Peer advocacy in homeless health

Homeless Health Peer Advocacy, set up by Groundswell in 2010 supports people who are experiencing homelessness to access health care appointments. People who have been homeless have a greatly reduced life expectancy and face multiple barriers to accessing mainstream health services. In effect peer-advocacy supports people to navigate care pathways which aren’t adequately adapting to accommodate needs. It makes the system more responsive to the person.

By training people who have experienced homelessness to act as peer advocates, we have supported nearly 7,000 people to attend over 15,000 appointments in the last eight years and reduced Did Not Attend rates by 50% – 70%.

How this service is person-centred is best described through stories of it in action.

Advocacy in its purest form

I was fortunate to shadow one of our long-standing peer advocates, Dennis (recently awarded a well-deserved MBE!). We visited a hostel where someone had been discharged from hospital. Dennis was keen to check on the person’s welfare. The person was clearly vulnerable and still unwell. He was unable to manage his medication and he had significant unmet personal care needs which left him in a situation which left a lasting impression on me. With that level of need, I believe if he wasn’t homeless at point of admission, he would have been discharged with a domiciliary care package or perhaps to a care home. For me it highlighted the way the system can let down the most vulnerable and excluded. Dennis engaged social workers and health services, compelling them to act. This is advocacy in its purest form. Ensuring that people’s rights are upheld, and their needs are articulated.

Compassionate care

We visited another person to discuss an appointment the following day. The person was extremely anxious about his appointment. Dennis discussed with him the preparation needed for the appointment and talked through the consequences of not doing it. He spent considerable time comforting him and patiently listened to his concerns. He read through letters and put them into language that was understandable. He liaised with hostel staff asking for their support overnight. Dennis works closely with the Homeless Health Service to find ways to change and adapt the way care is delivered to ease concerns and increase likelihood of completing treatment.

Care built around the person

Whilst the first example shows how advocacy was needed to retrospectively correct system failure to personalise or deliver care with compassion, respect and dignity, the final example exemplifies person-centred care. This was care coordinated with compassion and tailored to the needs and circumstances of the individual, rather than expecting people to conform to standard service pathways. This was skilfully enabled by Dennis, who understands first-hand the challenges people experiencing homelessness face. He is on their side, unconditionally fighting their corner.

We have proven that person-centred care isn’t hard to deliver even when systems present barriers. Groundswell is committed to scaling up our work with people who have experience of homelessness, putting them in the lead of identifying solutions to overcome the barrier to health inequality for homeless people. These are the solutions that work and put the person firmly in the centre of the care journey.