WYTHAM HALLAnnual Report 2005 - 2006

Breaking the cycle of street homelessness

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The sentiments of others can never affect us,but by becoming, in some measure, our own…

David Hume

A Treatise of Human Nature (1739-1740)

WYTHAM HALL ANNUAL REPORT1st April 2005 – 31st March 2006

CONTENTS

Wytham Hall - An Introduction ..................................................................... 2

Benefactors of Wytham Hall ......................................................................... 3

Council of Management ................................................................................ 4

Members of Wytham Hall ............................................................................. 5

Chairman’s Report ......................................................................................... 7

Doctors' Report .............................................................................................. 8

Case Reports .................................................................................................. 9

Residents’ Accounts ..................................................................................... 12

Student Quote .............................................................................................. 13

Events of 2005-2006 ................................................................................... 13

Patient Services Report ............................................................................... 14

Statistics ....................................................................................................... 17

Supported Housing Report .......................................................................... 19

Cash Flow Statement ................................................................................... 21

Income and Expenditure Account ................................................................ 22

Visitors to Wytham Hall .............................................................................. 23

Publications ................................................................................................. 23

Wytham Hall117 Sutherland Avenue Maida ValeLondon W9 2QJ

(Registered Office at this address)Company Registration No: 1777775 Charities No: 289328

Tel: 020 7289 1978 e-mail: enquiries@wythamhall.co.ukFax: 020 7266 1518 website: www.wythamhall.co.uk

Wytham Hall is a Charitable Company Limited by Guarantee.

National LotteryCharities BoardRecipient

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Wytham Hall Recovery Unit was opened in1984 as a unique and innovative projectproviding residential care to homelesspatients with medical and psychiatricillness. Dr David El Kabir, the thenPhysician-in-charge of Great Chapel StreetMedical Centre (websitehttp:/business.virgin.net/gcs.medical/index.htm), and a group of medical students setup the project. At Great Chapel Street, awalk-in surgery for the homeless in CentralLondon, many patients were seen whowere having difficulty coping on the streetsdue to ill health. Wytham Hall wasestablished to provide an alternative tohospital admission for these people. Itsother aims were to research the causes andconsequences of homelessness and toprovide medical education.

The recovery unit has fourteen beds and isrun by a team of care-workers and doctors.During a patient’s stay, medical problemsare addressed in parallel with social andhousing needs. A period of illness maygive people a valuable opportunity toreconsider their options - Wytham Hallalso owns a shared house and two flats.These have a total of sixteen beds wherepatients may be housed, providingcontinued care and rehabilitation.

(Great Chapel Street Annual Reportavailable on request).

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n WYTHAM HALL - An Introduction

n BENEFACTORS OF WYTHAM HALL

We would like to thank the following organisations and individuals, as well as thosethat wish to remain anonymous, for their kind donations and gifts.

ABT Photocopiers; Alcohol RecoveryProject; Alcohol Resource Centre;Alcoholics Anonymous; Allied Carpets;Angel Recruitment Agency; AndrewsComputers; Atis Real WeatherallsSurveyors; Atlas Boilers; The BenefitsAgency; Birthday Bakers; Brent SocialServices; Broadway; Browns Chemist 195Shirland Road; Camden & IslingtonHealth Authority; Camden SubstanceMisuse Team; CARA; Central CAT Team;Central North West London CMHT;Chubb; The Commission for Social CareInspection; The Connection at St.Martin’s; The Core Trust; Dental Surgery392 Edgware Road; E K Mechanicals;Eurogard; Flexicare; The GordonHospital; Great Chapel Street MedicalCentre; Guy’s Hospital; Harringey SocialServices; Health Support Team; HomelessLink; Homeless Persons Unit,Westminster; Housing 21; HungerfordDrug Project; JAG Plumbing; JointHomelessness Team; Kairos; Kensington

& Chelsea Primary Care Trust; LancasterDay Centre; Lisson Grove Health Centre;MAC Electrical Services; TheMetropolitan Police; MIND; NarcoticsAnonymous; Paddington ChurchesHousing Association; Paddington DrugTreatment Centre; The Passage DayCentre; The Paterson Centre; PortugalPrints; Ronald Brown Optician 393Harrow Road; SEC; St Charles Hospital;St George’s Hospital; SRAC; StMargaret’s Drop-In Centre; St Mary’sHospital; St Mungo’s Outreach; SalvationArmy; Soho Centre; Supporting People;Thames Reach Bondway; The Terrace DayCentre; WAMH; West End CMHT; WestLondon Day Centre; Western EyeHospital; Westminster Drug Project;Westminster Housing Benefit;Westminster Social Services; WestminsterTransport Department; WestminsterVolunteer Bureau; Wharfside Clinic;Westminster Adult Education Service;Woodfield Road Health Centre.

