How can health and care services better support people who sleep rough?

This content relates to the following topics:

Part of Health and care services for people sleeping rough

The woman who spoke to us about what it was like sleeping rough looked so young and vulnerable.

She told us she slept in a tent, on waste ground, with an iron bar to hand. But she didn’t just look vulnerable, she was vulnerable. I knew her situation was likely to take a significant toll on her health. In 2018 the average age of death for people who died while experiencing homelessness was more than 30 years below that of the general population, with women on average dying at the age of 43 years old – 38 years earlier than women in the general population.

This young woman was one of a group of people experiencing homelessness who had been invited to speak to us by the team behind Street Health. Every quarter, Street Health sets up shop above the soup kitchen in a local church in Mansfield and offers a range of services.

On the night we turned up, you could get hot food and a haircut downstairs. On offer upstairs were advice on drugs and alcohol; treatment for wounds, eyes, teeth and feet; flu jabs; and support on sexual health, mental health, and nutrition. There were also ‘goodie bags’ that included food, socks, chocolate and deodorant – largely donated by staff at the Sherwood Forest Hospitals.

Established by a group of health care professionals from Sherwood Forest Hospitals, Street Health began as part of the trust’s nursing strategy. Lynn Smart, Head of Nursing and Allied Health Professionals, Diagnostics and Outpatients, explains how they wanted to transform the health and care of their community: ‘focusing on people who sleep rough seemed like the right thing to do... We weren’t commissioned to provide outreach services… but we knew there was a need.’

It’s early days – Street Health has been operating for less than 18 months – but it is clearly having an impact on the way health and care is delivered in the local area. I’ve picked out four comments made by the nurses and allied health professionals involved about why they think they’ve been successful.

‘We sat and chatted’ (in fact they do so much more)

At the suggestion of a nursing colleague who volunteered at the local soup kitchen, senior health professionals met with people who were experiencing homelessness. Armed with large pieces of paper and coloured pens, the team went and sat with the group and asked them what they needed, and what they thought would make a new service work. Lynn explains, ‘I had to throw my assumptions out of the window – I was quite naïve – I thought if we offer the services, then people would come and use them.’

This nursing team listened to why people weren’t using the health services on offer: practical issues such as having no phone to make appointments, no watch or no money for the bus, often combined with drug and alcohol use. And the stigma: this group had faced hostility and rejection from both general practice and hospital staff primary and secondary health care. Many had also experienced trauma in their lives.

As a result, Street Health now takes services to the places that people who sleep rough use, the places where they feel safer and welcomed.

‘We started with what they said was important’

People who had slept rough were asked what was important to them. Getting their wounds treated was high on the list. Imagine how hard it is to keep a wound clean and dry if you sleep rough. An infected wound can be excruciatingly painful. They can also smell. The tissue viability nurses described the shame and embarrassment that some people expressed about their foul-smelling wounds. They knew that people didn’t want to be near them.

Treating people’s wounds with care and understanding has provided a bedrock for building trust between health professionals and people who sleep rough. The drug and alcohol service offered their treatment rooms, which proved something of a breakthrough for that service. People who often missed appointments with the drug and alcohol team now started turning up for their appointments to get their wounds treated. And while they were in the building, they also got to know the drug and alcohol team.

‘We work out collectively what’s needed – not what we each bring’

Street Health is a shared endeavor across a local community. Led by a team of health care professionals, it has grown organically. Increasingly health, housing and care professionals ask if they can take part. Lynn explained: ‘We’d have failed if we’d tried it alone. There was already lots going on but now it’s not what each person or agency can offer, but how we can each contribute to what that patient needs.’

‘People who sleep rough are part of our community’

It’s not just direct care that Street Health delivers. It is also changing attitudes. When the project began, some hospital colleagues questioned whether a homeless health initiative was a good idea because it would only ‘encourage them’. During our research on rough sleeping, due out later this month, we also heard that colleagues could sometimes be anxious about providing too good a service in case it generated demand from people sleeping rough. Street Health has never shied away from advocating for people who sleep rough. Indeed, hospital staff have been remarkably generous in supporting the programme. In fact, the collection of food to be donated to people who sleep rough has revealed an unrecognised need for support among the hospital’s own staff – and an insight into how fragile the line is between being housed and homeless within all our communities.

Street Health provides one approach to improving health outcomes for people who sleep rough. It’s not, as our forthcoming report outlines, the only way. But it clearly illustrates the importance of building trusted relationships with people who sleep rough so that they feel able to tell you what it’s really like so you can deliver services that meet their needs.


Add your comment