TRUST – befriending, social & health service for people who are homeless was established in 1975.

Its’ philosophy is based on two central principles:

  • the recognition of every individual’s right to be treated as an autonomous and unique human being;
  • the need to restore the dignity of individuals whom society has labelled deviant and undesirable.

Homelessness is not just about lack of a roof, it is much more complex, as health is not merely the absence of disease and disability.

Daily we meet 30 – 40 men and women – all surviving in appalling conditions and many of those we have had contact with died in equally appalling conditions. The people we work with suffer from the same medical conditions as the rest of society but all exacerbated by their living conditions. The current climate of concentrating only on those likely to change and fit neatly means that the most needy can be forgotten about. This is also evident in research being carried out and dare I say it, even in the manner in which submissions are requested to fit into space allocated. It is precisely this tailoring of debate around Health / Social Issues that is leading to increasing gaps in knowledge of needs and planning, and frustration on the part of the service providers.

The work of TRUST was developed by a nurse following research carried out in tandem with clinics run in city hostels and people who sleep rough. The service is directed by a nurse with a board of Trustees, an experienced R.G.N. runs the centre daily and qualified nurses do voluntary work.

See our website:

Our views on the role of the nurse in the community are based on our day-to-day experience of dealing with people needing a nursing service and looking at the bureaucracy around nursing currently and diversity of nursing roles and indeed expectations from nurses.

It is becoming increasingly difficult for service providers and more importantly those needing nursing attention to not only access services but to know who is the appropriate person to contact. We all view the world from where we stand, and the area of work we are involved in is a world apart.

The Public Health Nurse is seen as the person to provide care, however, hostel visits are irregular, sometimes once off. The hospital liaison nurse, while participating at pre-discharge meetings makes arrangements for discharge to hostels while knowing nothing about the hostel facilities or much less even location.

  • Those not fitting into hostels get no nursing care apart from that provided by voluntary groups and occasionally Community Mental Health Nurses;
  • Discharge notes re those over 65 years and others can remain in Directors offices for weeks by which time the person may have moved on;
  • The distinction between P.H.N. vis a vis other nurses is creating an elitism not warranted, and indeed not helpful;
  • The amount of time taken up by experienced P.H.N.’s in administration is questionable and the widening gap between bureaucracy and hands-on work could ultimately prove to be disastrous for nursing rather than enhancing the nurses role and ultimately the service being provided for those needing care.
  • The gap between the various nursing categories – while it may be the intention to ensure specialist nurses provide specialist care as requested, at times only helps to off-load responsibility and allows salary differentials that are not helpful.
  • Any community service must clearly assess its’ needs in that community but assessment is fundamentally flawed if other service providers apart from nurses are excluded.

All the above does little for morale of nurses and as yet, we haven’t seen the real gaps in service provision because agency nurses and nurses from abroad are meeting some needs.

We somehow feel it is inappropriate to discuss pay. Clearly hands-on work is not valued, because we are unable to put a price on it. Success in our society is based on salary paid and not salary due. Job satisfaction, i.e. feeling someone has been helped and their life made easier by our intervention, cannot at this time be isolated from the above.

We can no longer see nursing as only a vocation to be exploited, however the value of the vocation must not be diminished. Nurses must ensure that the structures put in place will provide better services, and not just reinforce control through categorisation, but recognise the value of the provider and the persons needing the help – this requires vision, expertise and a willingness to break down barriers within our own profession.

Non-threatening environments are crucial to the success of this exercise.

Until the above is addressed, there is not much point in discussing a strategy in a vacuum because it is the recognition of, and value placed on the hands-on work and human contact together with academic skills that will ultimately help the provision of a service nurses can be proud of.

I write as a nurse proud of my profession but now not alone in wondering where we are all going.

Alice Leahy.