Pictured: the HealthBus team

by Lucy Cribb, Healthwatch Dorset Engagement Officer – December 2020

Working with HealthBus in Bournemouth

In October and November 2020, I carried out some engagement work with people who are experiencing homelessness and people who use drug and/or alcohol services, to inform Dorset Clinical Commissioning Group’s review of community mental health services.

I contacted a local charity called HealthBus to see if I would be able to visit their service and chat to some of the people they support.  HealthBus, is a free medical drop-in clinic providing specialist GP services for people who are homeless and sleeping rough in Bournemouth and the surrounding areas.  For many HealthBus patients, this is their first contact with health care in many months, years and sometimes decades.  The people who visit can get blood tests, winter immunisation, smear tests, suture removals, wound dressings, and much more.  HealthBus also offer referrals to drug and/or alcohol support services, community mental health services, the crisis team and housing support.  The service they provide is essential to the homeless community.

With the permission of Kate, the HealthBus Operations Director, I decided to write a diary about my time with the HealthBus team and their patients.

First visit – Sleepless nights on the street and vital smear tests

Today is my first visit to the HealthBus and it is also my birthday, so I picked up cakes on the way, so that I could celebrate my birthday with the team and their patients.

When I arrived, I was greeted by Sam, a young guy who is volunteering for the HealthBus.  Kate, the Operations Director, put the kettle on and showed me around the premises.  We went through the Covid-19 restrictions and the social distancing measures that have been put in place to make the clinic safe.

We helped set up the treatment bays before Dr Maggie arrived.  The first of the patients usually arrive around 9am, so I went outside and sat under the gazebo which is used as a triage area.  Sam welcomes people, asks a few health questions, a few Covid-19 questions and then takes the patients temperature as they wait to be called in.

Too scared to close his eyes and sleep

The first of the arrivals was a young man named Alan.  He said hello and sat down in front of me.  He was wrapped in a thick hooded coat but looked frozen.  He was shivering and falling in and out of sleep.  He told me that he hadn’t been able to sleep last night as he was woken in the night by two men near to where he was sleeping who started kicking in the door of a nearby business.  Alan said it went on for ages and he felt too scared to close his eyes after that.  He is a regular visitor to the HealthBus and speaks very highly of the team.  He said the service has been a lifeline to him recently.

Smear tests and so much more

A young lady then arrived, who took me up on the offer of a cake.  We had a quick chat before she was called in by Fiona, the nurse.  Kate said it was the first smear test they had carried out at HealthBus.  I was impressed at how much they can do with very little in the way of medical facilities.

Second visit – I don’t know how people survive in this cold, especially when their sleeping bags are taken

Today I noticed a drop in temperature and quickly regretted wearing the clothes I had put on this morning.  After an hour of sitting outside my feet and hands had gone numb.  I really don’t know how the patients who visit the HealthBus survive in this cold.  I can’t imagine how cold they must feel in the night when sleeping on the streets.  After two hours outside I started shivering but I can’t really moan about the cold as I’m fortunate to be going back to a warm house later.

It’s good to chat and connect

The first person I spoke to this morning was Trevor.  He’s an older gentleman who can be a bit temperamental at times, understandably, but this morning he was quite buoyant.  We chatted about his move from London, family connections and his time in Bournemouth.  He was interested to hear where I’m from and where my family live in London.  It was nice to chat with him and when he left, he asked if I’d be back again next week.

Trying to keep warm by sleeping in a car park

Another gentleman arrived shortly afterwards; he had a dog with him called Buster.  He was freezing cold and told me that he had spent the night with no bedding because his sleeping bag had been taken.  During the night he moved himself to an underground car park to try and keep warm.  I found it very worrying that his sleeping bag had been taken away.

He told me about his difficulties trying to access emergency accommodation in the hotels.  He said that because he doesn’t have any family connections in Bournemouth, the Council won’t put him in a hotel, they keep offering him his train fare back instead.  He said that he was starting to worry as the nights are getting a lot colder.  I couldn’t help but think that even if the Council did send him back, how is that helping the situation?  It’s just moving a problem on?