FINANCIAL YEAR 2005-2006

Trusts and Statutory Bodies:

The Barbara Welby Trust

The Sidbury Trust

Priory Trust

Paddington Rotary Club

Individuals:Mrs B. Banham Mr D. Derx Ms A.GleaveMr and Mrs Jupp Mr A. I. MacMillanMr J. Streets Mrs C. B. TubbMs S. Willson

We would also like to thank the following organisationswith whom we regularly cooperate:

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n PRESIDENT

Belinda Banham, C.B.E, J.P. (supplemental list), B.Sc. (Hons Econ) Dip Philosophy ofMedicine (Society of Apothecaries) R.G.N. President of Wytham Hall Sick Bay.Independent Assessor in the Office of the Commission on Public Appointments.

n COUNCIL OF MANAGEMENT

Dr Bernard Adams, M.Sc., M.B., F.R.C.P., F.R.C.Psych., D.P.M. (Deceased December 2005)Honorary Consultant Psychiatrist and Honorary Senior Lecturer, University College Hospital

Terry Bamford, O.B.E., M.A. (Oxon), Dip. Soc. Admin.Director, Social Perspectives Network

Peter Barry, M.B.A. (City), FCCA, DipM, I.M.I.S.Finance Director, Meiko UK Limited

Sir John Birch, K.C.V.O., C.M.G., M.A.Director, British Association for Central and Eastern Europe

Jeremy Booth, M.B., F.R.C.S., F.F.A.E.M.Director of Accident and Emergency Medicine, Chelsea and Westminster Hospital

Dr June Crown, C.B.E, M.Sc (London), M.A., M.B., B.Chir. (Cambridge), F.R.C.P.,F.F.P.H.M.Past President, Faculty of Public Health Medicine, Royal College of Physicians

Dr David El Kabir, M.B.E., M.A., D.M. (Oxon), M.B., B.Chir. (Cantab), F.R.C.G.P.Chairman and Principal of Wytham Hall Sick Bay

Sir Brian Jarman, O.B.E., M.A., Ph.D., M.B., B.S., F.R.C.P., F.R.C.G.P., F.F.P.H.M.Emeritus Professor of General Practice, St Mary’s Hospital Medical School

Chris Littmoden, C.B.E., CA.Non-executive Board Member, Immigration & Nationality Directorate. Non-executiveDirector, Low & Bonar plc

M.F.Woods, M.A. Dip. Arch. (Cantab), A.R.I.B.A., F.R.S.A.Formerly Chairman, Association of Consultant ArchitectsChartered Architect

Dr Theodore Zeldin, C.B.E., F.B.A., F.R.S.L., F.R.HisC.S., M.A., D.Phil. (Oxon)Fellow of St. Anthony's College, Oxford

Company Secretary: Dr Philip Reid, B.A. (Oxon), M.B., B.S. (Lond), M.R.C.P., M.R.C.G.P.,D.R.C.O.G. (Vice-Principal), Principal in General Practice

Solicitors: Dibb Lupton Alsop, 125 London Wall, London EC2Y 5AEAuditors: PKF, New Garden House, 78 Hatton Garden, London EC1N 8JABankers: HSBC, 196 Oxford Street, London W1A 1EZ

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n MEMBERS OF WYTHAM HALL

n RESIDENT MEMBERS

Robert Bolus, B.Comm.(Cape Town)(Bursar), Practice Manager, Great Chapel StreetMedical Centre

David El Kabir, M.B.E., M.A., D.M. (Oxon),M.B., B.Chir. (Cantab), F.R.C.G.P. (Principal) Chairman and Principal of Wytham Hall Sick-Bay

Philip Reid, B.A. (Oxon), M.B., B.S. (Lond),M.R.C.P., M.R.C.G.P., D.R.C.O.G. (Vice-Principal and Secretary), GeneralPractitioner

Petr Valasek, M.D. Ph.D (Prague)Senior House Officer, Royal Sussex Hospital,Brighton and, Institute of Anatomy, First MedicalFaculty, Charles University, Prague

n NON-RESIDENT MEMBERS

Angela ClarkeChef Manager

John FrenchSupport Worker

Julie Gaudion, PGCE Health & Social ServicesManagementRegistered Care Home Manager

Bridget McCarthySenior Project Worker

Alfred Roibal, B.A. (Hons) Social Sciences Weekend Project Worker (until April 2006)

Rashpal Panesar, B.A. (Hons) InternationalRelations Supported Housing Worker (from March 2006)

Wendy Sutton, B.A. (Hons) Social Policy andAdministrationWeekend Project Worker

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n VISITING MEMBERS

Desiree El Kabir, M.A., M.B., B.Chir. (Cantab), M.D. (Lond),M.R.C.P., M.D. Physician

Jeremy El Kabir, M.B.,B.S. (Lond), F.R.C.S. F.R.C.S.(Urol)Consultant Urological Surgeon, Northwick Park Hospital; Honorary Consultant Surgeon,St. Mark’s Hospital, Honorary Senior Lecturer in Surgery, Imperial College

Philip Joseph, B.Sc., M.D. (Lond), M.R.C.Psych.Senior Lecturer & Honorary Consultant in Forensic Psychiatry, St Mary's Hospital, London;Honorary Senior Lecturer in Forensic Psychiatry, Institute of Psychiatry, London

George Osborne, F.C.C.A.Accountant

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n CHAIRMAN’S REPORT

The past year has been one of relative stability. There have been no changes in the Boardof Trustees and our membership stays as it was last year. Among the staff, we welcomeRashpal Panesar who takes the place of Emma Rembalski. The staff now comprise theManager, Senior Project Worker, Project Worker, Supported Housing Worker andSupport Worker, as well as caterers and cleaners.

Various improvements have been carried out. Furniture and fittings in the Sick Bay andin the Supported Housing Units have been renovated and both have undergoneredecoration. The computers have been upgraded.

Dr Petr Valasek is back at the Royal Veterinary College as Senior Research Fellow,following a year’s stint as a House Officer and Senior House Officer at the Royal SussexHospital. He was awarded the First Prize at this year’s annual meeting of the CzechAnatomical Society, following on his winning the same distinction at the annual meetingof the Association of British Urological Surgeons last year. Clearly there is no stoppingthe man.

