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HART Nurses + Triangle of Care

Updated: Nov 20, 2023

What is Triangle of Care?

There are several complex social and health inequalities often experienced by those who are homeless. Effectively tackling these requires a co-ordinated multi-agency response, to both prevent and tackle the harms associated with being and becoming homeless.

Social relationships are essential for a human thriving. Throughout one's life, the warmth and quality of one's social relationships have a profound effect on the development of one's sense of self-worth. They can improve our physical and psychological well-being and buffer against the effects of stress, increased depression, and anxiety. Homelessness can cause isolation through a lack of social and health support. The collaboration of health professionals is extremely important to encourage the inclusion of the homeless population.

In Rochdale Heywood and Middleton, we have a large cohort of people who come under the umbrella of homeless. Over the last four months, the HART nurses – (Homeless Alliance Response Team) have linked up with the Hepatitis C nurse team from North Manchester General Hospital, in a project called ‘Triangle of Care’.


“Coming together is the beginning, keeping together is progress, working together is success.”

Henry Ford.


We aim to visit all hostels within the borough and other places homeless people attend.

The HART nurse's role is to discuss general health and wellbeing, ensure people are registered with a GP, support with prescribed medication, gain consent to do a mini health check to include BP, pulse and weight and liaise with their GP. They also refer to other relevant services that may be required such as housing, Turning Point, and mental health. The HART nurses also chat, be a kind friendly face and arrange to see the person again if necessary.

The Heptatises C Team

The Hepatises C team provide support and comprehensive service, which includes an outreach assessment, anyone testing positive is fast-tracked on to treatment, counselling, education, medical assistance and support throughout the process.

Working within the Hepatitis C Hep C) Elimination Programme

What is Hepatitis C?

Hepatitis C is inflammation of the liver caused by the Hepatitis virus. It can be very serious if not treated leading to cirrhosis and cancer, there are often no symptoms of Hep C at first.

The cohort we are caring for can catch Hep C from contact with the blood of an infected person, such as sharing needles, sharing equipment used to prepare and inject drugs, razors, toothbrushes, tattoos, piercings, sharing self-harming tools, nail clippers and sexual practices that lead to exposure to blood.

The usual treatment is initially a blood test, called an HCV antibody test to find out if someone is infected with the Hep C virus. The ones with acute hepatitis C virus are generally contagious, so by doing this test it can be treated with antiviral medication -taken for several weeks. There is a 95% cure rate.

We have now completed testing in multiple hostels across the Rochdale borough, Petrus Hub and the Reach Out café (ROC), with a mixed level of attendance and several people have been identified requiring further treatment for Hep C.

We aim to eliminate Hep C for the clients we deal with across the borough, as no one needs to live with or die from Hepatitis C.

A new pilot initiative to check for liver cancer in high-risk communities has been rolled out as part of a major NHS drive to catch more cancers earlier and save lives. This has been set up by NHS England, this has led to the team doing the Liver Fibro scans contacting HART to see if they can link into the ‘Triangle of care’.

It is felt that the cohort of clients we are capturing could be in the ‘difficult to reach’ people cohort and therefore, they are offering Fibro scans to at-risk individuals that would not be scanned as part of a routine Hepatitis C virus ODN work, alongside the Hep C team and HART within the Rochdale borough.

By incorporating this team alongside the HART and Hep C team we aim to develop a strong rapport with these clients, which will encourage more people who otherwise would be reluctant, to come forward for potentially life-saving scans by performing a quick, non-invasive liver scan.

FibroScans are offered to adults from the following high-risk groups (cirrhosis and liver cancer):

• With, previously had or at risk of Hepatitis C/Hepatitis B

• More than 10 years of excess alcohol consumption (this has now been modified to five years due to the broad scope)

• With or suspected Alcohol-Related Liver Disease (ARLD)

• With or suspected Non-Alcoholic Fatty Liver Disease (NAFLD)

• Other (Including Diabetes and HIV)

Seven thousand fibro scans were carried out in the UK from June 2022 to January 2023 identifying over eight hundred and thirty people with cirrhosis or advanced fibrosis, a leading cause of liver cancer, with the majority of those identified referred on to further care.

Checks are being offered in the community to adults with high levels of alcohol consumption, a current diagnosis or history of past viral hepatitis, or non-alcoholic liver disease, as these factors increase the risk of developing liver cancer. NHS staff are visiting at-risk communities as part of the Hepatitis C Elimination Programme and the programme is being expanded to include a liver health check involving an on-the-spot fibrosis scan which detects liver damage.

Around six thousand one hundred people are diagnosed with liver cancer each year, but the number of cases has doubled over the past decade and is expected to continue to rise.

Currently, only one in three liver cancers are diagnosed at an early stage, but this programme will help catch more cancers earlier, giving patients a much better chance of surviving the illness. If caught early, patients have a 70-90% chance of survival for five years or more with treatment.

Those who are deemed high risk will be provided with information about their level of risk and, where appropriate, will be referred to their GP. If needed, people will be referred straight into a six-month liver surveillance care programme, where they will be partnered with a peer support worker who will continue to check in, as well as offer guidance and help informed by people who have experienced liver disease themselves. Liver cancer can be hard to detect at an early stage and so these checks, for people who have been identified as higher risk, are an essential part of the NHS’s action to find more people with cancer, and in groups that may otherwise find it hard to access lifesaving tests.

Collaboration within secondary and primary care is extremely important.

Working together can only provide vital care to the people in the HMR borough, ensuring an inclusive approach can only enhance their take in engaging with health professionals and taking some responsibility for their health and well-being.

Also knowing someone cares and is willing to support them can only help in their self-esteem, mental health and maybe a more positive outlook towards the future.


Order a free and confidential home Hepatitis C testing kit:

Hepatitis Team.

Call us on - 0161 922 3374.


Elaine stone. HART outreach nurse - 07741321844

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