I am a junior doctor in my first year of specialist training to become a GP and throughout my medical career I have cared for people who are homeless in different hospital settings including A&E departments, medical, and surgical wards. These experiences have often left me feeling frustrated and disappointed that services do not work better for this group of people who are often ignored and forgotten by our community, health care organisations and health care policies.
Find and Treat has taken a different approach and has responded to the needs of people accessing its services, for example, by providing additional health services such as blood-borne virus care and immunisations to its TB screening. This continual evolution meant that in December 2020 I walked into what felt like a health care Tardis – a regular white van from the outside, but inside a one-stop roaming health care clinic. The service now has two bespoke vans that have between them a chest x-ray machine, liver scanner, blood-test and vaccination kits, as well as everything you need to make a cup of tea on these cold winter days.
Find and Treat’s most recent adaptations have been in response to the Covid-19 pandemic. People who sleep rough have significantly worse health outcomes than the general population, where many suffer with ‘tri-morbidities’– a combination of physical and mental health conditions along with substance misuse issues. Pathway and the Faculty for Inclusion Health estimate that more than a third of this group are extremely clinically vulnerable to Covid-19 and meet the government’s requirement to ‘shield’. The clinical vulnerability of people in this group is compounded by their lack of means to follow the government guidance to ‘Stay at home’ and other public health measures, such as hand hygiene and social distancing.
Find and Treat responded to the pandemic by bringing health care to this group. The team visits hotels and hostels in London that are providing temporary accommodation during the pandemic for people who are sleeping rough or experiencing homelessness and not able to self-isolate. During these visits I helped the team to provide mass testing to asymptomatic residents, rapidly clinically assess anyone with Covid-19 symptoms and complete health risk assessments to access the most appropriate temporary accommodation and support. This approach aims for early detection, treatment and containment to prevent outbreaks by offering health care that’s easy to access by removing barriers such as online registration, postal address requirements and travel costs. We currently lack validated data on the effectiveness of this approach, but early data has shown that, during the first wave of the pandemic, London reported fewer cases and outbreaks in homeless hostels compared to cities in United States and Canada. Estimates suggest that the UK may have prevented more than 20,000 infections and over 250 deaths from Covid-19.
Find and Treat offers a service that removes the physical and practical barriers to accessing health care, but staff also provide health care with empathy, understanding and authenticity. Staff work alongside paid peer advocates – people who have experienced homelessness themselves, some of whom have also lived through the same conditions that Find and Treat test for. Peer advocates invite potential clients to access the service and explain the reasons to be screened, they describe the treatment and provide ongoing holistic support. It is this multidisciplinary teamwork that enables Find and Treat to respond to, offer services to and engage with the population it is caring for.
It was inspiring to join Find and Treat’s diverse and welcoming team in their jam-packed mobile clinic to experience how health care services can be delivered effectively for people who experience homelessness. By working with people who have lived experience of homelessness, Find and Treat has successfully developed an innovative service that responds and overcomes the traditional barriers that people in this group face in order to improve their health care outcomes.
This blog was amended on 10 February 2021 to correct the wording around estimates of Covid-19 deaths that have been prevented. These estimates refer to the UK, not the Find and Treat service.