Our financial position can best be described as static but fragile. Needless to say, wecontinue our negotiations with the powers that be for possible sources of funding,activities which I have dutifully reported over the past twenty odd years. I have, alas,nothing new to add and the endless ritual dance goes on. “Life,” wrote Ortega y Gasset“is our reaction to the basic insecurity which constitutes its substance.” There certainlyseems no danger of our losing out on that score.

Dr. David El Kabir, Chairman

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n DOCTORS’ REPORT

Wytham Hall was founded by doctors andmedical students. In all some 20 medicalstudents and doctors have resided here andhelped with the medical and social care ofour patients since 1984.

The presence of doctors who live on-sitein a project like this is unusual andcontributes to its special value as a placewhere people can receive a comprehensiveassessment of physical and mental healthcombined with social care. As our ownexperience, statistics and case reportsreveal, homeless people usually have acombination of problems, which are noteasily addressed in a piecemeal fashionand certainly with great difficulty if theyare homeless. (see Great Chapel StreetMedical Centre Annual Report)

The three doctors currently involved withthe care of the patients at Wytham Hall andits move-on houses live on site. Two aregeneral practitioners (one retired) and theother is a researcher. We have our normalday jobs and provide the medical care atWytham Hall on a voluntary basis. One ofus will assess new patients on the eveningof their first day and design a treatmentplan. This is then monitored and modifiedat the weekly meetings attended by allstaff. Medication is prescribed anddispensed daily or weekly to the patientsand supervised by the doctors, allowing

prompt adjustments of treatment whenneeded. The general practitioners havemany years experience of working withhomeless people both at Wytham Hall andat Great Chapel Street Medical Centre.We know the local medical services welland in particular use St. Mary’s Hospital,

Paddington, and the PatersonCentre for Mental Health foropinions or investigations. Inturn they refer us patients forfurther care and rehabilitation.

The majority of referrals donow come from hospitals andsocial services unlike the earlyyears when most came form thesurgery at Great Chapel Street.This has been largely driven by

funding requirements but represents acost-effective form of intermediate carefor patients who have just receivedexpensive inpatient care. We are keen toexpand the referral sources to includeother hospitals in central London.

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Over this year there has been apredominance of alcoholism and itsconsequences amongst the physicalconditions we have seen. Tuberculosis hasalso featured strongly and we have hadgood success in seeing patients completetheir treatments. We have also had someindividuals with severe consequences ofdrug addiction. This year a smaller

proportion of our residents suffered fromsevere mental illness.

The student elective programme atWytham Hall, initiated and sponsored bythe Conanima Foundation for an initial 5-year period, began in 1989. Since 2000,rather than taking students from abroad wehave medical students on Special StudyModules from Imperial College andOxford. UCLH students also attend for aday early in their course. The attachmenthere gives a fascinating opportunity tomeet a range of homeless people indifferent environments and to witness andunderstand their lives in depth. It alsoshows how a difference can be made to thedamaged lives of this group of people.Students also attend the Great ChapelStreet and the Notting Hill surgery and cansee the contrasting problems of thedifferent populations and the fundamentalsimilarities in the approach to care.Students’ reports make interesting reading.

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n CASE REPORTS

Case Report 06

This 49 year old man was admitted toWytham Hall after being referred here bythe Great Chapel Street Surgery.

He had recently been discharged fromGuy’s and St Thomas’s hospital aftersuffering from alcohol-related seizuresand neurological problems due to years ofalcohol abuse.

His health had been deteriorating for thepast four years after being evicted from hisflat and sleeping rough beneathBlackfriars Bridge. He had been drinkingfrom the age of 14 and continued to drinkheavily until his admission into hospital.

On admission to Wytham Hall he settled in

well and his physical condition slowlyimproved. His dizzy spells decreased andhe attended follow up appointments at thehospital. He still continues to have speechand balance problems but he is managingthese well.

He initially refused to see an alcoholcounsellor but after encouragement fromstaff he eventually agreed to see one. Afterattending these sessions he admitted hehad begun talking through and dealingwith issues that he had never spoken ofbefore and it felt like a weight had beenlifted off his shoulders.

He continues to attend regular counsellingsessions and since they began it has beennoticeable that he seems more relaxed andhas become a bit of a practical joker.

He has been staying at Wytham Hall

unfunded as no local authority was willingto accept responsibility for him. He hasnow been offered the chance to move intoone of our supported accommodation andis delighted.

He remains abstinent.

Case Report 06

This 55 year old man was admitted toWytham Hall from St Mary’s hospital afterspending 6 months there after sufferingsevere pneumonia and complications due

to alcohol abuse. He had had a drinkproblem since his teens.

He has problems swallowing and as aresult is nil by mouth. He has to be fed viaa tube through his abdomen into thestomach, which he uses for 14 hrs duringthe night. Staff are liaising with thehospital and his GP for all his prescriptionsand food to be sent to Wytham Hall. Adietician comes to review him.

Prior to his admission to hospital he hadbeen staying in semi independentaccommodation but this had been a ‘wet’environment and was just compoundinghis problems. It was also alleged that he

was being exploited financially whilestaying there.

Since being admitted into Wytham Hall hehas settled in well and although a quiet andgentle man does get on well with otherresidents and staff alike.

He has also taken it upon himself to takeresponsibility for the residents’ cleaningrota when other residents are away.

