An interview with Andy Lane on DORIS – the East Lancs clinical van
Andy is the clinical lead at Inspire East Lancashire. He has 17 years of experience in the substance misuse field. Last year, Andy and the nursing team began an innovative clinical van project.
Tell us about the clinical van project
We don’t call it a clinical van anymore, we call it DORIS. We went on Facebook and asked for name ideas and a volunteer came back with DORIS, so I went home one evening and came up with “Drug Outreach and Recovery Initiated Service”.
When did you first get the idea?
Another CGL project had a clinical van that was a needle exchange – they no longer needed it, so it came over to East Lancs. Our lead nurse Pauline looked at it and thought there must be something we can do with this, and considered whether it was practical to do health care assessments from the van.
I picked up on this and thought let’s take it a stage further, why not do medical assessments and reviews along with the healthcare, and arrange for parking in areas where clients would find it difficult to come to us due to distance, cost and mobility.
I got insured to drive the van straight away. Pauline phoned round the areas that we felt needed a service and got permission for us to park there, with a view to providing medical care in local car parks for free.
What services do you offer from DORIS?
We carry out full medical reviews with prescriptions generated for the next day, physical checks, Dry Blood Spot Testing for hepatitis B, C and HIV (thumb prick), take home naloxone kits and training, hepatitis B vaccinations, flu vaccinations and any other health care advice plus a full needle exchange service.
Why are you so passionate about the project?
For me, it’s social, it’s not clinical, there’s no waiting room – it’s all about the people we’re helping. They quite like the experience and it’s usually within about a mile from where they live. It’s extremely relaxed, I’m very laid back and my consultations are social, they’re not too clinical.
I think the social side is something we don’t really address enough. We can do the medical side, we can do all the prescribing, but behind the people we help – and they’re quite special really – they are often vulnerable and misunderstood.
In my opinion, our service users don’t choose to be in this situation, it happens and they can’t get out. When people are given the opportunity, in the right environment (like the van), just to be able to talk about themselves, it gives us a full picture of exactly what they’re doing and where they want to go.
It’s the ambience of the situation, it’s not sitting next to a desk - it’s sitting next to each other. We know all about the health care side, because they’re being tested when they’re with us, but at the same time we’re just talking.
It’s about treating people with dignity and appreciating where they’re coming from – helping to improve their self-esteem.
The job’s all about the clients – not always focusing on the medical side.
What impact is the service having?
We’ve been doing it six months now. The non-attendance rate for clinics in the drug team is around 25-30%. To date, with DORIS, we’ve given 77 appointments, 75 have turned up and 79 have been seen with 4 opportunistically. We’re quite proud of it.
It’s worked amazingly. It’s outdone our expectations and captured the imaginations of a lot of people.
What are the future plans for DORIS?
We want to extend its use. The plan now is for the hepatitis team to take the van out and do the same as I’m doing but for hepatitis C and alcohol related liver disease - screening, reviews and treatment for the positive clients.
We are also starting to take the van out to engage with street sex workers and look at women’s health in the evenings and see what we can provide for them, using the van for vaccinating ,BBV screening, advice and general wellbeing. I now have the volunteer coordinator for the local women’s centres involved.
We’ve got quite a few drivers, all working within health care, and they’ve already taken the van out to provide different services. I think it needs to be used every day of the week eventually.