29 March 2022
By Dan Bleksley
“We heard about solid, enduring relationships many times: the friendly local pharmacy staff who ‘don’t judge’. The GPs who were ‘always kind and took their time’.
The drug recovery workers whose own experience of addiction meant that they truly understood the value of listening.”
Between July and October 2021, we interviewed 75 people experiencing homelessness in Calderdale, Kirklees and Wakefield.
We wanted to understand people’s experiences of using health services and the barriers to accessing them. This would then be used to create a local‑level action plan for eradicating the barriers identified.
As with any research over the last two years, the COVID pandemic dramatically reduced the possibilities for what kind of project we could plan.
In those other areas, the only option had been to conduct nearly all our interviews by phone, so our plan in West Yorkshire was to do the same.
Participant recruitment proved tricky. Groundswell had never worked in West Yorkshire before and building connections with local organisations remotely took time.
Added to that, we expected digital exclusion to have made a big difference to the experiences that many of our participants had had with health services.
This was especially the case during the pandemic when mobile phones and internet access were becoming increasingly necessary for making and attending appointments.
So talking to people by phone seemed far from ideal. We also knew that it would mean missing out on speaking to many of those most affected by transitions to remote health services.
As restrictions lifted, we were granted access to a number of hostels and daycentres, and we planned two trips to the area. That made a big difference.
Despite some localised COVID scares and a few last-minute cancellations, interviews were much easier to arrange. In the end around two in three were conducted in person.
I fell in love with West Yorkshire
It felt like everyone I spoke to was genuinely interested in taking action to help eradicate local health inequalities.
Local stakeholders were passionate and engaged; the staff and managers who helped us recruit participants were friendly, knowledgeable and keen to help. I could have talked to some of the participants all day and was sometimes in danger of doing so.
We told participants that we expected to take up around half an hour of their time, but often this wasn’t nearly enough. That was partly because talking to them was so much fun, but sometimes it also felt like it was because our questions gave people an opportunity to express some of their thoughts for the first time.
Once participants started talking, they couldn’t stop. But getting started wasn’t always easy. One participant said to me, “why are you asking me about this stuff? Aren’t you lot supposed to know?”.
That stuck with me. Not just because it exposed how alien it felt to some people to be asked for opinions about their own medical treatment, but also because I realised that I was just another one of “you lot”: the establishment.
As with all our research, people with lived experience were key throughout the research design and action-planning stages. Nearly all #HealthNow research interviews have been done by staff and volunteers with personal experience of homelessness.
In West Yorkshire, they were all conducted by staff. Certainly, there were benefits to this. It meant, for instance, that our statistical data was perhaps a little more robust, enabling us to collect some persuasive evidence on things like the relationship between drug dependency and increased challenges with accessing mental health services.
But volunteer-led ‘peer’ research also has some significant advantages. One of those is a relationship between interviewer and interviewee that instantly feels more comfortable and equal.
I think that my awareness of this made me more open to thinking about power relations during interviews. It also affected how I interpreted some of the research data.
Power and trust
Power seemed central to everything, and still does.
When people experiencing homelessness arrive at a GP appointment, they’re often already on the back foot. They may be bracing themselves against the fear of being judged for their drug dependency, or unable to use a computer but aware that a stranger will be using one to look at their medical history.
It’s no surprise that trust is hard to come by. It was difficult to hear people say things like, “they look down their nose at me. They make me feel so little.”
My takeaway finding
For me, the most interesting finding from this research was the suggestion that these differences in power and status can be balanced by establishing solid, enduring relationships between practitioners and patients.
We heard about this happening many times: the friendly local pharmacy staff who “don’t judge”. The GPs who were “always kind and took their time”. The drug recovery workers whose own experience of addiction meant that they truly understood the value of listening.
Hopefully, both the positive and the negative stories in this report will help to influence change in West Yorkshire.
We know that the appetite is there to improve access to – and experiences of – health services for people who are homeless.
We also know, through continued conversation with local stakeholders, that many of the changes needed are already underway and that this research will provide some much-needed evidence to support their progress.
Sarah Roxby, Housing for Health Programme Lead, West Yorkshire Health and Social Care Partnership, said:
“The West Yorkshire Health and Care Partnership is delighted to have worked with Groundswell on this important research. The findings have given us a better insight into the complex and subtle barriers faced by people who are homeless or sleeping rough – as well as what we can do collectively to tackle those difficulties.
We will build on the recommendations to create local level action plans that will aim to eradicate the health inequalities being experienced and support people on their journeys out of homelessness.”
Findings from the West Yorkshire research will also feed into the ongoing #HealthNow campaign. At Groundswell, we know some of the issues highlighted in this research require national change too.
We are utilising the findings from all four #HealthNow areas to influence and ensure decision makers are listening to the direct experiences of people who are homeless, coproducing solutions, and being held to account for completing the actions required to ensure equal access to healthcare.