John Gibbons on ‘why are there so many non-attenders?’

Most of us receive a letter or even a text reminder about our appointments. What if you haven’t got a phone or an address? Some of the patients we come across don’t even open their mail.

First published April 2019 by John Gibbons, Hep C Case Worker, Groundswell in partnership with Find & Treat.

Let’s say you’ve opened your mail or received a text. You then must attend an early morning appointment. Have you got enough time to collect your methadone first? Did you remember to set an alarm on the phone you don’t have? Can you afford the bus to the hospital? Do you have mobility issues? Do you have enough energy, substances or alcohol in your system to manage the walk? If you don’t make it, do you have enough credit on your phone (if you haven’t lost it again), to re-book the appointment? Has anyone got the patience to be bounced around a hospital switchboard?

Let’s say you received a letter and a text about your appointment and managed to get to the hospital or clinic. Most of the patients we see are full of anxiety; Homeless Link found that 45% of homeless people had been diagnosed with a mental health issue, with 80% reporting some form of mental health problem. Do we expect someone full of anxiety to navigate their way around the maze of busy hospital corridors only to be received by a 40-minute wait in a crowded reception?

Completion of Hepatitis C treatment requires multiple appointments and our current method of notifying patients will not work. The easy patients have been treated. We can’t just expect our patients to turn up, we need peer support.

Dedicated peer case workers who have experienced homelessness or substance misuse can remove these barriers to care. We can case manage through treatment and work closely with the nurses and clinical teams to ensure that everyone knows where they need to be and when they need to be there. We will remind you, we will come pick you up, pay for your bus or your taxi fares and get you a bite to eat. We help to remove the anxiety caused by the busy maze of a hospital or clinic and help keep your eyes on the prize while in the waiting room. Even with all this planning there can still be DNA’s (the term used in the NHS for someone who did not attend their appointment and did not cancel it in advance). Peers will persevere and we can use our experience to develop a better plan for engagement next time.

Being affected by anxiety, addictions and homelessness myself, I know that when you invite peers to help, you’re not just helping to improve attendance – you’re helping the peers to change their lives too.  Some of us peers have none or very little education or qualifications and a career seems a million miles away. Being trusted with the responsibility for others is massive. It helps us to develop key skills to move on with our lives. Helping others helps us to help ourselves.

Find out more about Groundswell’s partnership with Find & Treat to support people with Hepatitis C.

The Hepatitis C HHPA project is supported through an educational grant by Gilead UK&I fellowship programme.