Staff are liaising with him and his localhousing services to try and find himindependent accommodation for when heleaves.

He has mentioned that he has benefitedfrom being at Wytham Hall as it has gothim into the routine of doing things forhimself again.

Case Report September 2006

This 61 yr old man returned to WythamHall for a third admission following hiseviction from the hostel where he had beenliving. He has a long history ofhomelessness and alcohol dependence. Hehad a relapse after 18 months of sobriety.

On admission he was suffering fromalcohol withdrawal symptoms as his lastdrink had been the previous day. He wasimmediately started on a detoxificationprogramme. Within a matter of days hissymptoms had decreased and he appearedcalm and settled.

He said he was committed to remainabstinent from alcohol but was aware thathe would need on-going support when hewas discharged from Wytham Hall.

It was agreed with his Care Manager thathe would benefit from a rehabilitationprogramme and work began to find him asuitable programme. In due course aplacement was found for him in Devon.

He left Wytham Hall after a four week stayfeeling positive that this programme was

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going to be able to support him in his longterm goal to stay sober.

Case Report 2006

This 45 yr old gentleman was admittedinto St Mary’s hospital after collapsing onthe streets.

During his assessment at Wytham Hall hetold staff that he had been drinking from avery young age. He had tried to stopdrinking in the past (without support) buthad always failed. He also spoke aboutbeing in and out of prison many times forvarious criminal offences. Consequentlyhis relationship with his partner anddaughters had broken down.

On admission he settled well at WythamHall. He established a good daily routineand agreed to attend an alcohol supportservice for counselling.

After a time he made contact with hischildren. He eventually re-establishedvisits with them on a regular basis.

In due course it was decided that he wouldbe a suitable applicant for our supportedaccommodation at Lanhill Road and hemade a successful move there earlier thisyear.

Case Report September 2006

This 71 year old man was admitted toWytham Hall from St Mary’s hospital. Onadmission it was clearly evident that hewas suffering from self neglect and otheralcohol related conditions.

Initially he was sharing a room with otherresidents but it soon became evident that asingle room was more appropriate for himto manage his condition and he becamemore relaxed about it.

He quickly settled into a good routine andattended the various medical appointmentsthat were arranged for him.

Throughout this time Wytham Hall staffwere liaising with Westminster SocialServices regarding his move on fromWytham Hall. It was eventually decidedthat all that could be offered was B&Baccommodation with a care package inplace.

Inside days of his move into B&B he wentmissing! He subsequently arrived atWytham Hall. It was apparent that he wasin urgent need of a bath, some food andrest.

He was re-admitted into Wytham Hall.Within a matter of days with medical

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intervention and care he appeared torecover.

Following this episode negotiations werestarted for him to remain at Wytham Hallon a semi-permanent basis. Eventually thiswas agreed.

To date he remains in his own room atWytham Hall. He appears to haveblossomed through on-going support. Hecontinues his daily routine and remainsabstinent from alcohol.

n RESIDENT’S ACCOUNTI am a 26 yr old homeless man from Ugandaclaiming Asylum.

I was admitted into The Paterson Centre afterbecoming unwell and was subsequentlydiagnosed with Schizophrenia. On mydischarge from hospital I was admitted intoWytham Hall.

At first I was not very comfortable with thisaccommodation mainly because of the 7.00pmcurfew and the fact that I had to share a roomwith other people that I did not know.

However with time I accepted this andappreciated the staff’s flexibility when Istarted my college course and wished to returnlate (by the way Wytham Hall paid for thiscourse as I had no source of income because Iwas an asylum seeker).

My stay at Wytham Hall was for much longerthan I had anticipated. It eventually turned outto be for just over one year! The reason for thiswas because Social Services needed todecide who was responsible for me!Westminster or Watford? I had been livingwith some friends in Watford before I wasadmitted into hospital.

During this time I accomplished manythings with support and encouragementfrom the staff. They arranged financialassistance for me from South PaddingtonCMHT. They instigated my morningjogging (for a short time). I started andcompleted a Creative Writing Course. Ijoined a Karate Course and obtained myorange belt. I started and completed anIntroduction to Journalism Course. Iattended a workshop editing tapes of thenews so that they can be heard by theblind. I attended a Goals and Crossroads

training programme etc. Along with this mymedical needs and appointments weremonitored by Dr Reid and Wytham Hall staff.

During this time I heard from the Home Officethat I had been granted leave to stay in the UKuntil 2009. Following this I was supported inapplying for a National Insurance number andsubsequently State Benefits.

Eventually it was agreed that Watford SocialServices would take responsibility for my on-going care and I realised that my time atWytham Hall would be shortly coming to anend. I had mixed feelings about this, part ofme was excited because I was going into ashared house where I would have my ownroom and part of me knew that I was going tomiss the care and support that I had receivedfrom Wytham Hall. However I am optimisticand feel that I now have the skills to cope withwhat life throws at me in the future.

I feel lucky and thankful to have stayed andworked with the staff at Wytham Hall.

n EVENTS OF 2005 - 2006

FundraisingA total of £9,010 has been received frompersonal and other donations.

National Minimum Care StandardsAn unannounced Inspection by theCommission for Social Care Inspectiontook place in October 2005 and March2006. Both inspections were verypositive and all the recommendationsand requirements stipulated have beenimplemented. There were tworequirements overall.

MaintenanceGeneral ad hoc internal redecoration andreplacement of furniture and fittings hasbeen undertaken in the Sick Bay and theSupported Housing Units.

