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Posted on 4 Sep 2025

A respiratory clinic in Nottingham set up to prevent premature deaths of rough sleepers and reduce pressure on hospital admissions is in the running for a national award. Nottinghamshire Healthcare is very proud to be a part of this work.

Held at the Nottingham Recovery Network's Wellbeing Hub in the city centre, the Respiratory Rough Sleepers Virtual Ward is transforming the way a vulnerable group of people experiencing severe and multiple disadvantages can receive vital treatment.

The life expectancy of a rough sleeper in the UK is 44, according to the ONS , with one of the most common causes of death being respiratory disease. Many slip through the net of traditional health services due to difficulties accessing appointments and stigma around hospitals. 

Launched in August 2024 as the first of its kind in the UK, the pioneering new initiative has saved lives as well as reducing hospital admissions, emergency department attendances and ambulance call outs. 

Led by Professor of Respiratory Medicine Dominick Shaw, the partnership with Nottingham University Hospitals NHS Trust (NUH), City Care, Nottinghamshire Healthcare and Framework has been named as a finalist in the prestigious Health Service Journal (HSJ) Patient Safety Awards.

Now in their 15th year, the awards have long been a beacon of excellence, celebrating the individuals and teams dedicated to improving patient safety across health and care. The Respiratory Rough Sleepers Virtual Ward is in the running for the Urgent and Emergency Care Safety Initiative of the Year, with winners announced on 15 September.

Sandeep Nagra, Clinical Nurse Specialist (RGN) in the Trust, was involved in the implementation and development of this fantastic clinic. He is also the service manager for the Rough Sleepers Drug and Alcohol Treatment team for the Nottingham Recovery Network, which provides drug and alcohol support for people living in Nottingham City. They do outstanding work in engaging, building relationships and outreach provision, to assist the most entrenched and hard to reach service users access the respiratory clinic.

His role includes managing and coordinating the clinic, including, overseeing the referral process, emergency and follow up appointments and directing assertive outreach provision.

He also acts as the onsite nurse when required, providing and receiving handovers of patients, facilitating access to X-rays and CT scans. He also liaises with the hospital team and housing specialists to facilitate safe discharges. 

Becky Sutton, Chief Operating Officer at Nottinghamshire Healthcare said:

We're really proud to be involved with this fantastic partnership work. Everyone works exceptionally hard together to ensure crucial care and support is provided to vulnerable members of our community. The project thoroughly deserves this national recognition and we wish everyone involved the best of luck for the ceremony. 

Other Trust colleagues are also involved through their work with the Nottingham Recovery Network, such as our team at The Health Shop. Sarah Paling, Harm Reduction worker for the Health Shop has facilitated significant levels of referrals to the clinic.

Professor Dominick Shaw said:

The value of the service is that it offers hospital-level clinical respiratory care to patients who can't access that for multiple reasons - because of deprivation, because of poverty, because of stigma. We offer that service in an area they're comfortable with, giving them treatments that prevent them getting admitted to hospital, and improving their chances of breathing properly.

Pneumonia, TB, COPD, asthma - all those diseases are treatable and preventable. This could be scaled up across the East Midlands, across the UK, in each city, if we got the same joined-up partnership that we get here with different hospital trusts, third-sector organisations, and experts in their field. 

In England, homeless people are 60 times more likely to visit the emergency department in a year than the general population ( RCEM , 2020). The clinic targets people experiencing rough sleeping or homelessness who have acute or chronic respiratory conditions, aiming to reduce health inequalities, prevent hospital admissions and avoid complications through access, early detection, and treatment for underlying or undiagnosed conditions. 

The partner agencies such as Framework play a critical role in facilitating engagement among rough sleepers, encouraging them to attend the clinic where patient data is kept on the live virtual ward. Rough sleepers who potentially need a respiratory review are identified by outreach teams the night before their appointment, and encouraged to attend with a £5 voucher to cover a meal or hot drink. 

Apollos Clifton-Brown, Framework's Director of Health and Social Care, said:

The drop-in respiratory clinic is changing and saving the lives of some of the most vulnerable people in Nottingham and demonstrates the impact of reconsidering how and where we deliver treatment services. The Wellbeing Hub on Hounds Gate is home to the Nottingham Recovery Network - a partnership delivering Nottingham's substance use treatment service. The partnership includes Framework, Nottinghamshire Healthcare, Double Impact, and Al-Hurraya, and integrates Voluntary sector responsiveness with NHS resources and lived experience community knowledge.

This rich mix of connections, expertise and experience, combined with the clinical skills of NUH, is what makes the respiratory clinic such a fantastic success.  We are delighted it has been shortlisted for one of the nationally-acclaimed HSJ Patient Safety Awards. It would be a worthy winner.

Treatment at the clinic has had a big impact on Ross Nixon's life. The 46-year-old has been sleeping rough for three years after leaving prison and struggling with his mental health. The clinic was able to diagnose him with severe asthma and show him how to use his inhaler correctly. It's been transformative.

It's amazing. I feel so much better. It's like I'm a different man. Before I could only walk so far and I would get out of breath. They talked to me and I went in and I'm glad I did because I feel so much better. 

I notice the difference when I'm sleeping. My breathing is much better. I used to be worried about sleeping in case my breathing would stop. I'm just lucky I've got workers around me that show me lots of love. They help me with everything, they're amazing, brother. 

Another service user said: "Since this clinic visit, my health has been better, a lot better. It's improved a lot since my younger days where I was struggling to breathe."

With the government's new 10-year healthcare plan arriving in 2025, the HSJ awards take on even greater significance, reflecting the critical work being done to address the complexities of delivering safe care amidst times of significant change and long-standing pressures. 

These awards continue to inspire progress, drive collaboration, and set the benchmark for best practice in patient safety, ensuring that the care of patients and their families remains at the forefront of healthcare system priorities.

To view the finalists and find out more about the HSJ Patient Safety Awards, go to https://awards.patientsafetycongress.co.uk/

 

You can watch a video below:

*Photo credit to Alex Wilkinson