Improving patient safety – Greater Manchester

Improving Patient Safety and experience of healthcare for people experiencing homelessness

Groundswell and the NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) are conducting a study to evaluate changes in service provision and to understand experiences of using primary care by people with experience of homelessness, in Manchester during the COVID-19 pandemic. People experiencing homelessness commonly face high levels of complex health problems and lower life expectancy, and yet face many barriers to accessing healthcare. They also commonly face stigma and poor experiences when they do access services. This study is part of a two-year research collaboration that aims to understand how best to improve the quality and safety of healthcare for patients who are experiencing homelessness and develop ways to improve the healthcare experiences of patients who are homeless.

In year one of the study, we explored the perspectives and experiences of participants with experiences of homelessness regarding access to and use of health care. Now in the second year of the study and due to the current COVID-19 pandemic, the focus has shifted to understanding how primary care provision has changed, and the impact of those changes on access to healthcare and the quality and safety of care for people experiencing homelessness. The current study aims to evaluate the experience and impact of organisational and technology changes (such as facilitation of remote consultations) based on the perspectives and experiences of people experiencing homelessness, as well as health professionals and other key stakeholders.

The project is an academic and community partnership, bringing together people with experiences of homelessness and those that support them in health and social care settings. To explore the impact of Covid-19 on access to primary care, we are currently working with thee primary care case study sites including Urban Village Medical Centre, Salford Primary Care Together and Bolton Homeless and Vulnerable Adults Service. Data is being collected through qualitative interviews with people who are homeless and health and social care staff that are providing care. Clinical staff in the case study sites are also keeping an audio diary of their experiences of providing care for people experiencing homelessness in the context of the Covid-19 pandemic.

Across the case study sites there have been some significant shifts in how primary care is provided to patients who are homeless as a result of COVID-19. This is particularly the case where consultations have been moved to remote delivery rather than face-to-face with the risk of exacerbating health inequality due to the ‘digital divide’. The study is tracking how these adaptations in practice are implemented and how they influence the care for homeless patients.

The research team includes academics, researchers with experience of homelessness and clinicians working in the case study sites. The project has an action research focus where findings are shared back with delivery partners on an ongoing basis in order to shape service improvement and practice.

Research findings will be published in early 2021.

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In December 2020 the team working on this project wrote a blog asking:

“Is COVID-19 our chance to build a safer and more compassionate health and social care system for people experiencing homelessness?”. Read it here.