ComputersThe Wytham Hall computers wereupgraded in April and May 2006.

External RelationsA new contract is under discussion withSt Mary’s hospital for TB patientsrequiring ongoing care. Contacts are

being made with various agencies with aview to increasing referrals to WythamHall and the Supported Housing.Meetings have been held throughout theyear with the Supporting People Teamfrom City Hall including Greg Robertsthe SP Homelessness Strategy Managerand Lorraine Baker the ContractsManager. A meeting was held withSenior Managers from St Mungo’s toassess the viability of joint workingpartnerships.

StaffingThe present staffing arrangementsinclude the Manager, Senior ProjectWorker, Project Worker, SupportedHousing Worker, and Support Worker asfront line staff. There are catering andcleaning staff in addition.

Supporting PeopleWytham Hall was registered as aSupporting People Provider with anoverall ‘C’ score, although many scoreswere of ‘B’ level. A plan to achieve a ‘B’score overall was developed and thecontract successfully renewed. A rentalincrease was implemented.

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n STUDENT QUOTE

What to say of my week at Wytham Hall and Great Chapel Street. I wasn’t really surewhat to expect at all. I do some voluntary work with the homeless in Oxford, and find itimmensely rewarding; I also realised from this experience that the health care demandsof the homeless is different from that I normally see in the hospitals in Oxford, and is alsopoorly addressed in many areas. I thus thought that Wytham hall would be an interestingexperience, and I might learn something useful for my future career as a doctor.

In reality, it gave me much more that I could ever have expected. It really reinforced theneed to treat a patient holistically, as physical health is so intrinsically related to socialand psychological well being. It is also a marvellous example of team-working and amultidisciplinary approach to patient care. Furthermore, this experience made meappreciate how lucky I am to have had the opportunity to learn such useful skills as adoctor, and inspired me to work with the homeless again in the future. I feel so lucky tohave had this experience, and would highly recommend it to any medical student.

In addition to the Registered Manager thecurrent staff team consists of; a SeniorProject Worker and Project Worker whooversee all the work carried out for theresidents in the sick bay: They also ensurethat the care plans and risk assessments arecarried out in accordance with theCommission for Social Care Inspection.There is a Supported Housing Worker whosupports the residents in the three move onproperties and is responsible for carryingout all their support plans and reviews andkeeping in line with the current SupportingPeople Contract, a full time SupportWorker who in addition to helping withthe work with residents also carries out allthe health and safety checks necessary.There is also a chef and a cleaner to helpwith the smooth running of Wytham Hall.The team of volunteer doctors are livingon site and provide medical care and on-call cover over night.

Support Provided by Wytham Hall

On admission to Wytham Hall each patientis allocated a key worker and a care plan isdrawn up to include the input of all theservices involved in the resident’s care.This plan is reviewed regularly. Clientsare assessed individually so that theirneeds can be addressed independently andconnections with appropriate externalservices can be made. Wytham Hall staffmembers receive relevant training toenable them to provide a high standard ofcare and support to the residents.Arrangements are made for counselling,physiotherapy, dental treatment,chiropody, optician appointments anddistrict nurses visit when necessary.Substance dependent clients are linked upto local Drug and Alcohol agencies andprojects and also attend Alcohol

Anonymous and Narcotics Anonymousmeetings in the area. Following adetoxification programme at Wytham Hallsome residents leave us to move toresidential rehabilitation centres.

Length of Stay

Residents stay at Wytham Hall for anaverage of seven and a half weeks.Occasionally a resident will leave after afew days finding that they can’t resistdrinking or going back to their homelesslifestyle. Other residents who for onereason or another have no appropriatemove-on accommodation availableoccasionally stay at Wytham Hall inexcess of a year. The Wytham Hall teamare careful to ensure where possible thatresidents’ resettlement is appropriate andfitting to their needs.

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n PATIENT SERVICES REPORTJulie Gaudion – Registered Project Manager

When moving on from Wytham Halloptions can include our own supportedaccommodation in the shared house inLanhill Road or one of the two shared flatsat Charfield Court. Alternatively, someresidents with substance dependencyproblems will be referred to residentialrehabilitation by SocialServices, some with long termmental health issues will go tospecialist rehabilitation unitsand housing associations maysometimes be approached orthe resident may return tofamily, friends or their ownflats. Westminster HomelessPersons Unit will take referralsin a few cases when theresident is deemed to bevulnerable and will be streethomeless on discharge fromWytham Hall.

Where clients wish to remainin their independentaccommodation as long aspossible, Social Services aresometimes able to arrangeindividual care packages tohelp with personal care,shopping, cleaning andcooking etc.

Referrals & Admissions

In the last year Wytham Halladmitted 33 patients whostayed for an average time ofseven and a half weeks. These patientswere admitted from St Mary’s Hospital,The Paterson Centre, Westminster SocialServices, Watford and Bushey CMHT,City of London, Camden and IslingtonMental Health and Social Care Trust andSubstance Misuse Team. These residentswere discharged to Wytham HallSupported Housing, residentialrehabilitation centres, Housing

Association and other agency supportedaccommodation, independentaccommodation and in a few cases,referrals were made to the HomelessPerson’s Unit for bed and breakfastaccommodation to be provided.

Referral Sources/Services Provided

6% of the total admissions to Wytham Hallwere from Great Chapel Street Surgery onan emergency basis and may well beunfunded unless the client can be referredto an appropriate local authority team whomay agree to fund for a short periodfollowing assessment.

