but often can be based on what we think we want, rather than what we may actually need. Bringing an attitude of non-striving to our interactions with clients may allow us to see more of what is important to them, and how we could respond.

While we can always continue to encourage clients to make positive choices, there will be times, (with good intention) where striving for particular outcomes will cause clients to disengage with us. If we continue to push an outcome without listening to what a client really wants, they may feel judged or that they have let us down.

How might they engage differently with us if we let go of wanting things to be different? How might this influence the way clients listen to the ideas we have about what might help?