The doctor will see you now
Improving relationships between health professionals and homeless people is key to addressing the shocking health inequalities experienced by this vulnerable group
STRATEGY
Image: Istock
Dan Bleksley
Research Officer, Groundswell
Issue: 63 | December 2022
Last year, a review of the deaths of 12 people who had been homeless found that seven had died from ‘treatable or preventable causes’, despite having long-term conditions. The review concluded that all 12 deaths might have been avoided if healthcare services had been more accessible and more considerate of the impact of past trauma.
Groundswell’s recent #HealthNow literature review showed that these findings fit a larger pattern of health inequalities. Improving relationships between healthcare professionals and people experiencing homelessness could make a big difference. So how can this be done?
Understanding health inequality
#HealthNow is a national campaign working towards an inclusive health system where everyone has access to the healthcare they need, ultimately moving people out of homelessness. Over recent years we’ve explored the healthcare experiences of people experiencing homelessness.
People who understand homelessness through their own experience have been central to the project. Our research – conducted with Crisis and Shelter – has been peer-led; people who have themselves been homeless set research priorities, co-designed surveys and conducted interviews.
The research highlights the shocking prevalence of ill health. Challenges with physical and mental health were each reported by around two thirds of 235 participants. But getting care and support can be complex.
Unmet health needs
Being treated differently because of homelessness and addiction can mean that health needs go unmet. We see evidence of this across health services, from A&E units to dental practices. Despite clear NHS guidelines, many people without proof of address still struggle to register with GP practices.
Drug dependencies present a barrier to mental health needs being met. One participant told us: “They don’t realise that my substance misuse is because I’ve had trauma in my life. I’ve never had a doctor actually sit down and talk to me in a manner where I can look at him and respect him and feel safe with him.”
Relationships matter
Many of these problems occur because there isn’t enough time and space for empathetic, respectful relationships to develop. This means patients can feel ignored and disconnected from choices about their treatment.
GP appointments are short, often with a different doctor each time. Complex and distressing stories can go unheard or need to be repeated many times.
The consequences can be serious. Losing trust in one healthcare professional can mean losing trust in them all.
People experiencing homelessness sometimes avoid seeking help until health conditions deteriorate and require emergency care. This can lead to deaths from ‘treatable and preventable’ causes.
Proven solutions
There are solutions we know can work. ‘Inclusion health’ practices are set up specifically for excluded groups. Their increased contact time and specialist, trauma-informed approach have been found to foster better relationships over time and to reduce the impacts of stigma. This can promote engagement with other health services.
Our research found that regular interactions in pharmacies were also highly valued. During the COVID-19 pandemic, pharmacy staff were the only health professionals that some people saw regularly. Trusting, non-discriminatory relationships frequently emerged.
Great minds think alike
Reducing homelessness by providing stable, safe housing is an obvious and well-evidenced way to address health inequalities. But improving relationships between health professionals and people who are homeless might be another huge piece of the puzzle.
Groundswell peers contributed to the development of the new NICE guideline on Integrated health and social care for people experiencing homelessness (March 2022) and we strongly support its recommendations.
In particular, we support its firm support for co-design and co-delivery of services with people with lived experience. We will only achieve the best solutions to ending homelessness and health inequalities in true partnership with people who have experienced homelessness.
Groundswell is a charity that works with people experiencing homelessness, offering opportunities to contribute to society and create solutions to homelessness.
“We will only achieve the best solutions to ending homelessness and health inequalities in true partnership with people who have experienced homelessness.”
Further reading: Homeless Link recently published ‘The Unhealthy State of Homelessness 2022: Findings from the Homeless Health Needs Audit’