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The contracts with Camden and IslingtonMental Health and Social Care Trusttogether with the Paterson Centre and St.Mary’s hospital, brought us 52% of ourtotal admissions. Patients continue to bereferred from various other hospitals suchas St Thomas’ and the Chelsea andWestminster for early discharge thusvacating valuable hospital beds for newadmissions.

Public Relations

Oxford and Imperial College Medicalstudents continue to carryout their electives atWytham Hall and writeinteresting and enthusiasticreports about their timespent with us and at GreatChapel Street Surgerywhere they spend daysgaining experience with DrReid, the psychiatrist, thecounsellor, various drugand alcohol advisors,nurses and all the otherstaff there. Homelessnessand Health modulesincluding Drugs andAlcohol, Circulation andBreathing and Workingwith VulnerableIndividuals are stillattended by UniversityCollege Hospital 2nd yearstudents and the final year students attendfor Alcohol and Drugs Misuse followingspending the morning at Great ChapelStreet Surgery.

Visitors to Wytham Hall to discuss currentand future funding contracts and jointworking included Rebecca Campbell &Prince Dacosta (St Mary’s HospitalDischarge Team), Greg Roberts, MickWalsh and Jennifer Samuels (SupportingPeople, Westminster City Council), Giles

Tinsley and Mike McCall (St Mungo’s),Linda Konedu (CHAIN) and Shirley Cupitand Louise Hodge (UCLH).

Future Plans

We are keen to look for new ways to fundadmissions to Wytham Hall, especiallyfrom Great Chapel Street, and hope theremay be opportunities in the new practicebased commissioning.

We are keen to continue developing ourworking relationship and liaising with StMary’s Hospital Discharge Team to enable

the early discharge of patients who stillneed specialist care and can be admitted toWytham Hall and thus free up a valuablehospital bed.

Wytham Hall is also working on plans tofacilitate funded discharges from StThomas’ Hospital for the homeless clientgroup. We shall carry on making ourunique services available to all hospitals,Social Services and other agencies thatrecognise the benefit of funding a patienthere for assessment and care.

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n STATISTICS ON ADMISSIONS TO WYTHAM HALL

April 1st 2005 – March 31st 2006Total number of residents: 35 (last year 38)Total number of admissions: 33 (32)

of admissions were male 31 (94%)were female 2 (6%)

Average age: 40-45 (40-45)Average length of stay: 7.4 weeks (8.5)Figure of overall occupancy: 47% (68%)

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Length of Stay

Accommodation on Admission / Discharge

Referral Source

Place of Birth

London

16%

Europe

3%

Scotland

27%

Northern Ireland

0%

Eire

19%

England

16%

Rest of the World

19%

No.of

patients

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A g e

Illnesses of Patients

Place of Birth

Lanhill Road (established with a grant fromGlaxo Wellcome in 1994) and CharfieldCourt (established 1996 and 1997 with agrant from the National Lottery CharitiesBoard, and a substantial donation fromHenry Smith Charity) are supportedhousing units located close to WythamHall. They were established to allowformerly homeless people to continue therelationships they had developed atWytham Hall with the staff and otherresidents and encourage a supportive

community spirit. Sixteen individualrooms are available to people who areready and able to live a more independentlifestyle. The house and flats are dryenvironments, which offer a safe place forpeople who are committed to not drinkingor using illegal drugs. Residents have thesupport of a team of workers includingvolunteer doctors, the Manager, aSupported Housing Worker, a SeniorProject Worker, a Project Worker, and aSupport Worker.

Residents have a short-term stay atWytham Hall before moving into supportedhousing which gives our staff team theopportunity to build a rapport with theresident and identify any specific needs.

This also gives the resident some time toget used to their new surroundings andmeet their new house/flat mates beforemoving in.

Residents will initially be offered a place atLanhill Road, which is medium-termaccommodation, and then possibly a moveto Charfield Court, which is long-termaccommodation and can be permanent ifthe resident wishes.

Residents have the opportunity to expresstheir views andopinions aboutissues arising intheir own homeat weekly housemeetings whichthey often dowith enthus-iasm. Individualsupport plansare developedwith eachresident givingthem theopportunity tolook over theprogress of the

last month and to make plans for the nextmonth. Residents from the supportedhousing units often come over to WythamHall to speak with staff and socialise withresidents staying in the medical bay.Residents also attend outings from WythamHall, such as our summer outing toBrighton where everyone spent anenjoyable day on the beach and on the pier.

Cleaning of communal areas in thesupported housing is co-ordinated by theresidents themselves and weeklyinspections are made by the supportedhousing worker. These inspections ensurethat the house/flats are kept clean and tidy,and that there are no health and safetyissues. Residents are responsible for

n SUPPORTED HOUSING REPORT

19

cleaning their own rooms and also forreporting any maintenance issues to staff atWytham Hall.

The majority of residents living in thesupported housing units are in receipt ofHousing Benefits and other types ofbenefits. Staff at Wytham Hall devote aconsiderable amount of time chasing upclaims and ensuring that residents aregetting their full entitlements. Eachresident pays a small rent contribution withthe utility bills and council tax being paidby Wytham Hall.

Staff recognise that it is imperative todevelop strong working relationships withother services and organisations involvedin the welfare of supported housingresidents. Staff are in regular contact withSocial Workers, Community PsychiatricNurses, Drug and Alcohol Workers, DayCentre Teams, and Outreach Workers. Toenable continuity of medical care, bothLanhill Road and Charfield Court residentsare given the option of registering with Dr.Reid at either Notting Hill Gate or GreatChapel Street Surgery.

