Dominic Maddocks was on the verge of homelessness. He’s now in charge of a street outreach team getting vital health services out to people who are homeless. Find out how the social enterprise he works for, Bevan Healthcare CIC, is transforming primary care services, breaking down barriers of access.

The right to access healthcare is a fundamental human right and in the UK we’re lucky to be able to get the care we need, free at the point of use on the NHS. But what if you have no address and are sleeping rough, are a sex worker afraid of the stigma your work may bring, or have fled war and persecution and have no idea as to what rights you are entitled to? It is unlawful to deny access to healthcare to individuals but real barriers do exist for too many people when it comes to getting treatment and care.

Between 2011 and 2017, homeless rose by around 60%, with rough sleeping going up by 141% in the last decade. This happened at a time when support services have been cut and local authorities have struggled to provide support. Rough sleepers in particular find it difficult to get access to health care with a 2019 study from Birmingham University showing that “perceived stigma and discrimination” in health settings is pushing people into repeat cycles of homelessness. People have described being turned away from primary care providers for not having an address and there are cases where people are discharged from hospital back onto the streets.

As well as bureaucracy and prejudice, there are also the barriers of self-esteem and a feeling of not being welcome which keeps many people experiencing street homelessness from registering with a practice.  Inequalities of access are baked into society and it is putting people’s lives at risk.

One social enterprise has set up to break down these barriers and provide vital care to some of the most marginalised groups. Bevan Healthcare CIC is a social enterprise primary care provider working in Bradford, Leeds and Hull, dedicated to caring for people who are homeless, refugees, asylum seekers and other vulnerable groups. Bevan is on the face of it a GP practice but it is so much more than a regular primary care provider.

Being a social enterprise, it does things its own way and at the heart of the organisation is a desire to ensure that everyone who needs it can access the best quality care. Core to how Bevan operates is a commitment to meeting people in their own reality – if people have trouble accessing services, why not take the service to them?

Bevan runs street medicine teams visiting locations across its geographical footprint, providing the care you’d receive at a GP’s surgery remotely. However, given the vulnerabilities of the individuals Bevan works with, it is important to centre the needs of each patient and not immediately act in a prescriptive way – starting with the question  “what is it that you need from us today” rather than immediately addressing specific health issues. As Managing Director Gina Rowlands commented “For us, we might think we really need to listen to your chest and maybe get you some antibiotics or some pain relief, etc. But for them, it could be something completely different. They may need just to have something to eat. Somebody asked me “you don’t have a toothbrush do you? I’d like to brush my teeth, I haven’t brushed them for six months” And we have them with us, just giving them a toothbrush, toothpaste and a bottle of water and we start a conversation and then we’re off!”

Bevan also run a pathway service based at Bradford Royal Infirmary working in partnership with a local housing association. The service provides accommodation for people who are homeless as they are discharged from hospital – ensuring people aren’t back on the streets after a hospital stay. The pathway service, providing this critical continuation of care, resulted in a 49% drop in further hospital admissions between 2013 and 2018.

Putting service users at the heart of services is a statement used so much by policy makers and politicians that it’s almost become cliché, but this is exactly what Bevan does and the results are transformative to the point where people supported by Bevan have even moved on to work for the social enterprise.

Dominic Maddocks leads the Leeds street outreach team, who over the last few months have been busy supporting people who are rough sleeping into emergency accommodation during the pandemic. Dominic was a former paramedic but found himself on the verge of homelessness, following challenges in his life linked to addiction. Bevan supported Dominic through his recovery and when a vacancy became available to drive its street outreach vehicle (at the time a 28 year old campervan ) Dominic was ideally suited for the job – given his background driving ambulances. Three years later he’s regained his registration as a paramedic and is in charge of a team changing lives for the homeless in Leeds.

Dominic Maddocks - Leeds Street Outreach Team Bevan Healthcare, Social Enterprise UK Stories

It is hard to capture just how much Bevan Healthcare does.  It runs Bevan House Wellbeing Centre where people can get advice on issues from employment and benefits to legal support for people going through the asylum process. It’s a place to bring communities together running activities around arts and exercise, offering language classes and also running bespoke support for particular groups such as female asylum seekers – all of this done in partnership with other organisations in the local community. It even has a dedicated women staffed outreach team to support sex workers access the care they need.

Bevan Healthcare shows the incredible difference the freedom of being a social enterprise brings – being able to create a model of care that places the people at its heart, all delivered in a way that is non-judgemental, compassionate and innovative

It’s little surprise that when the Chief Inspector of GPs visited Bevan, giving it an Outstanding CQC rating he said that it was best practice he’d ever seen.

“Health hope and humanity were key components to my recovery, I am so grateful for the investment made in me and my life, it’s a privilege to now honour these principles in the care I provide vulnerable patients” – Dominic 

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