Understanding homeless health inequality in Greater Manchester: New #HealthNow research paints a rich picture

17 August 2021

Today with Shelter, we launch our latest #HealthNow Peer Research report: Understanding homeless health inequality in Great Manchester.

Between November – December 2020, five volunteer researchers with lived experience of homelessness (Peer Researchers) carried out 51 interviews with people experiencing homelessness in Greater Manchester.

The aim: to identify the barriers to healthcare access at a local level for people experiencing homelessness, and develop action plans to eradicate them.

Here Greater Manchester’s #HealthNow Coordinator, Caroline Allison, talks through the research.

Caroline (right) with some of the Peer Researchers

The beginning…and COVID-19

We started this #HealthNow research project in January 2020 and by March 2020 we had recruited and trained volunteer Peer Researchers to conduct our first piece of research into homeless health inequalities in Greater Manchester (GM).

And then the pandemic hit. Our research was paused, and the project adapted to the situation we found ourselves in.

#HealthNow GM began to hold regular ‘Extraordinary COVID Alliance Meetings’ to share information and best practice between professionals working in the homelessness and health sectors. Our peers (volunteers with experience of homelessness recruited for the project) attended those meetings, set the agenda, and took any issues raised to strategic partners.

They also attended meetings with the Directors for Public Health locally and nationally as the testing and vaccine rollout were being planned.

Our volunteers were incredible – they had signed up for a two-month research project, yet stuck with us as we adapted to the pandemic. In Autumn we undertook a second recruitment for more volunteers with lived experience to join the team and an additional 5 volunteers got involved.

Their enthusiasm for the project was amazing and I’d like to say a massive thank you to all our volunteers for their passion and patience.

Debbie was one of our amazing volunteers:

“Hi, my name is Debbie, and I am a volunteer for #HealthNow, volunteering for Shelter in Greater Manchester. I am 50 years old and for much of my adult life I have been homeless, this includes being street homeless, living in hostels, emergency accommodation, and sofa surfing.

Even now I am classed as being homeless, as I live in the second stage of a rehab and have a “contract” rather than a “tenancy agreement”.

I was told about #HealthNow in the summer of 2019, by Dr. Wan-Ley Yeung, the GP for Salford homeless doctors’ service, but as I was about to go into rehab I could not apply to volunteer.

When I moved to the second stage of the rehab, I was told they were recruiting volunteers again so I applied and am happy to say that I was accepted.

When I started with #HealthNow, I thought that it was simply about helping people who are homeless with their health needs, I knew nothing about the research.

As I have never done any sort of research before, I was rather nervous about it. I have to admit that the process of designing the questions for the research confused me completely and I did not contribute much to the process. When it came to conducting the actual research, however, I sort of came into my element.”

 

The research got underway

In the September 2020 peers continued to work on the research. They adapted the research tool, a questionnaire with structured and semi-structured questions, to include experiences around accessing healthcare during lockdown, and were trained by Groundswell to conduct research remotely.

In November and December 2020, we finally undertook our research. Debbie explains how this was done:

“Due to COVID restrictions, the research was done over the phone, which in some ways I found easier than doing it face-to-face would have been – I didn’t have to look at anybody!

Before calling anybody, I ran through the survey myself several times, playing about with it and seeing what happened when you gave different answers to the questions, and found that this gave me a good insight into how it worked.

The first interview I did was with another of our volunteers, which helped me to settle into the process easier than diving in with somebody I did not know would have been.

After three or four interviews I even found that I could skip ahead a few questions as the people I was interviewing were answering questions before I had asked them.

In some ways this increased my confidence and I relaxed even more. This made the interviews feel more natural and speeded the process up, as we were not repeating ourselves.”

 

The findings

The findings are consistent with the #HealthNow research undertaken in Birmingham and Newcastle alongside our project. The issues that were highlighted by people experiencing homelessness included:

  • issues accessing dentists
  • digital exclusion brought by healthcare access going online
  • long waiting lists for mental health support.

Pharmacies were highly rated in GM, due to:

  • their long opening hours
  • lack of ‘receptionists’
  • consistency of staff allowing for relationships to be built
  • and importantly that pharmacies did not shut their doors during lockdown.

Mental health was identified by participants as their biggest health priority.

Our researchers worked with Groundswell to produce the report found here. They  have since shared their findings with partners across GM and are keen to spread their work further.

If you would like to join our local #HealthNow Alliance or find out more, including having one of our researchers to attend your team meetings and talk about their work, get in touch: [email protected].

 

Next steps

Going forwards the peers will be inviting strategic partners from across GM to a meeting to work on a GM action plan with the aim to address some of the issues presented in the report.

Mental health was identified as the most important health priority for those we heard from across all three #HealthNow areas. However, mental health services were also consistently the lowest rated service in relation to access and quality of care.

Consequently, the #HealthNow year two research will focus on people’s experiences of accessing mental health services across the country. Peer researchers will again be involved in the design, delivery and analysis of this research.

And here’s what Debbie’s been up to:

“Since this research, I have participated in more research projects with #HealthNow and I really enjoyed them. Strangely, I enjoyed doing the face-to-face rapid research about COVID testing and vaccination the most.

I found that actually being able to see people – the thing that I had dreaded – made it easier to talk to people and judge their next responses.

I am honoured to say that Dr Jo Brown, Research Manager, gave me the title of ‘Queen of Research’, and I am looking forward to the next round – which we start planning for on Monday!”

 

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