Lanhill Road

Lanhill Road is a large house ten minuteswalk from Wytham Hall, providingaccommodation for eight residents insingle bedrooms. Residents share aspacious kitchen, a living room, threebathrooms, two shower rooms with toilets,a laundry room and a garden. Lanhill Roadoffers temporary supported housing forhomeless people where residents usuallystay for a period of between 6 months andtwo years. Lanhill Road gives residents theopportunity to gain confidence inindependent living with the support ofWytham Hall staff. Residents spend theirtime participating in a number of activitiessuch as studying art, training, visitingplaces of interest and spending time withfamily. The residents currently living at

Lanhill Road take great pride in their homeand actively participate in ensuring that itremains a clean and safe livingenvironment.

Charfield Court

Charfield Court comprises of two flats,each with four individual bedrooms, ashared kitchen, lounge, balcony, bathroomand further cloakroom. They are located ina quiet area around the corner fromWytham Hall. Both flats function aspermanent homes, and are often used as amove-on accommodation from LanhillRoad. Residents view their homes atCharfield Court as ‘Homes for life,’ andtake pride in keeping them clean and tidy.Residents here spend their time visitingplaces of interest, keeping fit, spendingtime with family, one resident is currentlyworking and one is helping out at WythamHall. The residents living at CharfieldCourt have a very strong and trustingrelationship with Wytham Hall

Supporting People

Wytham Hall is continuing to self-assessworking practice in six core areas, workingto complete an action plan developed withSupporting People to reach a level B. Weand our Supporting People ContractsManager are confident that Wytham HallSupported Housing will be confirmed ashaving a ‘B’ status in March 2007. WythamHall has a good working relationship withSupporting People, meeting at leastquarterly, maintaining contact throughemail and telephone, and working togethertowards continuous improvement ofservice. Wytham Hall staff membersattend Supporting People Providers’forums which facilitate information sharingbetween providers within Westminster.Wytham Hall services have been accreditedand Supporting People contracts have beenrenewed.

20

CASH FLOW STATEMENT YEAR ENDED 31st

MARCH 2006

2006 2005

£ £ £ £

Net Cash (outflow)/inflow from

operating activities 33,053 (68,195)

Returns on investments and

servicing of finance

Interest received

Interest paid

6,726

----

_____

7,262

----

_____

Net cash inflow from returns on

investments and servicing of

finance

6,726 7,262

Investing activities

Payments to acquire tangible

fixed assets

(2,813)

_____

(11,158)

_____

Net cash inflow/(outflow) from

investing activities (2,813)

_____

(11,158)

_____

Net cash (outflow) /inflow before

financing 36,966 (72,091)

Financing

Donations received 5,553

______

9,010

______

Net cash inflow from financing 5,553

______

9,010

______

Increase/(Decrease) in cash and

cash equivalents 42,519

--------------

(63,081)

------------

21

INCOME AND EXPENDITURE ACCOUNT YEAR ENDED 31st

MARCH 2006

2006 2005

£ £ £ £

Income 301,155 259,043

Direct and administrative expenses 305,460

________

(358,736)

________

Operating (loss)/surplus (4,305) (99,693)

Interest receivable

Interest payable

6,726

______

6,726

_____

7,262

______

7,262

_____

(Deficit)/surplus of income over

expenditure for the year

2,421 (92,431)

Donations 5,553 9,010

Capital donations

Transferred to reserves

----

_____

5,553

_____

----

_____

9,010

_____

Surplus/(Deficit) for the financial

year 7,974

--------------

(83,421)

------------------

Full accounts are available on request

22

n PUBLICATIONS ON HOMELESSNESSGreat Chapel Street Medical CentreEl Kabir D J.British Medical Journal, 1982; 284:480-1.

Tuberculosis among the central London singlehomelessRamsden S S, Baur S, El Kabir D J. Journal of the Royal College of Physicians ofLondon, 1988; 22:16-17.

Medical care of the homelessRamsden S S.Royal College of General Practitioners Members’Reference Book, 1989; 362-4.

A mobile surgery for single homeless people inLondon Ramsden S S, Nyiri P, Bridgewater J, El Kabir D J. British Medical Journal, 1989; 298:372-4.

St. Peter’s and the HomelessEl Kabir D J.St. Peter’s College Record, 1990.

Mentally disordered homeless offenders - diversionfrom custodyJoseph P L A, Potter M. Health Trends, 1990; 22:51-5.

A psychiatric clinic for the single homeless in aprimary care setting in Inner LondonJoseph P L A, Bridgewater J, Ramsden S S, ElKabir D J.Psychiatric Bulletin, 1990; 14:270-1.

Approaches to medical care of homeless people incentral LondonRamsden S S.In: Smith S J, Knill-Jones R and McGuckin A,Eds.’Housing for Health’, 1991. UK: Longman Group.

Electives at a sick bay for the homelessEl Kabir D J.Community Based Teaching, Sharing Ideas 1,King’s Fund Centre, 1992

Homelessness, Doctors, le Grand Siecle and St.Catharine’sEl Kabir D J.St. Catharine’s College Society Magazine, 1992.

