Social enterprise Bevan Healthcare provides outreach heath support to rough sleepers from a mobile unit. Together, with its primary care centre and work with hospitals, it is providing vital help to vulnerable people.
Bevan Healthcare is a social enterprise providing primary care to homeless people, refugees and asylum seekers. Initially established with an Alternative Provide Medical Services contract in 2003, Bevan Healthcare spun out of the NHS in 2011 by becoming a community interest company.
Over the years Bevan has attracted funding from both the NHS and council to provide valuable services to these vulnerable groups from a primary care health centre.
However, working from one static location can only do so much to help rough sleepers. Bevan Business and Enterprise Development Manager Beth Kirby said: “We have had great success in providing primary care from tending wounds to providing screening and immunisations, but we realised we were not getting to everyone. Some on the streets were simply not coming in to the practice.”
In 2013, Bevan established an outreach service, which saw GPs and nurses go out on to the streets of the city to treat and engage with the hardest to reach homeless people. Within a few years the team started using a mobile health unit enabling the provision of a wider range of services on to the street.
The first vehicle was a converted camper van, but the social enterprise has now invested in a purpose-built vehicle, which is able to provide a range of medical interventions, including cervical screening, HIV testing and wound care.
Ms Kirby said: “It has made a huge difference to what we can do. Previously, we were struggling to find private areas in which to carry out consultations and assessments. The bus gives us the ability to do that and much more. We have a laptop on board so we can access health records and register them for the GP practice.”
Bevan also works within the local hospital, Bradford Royal Infirmary. The Bradford Bevan Pathway Team identifies homeless people who have been admitted on to hospital wards or who have attended A&E, carrying out a holistic assessment of each patient’s needs and a support plan is put in place for discharge. The plans often include addressing issues such as housing, mental health, substance misuse, alcohol problems and benefit problems.
The three-pronged approach also includes a 14-bed intermediate care unit known as BRICSS, which opened in 2013 in a partnership with Horton Housing Association. This is designed to be short-stay for homeless patients with on-going physical health needs, and referrals into BRICSS managed by the Pathway Team.
The new services have extended the impact Bevan has. The street medicine team operates five days a week, seeing around 60 patients a month. Many patients seen by the team are unregistered with a GP, but often go on to register at the primary care practice. A dedicated late evening clinic on Thursdays for street-based sex workers complements the outreach offering.
Across all its services, around 6,500 patients are registered. The effect on individuals interacting with the services can be huge. One patient who has been helped said: “I have been listened to and consulted on my own care for the first time in years instead of being patronised and dismissed.”
The impact of the services can also be seen in the 42 per cent reduction in A&E attendances and 49 per cent in hospital admissions over the past five years.
Meanwhile, an evaluation of the hospital discharge support and BRICSS service found it saved between £11,000 and £46,000 in hospital care. The average cost of a BRICSS stay was £5,600.
The services have also been praised by the Care Quality Commission, which has rated Bevan as outstanding. The then CQC GP Chief Inspector Professor Steve Field described it as “one of the best surgeries of its kind in the country”.
“The service goes above and beyond just meeting the medical needs of local people, providing a truly holistic one stop shop that has been replicated elsewhere in the UK and beyond due to its success,” he added.
Ms Kirby said: “You have to be prepared to monitor and evaluate. We have funded a number of projects ourselves like the mobile unit and provided the evidence that it works. That has enabled us to secure funding long-term.”
The second lesson she highlights is one that she says may seem obvious, but can make a huge difference. “Talk to people,” said Ms Kirby.
“Working with the soup kitchens we heard about a church group that provides food to rough sleepers. It was run from a car park. You would never know it was there, but people came from everywhere. We now go back there every week and have contact with a lot of people.”
How is the approach being sustained?
Bevan has now started providing services in nearby Leeds. It is the service provider for York Street Health Practice, another specialist primary care centre for vulnerable groups. The mobile health unit also visits locations across the city and Bevan intends to mirror the range of services provided within Bradford across Leeds.
Meanwhile, in Bradford Big Lottery funding has allowed Bevan to open a Wellbeing Centre adjacent to the practice in Bradford. This additional non-medical provision offers everything from cook-and-eat sessions and craft groups to health trainer sessions.
NHS Bradford District and Craven Clinical Commissioning Group Chief Officer Helen Hirst said: “Bevan is an inspiration to us all. In what are often the most challenging circumstances, it focuses on wellbeing and broader issues that impact on health, and time and time again has a positive impact.”
Business and Enterprise Development Manager