Third visit – It’s terrifying how quickly people can become homeless and desperate

As I walked towards the gazebo this morning, I noticed a rough sleeper under the doorway.  Kate went out straight away to check he was okay, and then Dr Maggie invited him in for a check-up.  He sat under the gazebo with me and joined a conversation I was having with a gentleman who had recently moved to Bournemouth from Richmond.

From local councillor to rough sleeper, hiding a sleeping bag so it can’t be taken

A year ago, the gentleman from Richmond was working as a local councillor, as well as holding down a good job.  His role as local councillor came to an end, just as his hours were reduced at his job.  In the end he was made redundant, could no longer pay the rent on his flat and found himself homeless.  He came to Bournemouth because he was promised work, but unfortunately that didn’t materialise, and he is now sleeping on the streets.

During our conversation he told me that he won’t sleep in the underground car parks because he’s scared of getting robbed by the people who take drugs there; he would rather sleep outside and get soaked in the rain.  He also told me he has to hide his sleeping bag during the day to stop it being taken.  The young man who was sleeping in the doorway interjected and said that he keeps having his sleeping bag taken away too.  I can’t help but feel that removing vulnerable people’s sleeping bags because they are seen as causing an obstruction in shop doorways or car parks, doesn’t help this situation.

The gentleman from Richmond then said something that will stay with me for a long time.  He has a mobile phone, uses his friend’s login to watch Sky Go, and sleeps in an area where he can connect to free Wi-Fi.  The previous night he had watched Gogglebox on his phone, wrapped in his sleeping bag, and for 45 minutes he was able to imagine that he was sitting in a living room watching TV with a roof over his head.  This bought a lump to my throat and I was close to tears.

“I don’t want to be stealing food but I’m starving.”

Alan arrived – the young guy who I met on my first visit here – he said he’d had a rough week.  He had to get tested for Covid-19 on his previous visit because he was showing symptoms, and he then had to self-isolate until his test result came back – fortunately, he tested negative.  He told us that he had gone without food for a few days that week and got so desperate that he ran into a shop and tried to steal some food.  He didn’t get very far before the security guard took it from him.  He had apologised to the security guard and said: “I don’t want to be stealing food but I’m starving.”

I came away from that visit feeling terrified and upset.  Terrified that you can have a job, a home, a stable life one minute and then lose it all the next.  With Covid-19 and the furloughing scheme coming to an end I fear the homeless crisis is about to get a whole lot worse.  I was also really sad that Alan had felt he had to try to steal food as a last resort.

Fourth visit – Giving people food makes such a positive difference; but Covid-19 makes everything more complex

Giving people food can make such a difference

Since my last visit, Alan has been playing on my mind, so I managed to secure a weekly 40kg food delivery for HealthBus from FareShare.  FareShare is the UK’s largest charity fighting hunger and food waste.  They save good food from going to waste and redistribute it to frontline charities.  Today was the first day distributing the food.  I took lots of cakes, biscuits, cheese, crisps and soft drinks for people to help themselves.

I saw Steve in the car park next to the hall, he was packing up his bedding and told me that he’d been woken up early by the salt gritters.  This morning was the first frost, and I was already feeling cold.  I can’t begin to imagine sleeping out in this cold all night.  I gave Steve a large pack of cheddar cheese, some biscuits, cakes and a banana flavoured milk drink.  The look on his face was lovely, he was so happy.  The way he reacted you’d think all his Christmas’s had come at once!  Steve came to HealthBus with all his belongings, had a cup of coffee with us and went on his way.  I felt happy that I was able to do something nice for Steve and the others, and that basic food provisions had made such a difference to his day.

The challenge of Covid-19 isolation in temporary accommodation

After a couple of hours of chatting to people and giving out food, Karen arrived.  I immediately noticed how unwell she looked – she had a hacking cough, was aching all over and said that she didn’t have any sense of taste.  Sam went through the Covid-19 test and temperature check and she ticked all the boxes for possibly having the virus.

