City-centre clinic supports inclusion health groups

A white van parked, with the words "Talk and be listened to" on the sideA pioneering clinic is providing health and wellbeing care for the most vulnerable people in central Bradford – one of the most deprived areas in the country.

Bevan Inclusive Health and Wellbeing is based at Bevan House nestled in the heart of the city-centre. Bevan hosts a number of Bradford District and Craven Health and Care Partnership funded projects to reduce healthcare inequalities; offering specific support for inclusion health groups who typically experience barriers to accessing health services. These groups include people experiencing homelessness or insecure housing, refugees and asylum seekers and vulnerable women.

The average healthy life expectancy within the practice’s catchment is 20 years lower than the rural towns and villages as little as ten miles away and the practice is committed to narrowing this stark inequality. With over 6000 registered patients, Bevan is leading the way in providing responsive healthcare for the most socially excluded residents and breaking down barriers to accessing primary health care.  The clinic also provides wellbeing and mental health support which empowers people to thrive and improve life outcomes as well as reduce inappropriate healthcare usage.

In 2019 the clinic became involved with the ‘reducing inequalities in communities’ (RIC) initiative and, thanks to additional healthcare inequalities funding from NHS England, has been able to further develop their work with underserved communities, at scale and pace.

A range of social factors can make it more difficult for Bevan patients to access mainstream care. Patients often have complex health needs which are driven by wider issues affecting their health, for example the environment they live in or their financial situation (sometimes called the wider determinants of health)

Emma Perry, Managing Director of Bevan, explains.

“The average age of death for men sleeping on the streets is 47; for women it’s 43. Those rough sleeping or in insecure housing face a tri morbidity of health issues. They are more likely to have multiple illnesses or conditions, are more likely to have experienced trauma and more likely to be impacted by poor mental health. They are also more like to misuse substances. Add into the mix complex lifestyles, which can make things like keeping appointments or storing medication hard, along with the common misconception that you need to have a fixed address to register with a GP, and it’s easy to understand how mainstream care can inadvertently exclude the populations we serve.

“Refugee and asylum-seeking populations face issues around language and cultural barriers as well as being put in a limbo like state of isolation whilst housed in temporary accommodation. We believe in providing health, hope and humanity for all and do that by tailoring primary health and wellbeing care in response to the specific needs of our populations.”

The Street Health Bus is a great example of how the clinic is tailoring their services to meet people’s needs. Effectively a clinic on wheels, the street health bus runs regular early morning multidisciplinary outreach sessions for people who are sleeping rough in the city as well as visits to hostels and other third sector services used by their patients. It is deployed to support refugee and asylum seekers homed in temporary hotel accommodation and can be a lifeline to those newly arrived in the country with little or no knowledge of English or how to access healthcare. The Central Locality Integrated Care Service (CLICS) is also available, delivering a holistic, person centred service for asylum seekers in the area. Together with a member of the CLICS team, asylum seekers are supported to identify what is important for their wellbeing and to develop a personalised care plan which encompasses both clinical need and the wider determinants of health.

Part of Bevan’s offer also includes a tailored outreach service for vulnerable women. This includes sexual health screening and contraception. This began life as a late-night city centre clinic but is now available via the street bus following feedback.

Bevan provides a range of support to equip people with the skills they need to improve their life outcomes. Trauma informed, one-to-one care is available from a team of professionals including GPs, nurses, social prescribers, wellbeing workers and clinical psychologists.

An occupational therapist with a special interest in homelessness has also been employed at Bevan House offering wellbeing support ranging from crisis support through to debt management and employability skills.

Groundswell’s model of Homeless Peer Advocacy has also been adapted by the clinic which is now delivering its own Peer Advocates programme, ‘Bevan Buddies’, which gives people with lived experience the opportunity to volunteer in the Wellbeing centre and co-produce Bevan services.  This not only helps to ensure the clinic’s services are culturally appropriate and accessible but also gives peer advocates the opportunity to gain skills, build friendships and have a sense of belonging.

Successes for the practice include exceeding their targets for engaging people experiencing homelessness and increasing engagement with the practice during daytime hours to address chronic health problems, mental health concerns and sexual health screening.

Dr Sohail Abbas, deputy clinical chair and strategic clinical director of population health and wellbeing in Bradford District and Craven Health and Care Partnership, said:

“There are significant inequalities across communities in Bradford and the gap in how long people live is stark. People in the most deprived areas of our district are living with more ill health and dying earlier.

Funding from NHS England enabled us to create our RIC programme which was developed in collaboration with health and care partners including the Bevan Health and Wellbeing.

“The programme builds on the principles of equity and proportionate universalism and follows a population health management framework, using data and knowledge about local communities to target those experiencing the greatest healthcare inequalities.

“The work happening at Bevan is a great example of what can be achieved when services are designed and delivered with patients at the heart.”

Dr Abbas talks more about the Reducing Inequalities in Communities (RIC) programme in this blog – NHS England » Reducing inequalities in communities: closing the health gap in central Bradford.

You can also find out more about the programme in this series of films from a visit to the clinic by Dr Bola Owolabi, Director, National Healthcare Inequalities Improvement Programme.

The Bradford Doulas (which means ‘wise women’) support vulnerable women in Bradford during and after their pregnancies. Dr Bola Owolabi, Director – Healthcare Inequalities Improvement met some of the Doulas and women and babies being helped by the scheme. The doulas, who are trained companions, come from the same communities as the pregnant mothers and understand their needs. The service is part of the Reducing Inequalities in Communities (RIC) programme which was created by the NHS Bradford District and Craven Clinical Commissioning Group (CCG) in collaboration with health and care partners such as the Bevan clinic.

Dr Bola Owolabi, Director – Healthcare Inequalities Improvement meets Hakki Ozal, who benefited from a NHS service supporting asylum seekers and who now works for the service. The service is part of the Reducing Inequalities in Communities (RIC) programme which was created by the NHS Bradford District and Craven Clinical Commissioning Group (CCG) in collaboration with health and care partners such as the Bevan clinic.