Home » What is PPI? » Involvement in practice » PPI Case studies » Working better together: Improving the podiatric care of homeless people in Belfast

Working better together: Improving the podiatric care of homeless people in Belfast

Service users from the homeless outreach service in two hostels, Rosemount House and Stella Maris, participated in the Belfast Health and Social Care Trust project. Focus groups of both residents and staff were set up and they provided a variety of experiences and information on how to develop podiatry services for people on the homeless spectrum. The impact of the project included:
1) a more efficient and effective delivery of outreach services;
2) a health promotion programme supporting self-care;
3) an information sheet for staff describing how to access the podiatry mainstream services in a timely and supported way.

At what level did the PPI take place?

Service development/delivery.

PPI helped the project to:

  • Improve efficiency of a service;
  • Improve quality;
  • Improve safety;
  • Inform commissioning;
  • Increase ownership.


Historically, health services often have difficulty engaging with socially-excluded people and vice versa. Often this group of people lead chaotic lives, maintaining poor relationships with primary care providers and facing the double disadvantage of both health inequality and inaccessibility to health services. They have poor expectations of services and limited opportunity to shape their care (DOH, 2010).

The importance of raising awareness of PPI in podiatry service development in BHSCT is well recognised. A number of workshops identified an opportunity to develop PPI in a project involving the podiatry Homeless Outreach Service. This project focussed on clinical risk factors associated with the development of a range of foot conditions in homeless adults. Podiatry managers, podiatrists and the Homeless Public Health Nursing Team collaborated to develop an environment where users of the homeless outreach service were given the opportunity to share their experiences and ideas for service improvement.

Aim of involvement

Give people who used the homeless outreach service a voice, and an opportunity to share their experiences and ideas for service improvement.

Method(s) of Involvement

Focus groups


Getting people to come to the groups, facilitating the groups and gaining trust. The two homeless hostels chosen for the project illustrated the wide spectrum of homelessness and variety of personal journeys.

Outcomes due to involvement

    • Stella Maris Group communication service users reported that they did not always know that the podiatrist was coming until the day of visit, resulting in some missing out on treatment. In urgent cases, an additional podiatry visit would have to be rescheduled.
    • Trust and gratitude.
    • Service users valued seeing the same podiatrist as they built up a relationship of trust and felt more comfortable presenting their feet for treatment. Some expressed how appreciative they were of the podiatry service provided.
    • Appointment attendance – despite being aware of the benefits of attending mainstream podiatry clinics, most service users did not attend their podiatry clinic appointments due to their chaotic lifestyle.
    • Rosemount House Group communication service users recognised the importance of continuing to improve communication between hostel staff, service users and the podiatry service. Hostel staff identified a need for information that would help them to support service users to access core podiatry services.
    • Residents requested the development of footcare packs to enable them to look after their own feet.
    • Residents requested that the Footcare Information Session be developed as part of their self-care plan.

Feedback/quotes from service users/carers involved

“It’s good to have this opportunity to say thank you.” – Stella Maris

“You have to realise that it’s a big thing for us to show our feet to a stranger.” – Rosemount


Feb 2016- May 2016

Further Information

For further information, contact:
Eileen Tiffney (Principal Podiatrist, Project Lead)
BHSCT, Podiatry Dept, Beech Hall HWC,
21 Andersonstown Rd,
BT11 9AF
Email: Eileen.Tiffney@belfasttrust.hscni.net
Tel: 028 9504 9459