Karen had to be isolated straight away, so Kate rang the Council housing department to inform them that she would need access to an isolation room.  Karen was unable to isolate in the temporary emergency accommodation that she had been placed in due to the pandemic because she shared a bathroom.  After several phone calls we were told that Karen would be moved to another room within her emergency accommodation with access to her own bathroom, so she could isolate safely.

Covid-19 poses a real challenge to the Council and Public Health, as there are limited isolation flats available.  This also caused Karen a lot of anxiety as she was worried that she would be housed in an isolation flat without her belongings and that she might lose her accommodation.  It worked out well in the end, but this did highlight the complexities involved when dealing with a potential Covid-19 case.  Kate had to contact the swab team, liaise with multiple agencies, arrange food delivery, and Karen’s prescription.

Fifth visit – A busy day for a vital service

Vulnerable people in need of health care

So today was very busy, and we had to hit the ground running.  There were already four patients waiting to be seen before I arrived.  I was introduced to James, who I hadn’t met before.  He is a very vulnerable patient and desperately needed to see a doctor, he also needed a flu jab as he said he is considered high risk.  I chatted to him about motorbikes (which I know nothing about) and after 10 minutes he was called in to see the nurse.

I set up a table outside with some food that I had picked up from FareShare and invited everyone to help themselves.  The cocktail sausages and peppermint Aero’s were gratefully received!

Karen arrived late morning and I have to say she looked a bit better than she did the previous week.  She was pleased to have tested negative for Covid-19 but was still feeling very unwell.  I made her a cup of coffee and Fiona, the nurse, came out to check how she was feeling.  I heard Karen say that she was worried she had pneumonia, as she had this in the past.  Fiona made space for her inside and treated her very quickly.

Passionate about helping people who are homeless

There was a steady flow of patients this morning with a couple of new people who hadn’t visited HealthBus before.  As I was leaving, I overheard Karen say to one of the new patients, “I get the impression that they really care about you here.”  I can categorically confirm that they do.  This is such a vital service, and the team are so passionate about helping people who are homeless and people who are sleeping rough.  The work that they do is admirable!

My final visit – Common issues around accessing mental health care

So today was my last visit.  I’m sad to leave, but I’ve said that I’d love to go back every so often and give them a hand making the teas and coffees.

My heart sank as Karen told me she’d lost her accommodation

I started the day by setting up the food I picked up from FareShare.  Karen was the first to arrive.  I felt my heart sink as she told me she had lost her accommodation and was now back on the streets again.  She was still feeling rough, so Fiona got her inside quite quickly.

I walked up to the bridge were Steve sleeps and gave him a bag of food and drink and invited him down for a coffee.  The morning went quite quickly, one of the guys got a bit agitated at one point and Kate came out and did a great job calming him down.  She does have a great way with people, and you can tell that she really cares about the patients.

By mid-morning I was freezing, so I went inside to say my goodbyes and thanked them for having me there.  I’ve learnt so much over the last few weeks about how the system works or doesn’t work for people who are experiencing homelessness.

Improving access to mental health care in the community

I’ve heard how difficult it is for people to access health and social care services, simply because they don’t have a fixed address.  The delay in accessing the crisis team was also spoken about, and the frustrations that the support team feel when they have a patient who desperately and urgently needs their help, and they are told that it will be seven days before the crisis team will come out to see them.  People also spoke of their difficulty in accessing community mental health services because they are using drugs and/or alcohol.  And, I’ve seen first-hand the daily struggles that people have to get something as basic as food – I really can’t fathom how in this day and age and in the relatively rich country that we live in, we have people sleeping on the streets, and starving!

Thank you

I want to say thank you to the HealthBus for the great work that you do.  You provide an incredible service to people who desperately need your support.  Keep up the good work!

I also want to say thank you to all the HealthBus patients who talked to me about their personal stories.  Keep well.

Help and support

If you’ve read this diary and want to find out how you can help people who are experiencing homelessness this Christmas, then please contact these organisations:

You can read more about this engagement project in the Healthwatch Dorset report Mental health in community care.