Background Exeter has a larger homelessness problem proportionally than Birmingham or Manchester with a ratio of 0.65 per 1000 households (Office for National Statistics, 2017), with the amount of rough sleepers being 25th city in the country (Ministry of Housing, Communities and Local Government, 2019). 73% of the homeless community have a physical health problem, alongside a reduced mortality age in comparison to the national average. Hospiscare, with grant funding, focused resource on building relationships with St Petrocks, our local homelessness charity, and together developed a pathway of care for this population.

Aims To ensure the local population living within the homeless community were aware of the accessibility of support from their local hospice for their end-of-life care needs (Hospice UK. Care committed to me. 2018).

Methods In 2019 we collaborated with the local homelessness charity with the aim of developing a care pathway which was flexible and responsive to need. We established training, both formally and informally, to upskill staff to the needs of the population they serve. Finally, we raised awareness to ensure the legacy of this work continues.

Results Our nurses have provided ground-level outreach support to meet the individual needs of the homeless community. This has consisted of at least 24 outreach walks across the city, clinics, and frequent communication with St Petrock’s staff. Seven patients have been supported to date, with two dying in the hospice. Others have benefited from general health advice or signposting.

We have also collaboratively produced specialist resources including advance care planning cards for patients, and a video, with the aim of building on the community of practice we have developed.

Conclusions Those in need of end-of-life care will now have an awareness of their local hospice, getting the support they need to manage complex holistic symptoms. Building rapport in the community, through outreach and drop in clinics has been essential to this (Care Quality Commission. A second class ending: exploring the barriers and championing end of life care for people who are homeless. 2017). We now understand the complexities of the homeless and vulnerable housing community, and our processes are now more flexible to ensure they don’t create barriers to our care.