January 2024: #HealthNow evaluation launch, blog by Dan Bleksley, Research Officer
It was one of those moments that can feel like an eternity: the silence following an invitation to take the microphone in a room of people. But this one lasted seconds.
It was a celebration event to mark the end of #HealthNow, a four-year National Lottery Community funded programme tackling homeless health inequalities. The room was filled with staff members from the three partner organisations – Groundswell, Crisis and Shelter – as well as various enthusiastic stakeholder and dozens of volunteers with lived experience of homelessness. It was the volunteers who were itching to get up and speak.
In interviews with volunteers for our newly published #HealthNow evaluation, confidence was a word that came up again and again: confidence to be themselves; confidence gained from feeling valued; developing the confidence to help others. Here was that confidence in action.
#HealthNow: a bold experiment of harnessing lived experience
It doesn’t feel like an exaggeration to say that #HealthNow was one of the boldest and most extensive experiments this country has ever seen in harnessing lived experience participation. Over four years, 635 people experiencing homelessness were supported to get the healthcare they needed through newly established Homeless Health Peer Advocacy (HHPA) services. Peer researchers interviewed over 300 people to better understand the barriers people faced to accessing healthcare when homeless in Birmingham, Manchester and Newcastle. Innovative alliances were set up locally and nationally to ensure lived experience was at the heart of influencing system change.
One thing the evaluation has made clear is that it’s impossible to make sense of what #HealthNow achieved without grasping that lived experience was at the heart of every activity. Participation was never an afterthought. Everything from naming the project to deciding research topics and setting agendas for meetings with NHS decision-makers began with our peer volunteers.
#HealthNow’s impact was twofold – embedding lived experience and reducing health inequalities
Conducting this evaluation without meaningful participation of people with experience of homelessness was unthinkable. Volunteers were a central part of the evaluation team, designing and delivering interviews alongside our staff researchers.
“I think all the volunteers who are involved, they make #HealthNow better. And #HealthNow makes us better.”
#HealthNow peer volunteer
Our findings told us that the trust placed in volunteers – and the way they were integrated into local staff teams at Crisis and Shelter– gave them a sense of purpose, meaning and belonging. This scaled up. That sense was even more profound for those who were part of the national #HealthNow community.
Volunteers found they could do things they’d never done before: they spoke at conferences; they taught; they shared not just personal stories about having been homeless, but informed, expert opinions with senior decision-makers. They learned to believe in themselves, and that self-belief inspired others, mobilised, and generated change.
Healthcare staff who received peer-led training learned to question and challenge their own assumptions about homelessness. The #HealthNow Peer Network’s contributions to the development of NICE Guideline 214 continues to ensure that NHS staff are better informed about providing healthcare to patients experiencing homeless.
Our findings suggested that #HealthNow’s use of Groundswell’s HHPA model in Birmingham, Manchester and Newcastle led to a more efficient use of NHS resources and improvements to clients’ access to healthcare, but that wasn’t the only difference for people experiencing homelessness. We heard that #HealthNow volunteers were a source of inspiration: living evidence that change was possible, that things could be different.
The systems that perpetuate health inequalities are broad and complex, and this evaluation could never hope to understand precisely how much difference all our interventions made. What we can say with confidence though is that #HealthNow showed to many, many people the importance of lived experience participation. Our evaluation showed that if you really take it seriously, so much more is possible.
Fully embedding lived experience of homelessness into local and national health and homelessness systems was an essential step in tackling health inequalities. The continuation of HHPA services beyond this grant, thanks to local funding in Birmingham, Manchester and Salford, is a positive step to keeping this going.
But, if #HealthNow is to be considered a long-term success, this needs to be sustained and it needs to be built upon. The battle to ensure that people experiencing homelessness are able to receive the healthcare they need is still far from won, but #HealthNow has provided perhaps the best evidence yet of how to win it.
To all staff and volunteers involved in delivering #HealthNow, our partners at Crisis and Shelter and the National Lottery Community Fund for funding the project.