Book Review ‘Homelessness: A nationalperspective’ Ed. Robertson M J., Joseph P.British Medical Journal, 1992; 305:658.

n VISITORS TO WYTHAM HALL APRIL 2005 - MARCH 2006

Jennifer Samuels, Supporting People Development Manager, Supporting People

Mick Walsh Supporting People

Greg Roberts, Supporting People and Homelessness Strategy Manager, Supporting People

Rebecca Campbell and Prince Dacosta, St Mary’s Hospital Discharge Team

Giles Tinsley and Mike McCall, St Mungo’s

Linda Konedu, CHAIN

Shirley Cupit and Louise Hodge, UCL

Robin Lane, Lambeth Primary Care Trust

Bill Welsh, Cater Care

Yvonne Robinson, CASH

23

24

Diversion revisitedJoseph P.Journal of Forensic Psychiatry, 1992; 3:219.

Non-custodial treatment: can psychopaths betreated in the community?Joseph P.Criminal Behaviour and Mental Health, 1992;2:192-200.

Diversion from Custody. I: Psychiatric Assessmentat the Magistrates’ CourtJoseph P, Potter M.British Joural of Psychiatry, 1993;162:325-330.

Diversion from Custody. II: Effect on Hospital andand Prison ResourcesJoseph P, Potter M.British Joural of Psychiatry, 1993;162:330-334.

Psychiatric assessment at the Magistrate’s CourtJoseph P.Report commissioned by the Home Office, 1992.London: Home Office and the Department ofHealth.British Journal of Psychiatry, 1994; 164: 722-4

Psychiatric court clinics in the United StatesJoseph P.Psychiatric Bulletin, 1992; 16:557-560.

The perception of emotion by schizophrenicpatientsJoseph P, Sturgeon D, Leff J.British Journal of Psychiatry, 1992; 161:603-609.

Psychiatric morbidity and substance abuse amongresidents of a cold weather shelterReed A, Ramsden S, Marshall J, Ball J, O’Brien J,Flynn A, Elton N, El Kabir D, Joseph P.British Medical Journal, 1992; 304:1028-9.

Quelques observations sur les sans-abrisEl Kabir D JParis, Les Temps Modernes, 1993: 567

A pragmatic approach to the health care of thesingle homeless: its implications in terms ofhuman resourcesEl Kabir D J, Ramsden S S.Dimensions of Community Mental Health Care, edWeller M, and Muijen M,London: W B Saunders: 1993

A psychiatric bail bed in a residential sick bay: aone year pilot studyJoseph P. and Ford J.The Journal of Forensic Psychiatry, 1995; 6:209-217

On creating a culture of care for the homelessEl Kabir DJournal of Interprofessional Care, 1996; 3: 267-272

Primary care of the single homelessHomelessness and Mental HealthEd. Bhugra, Cambridge University Press.1996Dr D El Kabir & Dr S Ramsden

nn MEMBERS’ OTHERPUBLICATIONS

Dr Valasek researches the embryological originand development of sphincter muscles responsiblefor continence. Other interests includedevelopment of blood and lymph vessels and thegeneral formation of body musculature. For moredetails visit www.pubmed.org (Valasek P)..

Copies of all papers and articles are available onrequest.

OPPORTUNITIES AT WYTHAM HALLFOR MEDICAL STUDENTS/JUNIOR DOCTORS

We would like to hear from medical students and junior doctors interested in spendingtime at Wytham Hall. We are an innovative project providing residential, social andmedical care to the homeless in London.

Priority is given to students who attend on a special study module from a University withwhich we have an established link.

Successful applicants will be given an opportunity to spend time with residents of therecovery unit and of our three move-on properties in order to gain an increasedunderstanding of the issues facing this vulnerable and complex group. They will also beexpected to monitor the progress of individual patients, assist with admissions and takehistories of new residents under the supervision of one of our resident doctors. Regularvisits to the Great Chapel Street Medical Centre, a walk-in surgery for the homeless, arealso part of the student programme.

On-site accommodation is available at a small cost and applicants are encouraged to beresident at Wytham Hall for the duration of their program in order to become fullyinvolved in our community.

SHORT PLACEMENTS

To obtain basic understanding of the work we do at Wytham Hall a minimum stay of twoweeks is advisable.

STUDENT ELECTIVES

Month-long residential placements enable the students and junior doctors to activelyparticipate in our work with the residents of both Wytham Hall and our SupportedHousing. Visiting other homeless agencies and undertaking an element of elective studyor related research are also recommended.

LONGER TERM PLACEMENTS

The students or junior doctors who demonstrate a sincere commitment to the care of thehomeless may be given an opportunity to play an active part of the community at WythamHall by spending an extended period of time with us whilst conducting their study,research or work.

Further details are available on our website at www.wythamhall.co.uk or on that of GreatChapel Street Surgery at http://business.virgin.net/gcs.medical/index.htm.

Please contact us if you are interested in any of the above opportunities.

Tel: 020 7289 1978e-mail: enquiries@wythamhall.co.uk

MAKING A REFERRAL

Contact: Project Workers to make an initial referralTel: 020-7289 1978

Care Provided:

Short term housing to allow assessment and stabilisation of care for the singlehomeless.

Supervision of treatment for those who need some supported care.

Alcohol detoxification when necessary.

Not for long term housing alone.

Not for drug detoxification or alcoholdetoxification alone.

To Harrow Road S u t h e r l a n d A v e n u e To Maida Vale/Edgware Road

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C l i f t o n G a r d e n sC l i f t o n V i l l a s

Warwick Avenue Underground Station

Flower Stall

To Little Venice

Church

Wytham Hall117 Sutherland Avenue

How to find us