Bevan Healthcare CIC is social enterprise providing care services to people who are homeless, asylum seekers and refugees. It’s so much more than just a primary care practice – operating street outreach teams, running a well-being centre and working collaboratively with other organisations to support patients who are extremely vulnerable. In this interview, Gina Rowlands, Managing Director at Bevan spoke to our Content Manager, Shehan Perera, about how Bevan works and the challenges faced in accessing healthcare for the homeless and people seeking refuge.

Could you tell us about yourself and your background?

I’m Gina Rowlands, the Managing Director at Bevan Healthcare CIC. I have a nursing background – I’ve been a nurse for a long time and I still consider myself a nurse. So I lead Bevan Healthcare and we provide care services to the homeless, asylum seekers and refugees in Leeds Bradford and Hull with a unique model of health and wellbeing.

Could you tell us a bit more about how you work as a social enterprise because you do you so much, right?  From street outreach teams to services in hospitals

We formed as a social enterprise because we were previously what was known as a PMS practice within the NHS, and we had the opportunity to form the social enterprise as part of the procurement process. We chose that model, rather than a partnership model because we believed it was the right way to develop the service and to deliver services to our particular type of patients. It’s a values-based organisation with a strong culture. And also it’s an organisation that is very forward-thinking innovative, and flexible. The social enterprise model allows us to do that. It’s actually been 10 years on the 26th of August this year that we had the initial meeting, to go through the best program to form a social enterprise, which is incredible.

Working as a social enterprise has allowed us to just be so creative and offer in primary care the type of service that we knew that our patients required, and from what they told us was required. So we’ve been able to cut through the bureaucracy, and be a lot more innovative and respond to their needs. You know, your doctors and my doctors, I don’t think they’ll give out food. I don’t think they’ll give out clothing, socks. I don’t even think that during the pandemic they’ll give you a mobile phone so that you’re connected wherever you are when you’re in isolation. But working the way we do has allowed us to do that.

Could you tell us a little bit more about that journey and how you started 10 years ago?  I think many people who are hopefully going to be reading this interview probably wouldn’t be aware that you could have a social enterprise offering primary care services to begin with.

How did you start with the premise of wanting to support people who are homeless and asylum seekers, and then build the practice around this? Is it about meeting people in their reality, speaking to them, and then developing the service around what people tell you are their needs?

Well, originally there were 11 staff, clinicians and receptionists in the team with 1400 patients. Now we’re 10 years old, this August with around 74 staff, and we have across Leeds, Bradford and Hull, probably around 7,500  patients registered that are from backgrounds with multiple complex needs or challenging lives, whether they’re a refugee, asylum seeker or whether they’re homeless or have other degrees of vulnerability. The business grew with an initial contract of just around £350,000 to well over £3 million now. So it’s a successful business. And with everything that we’ve done, we have reinvested back into Bevan Healthcare. And the way that we do that is by good engagement with our staff. We have very good engagement with staff. There’s a lot of talking. A lot of ideas come from the staff and from our patients as well. Feedback, patient participation groups, experts by experience – in fact, they drive our service on. It comes from there – that’s really how we develop the health and wellbeing model.

The average age of our patients is 34 years old. The homeless don’t live long lives, unfortunately, and you don’t get many refugees, really over the age of 50 -55 because it’s such an arduous, torturous journey to get to this country. And we’ve all seen it on television. We see it now, don’t we trying to cross the channel, or see what’s happened in Syria. And so the average age is 34, which is really unusual in general practice. So we realised that once we sorted out those initial physical and mental health needs, they really needed support with getting their lives back on track either back into employment, or volunteering or English classes or being computer literate, a whole host of things that we do here. And the homework club for refugee children on a Thursday and Friday evening

So much more than just primary healthcare then!

Oh my god! Primary care is actually a tiny element of it because we have the outreach. We have the pathway teams in the hospital. We have the street outreach teams.  It is a multifunctional model of care for people, as I said, with huge challenges in their lives.

And the results of our model, because we’ve got high levels of engagement with our patients/ clients, is that we now have people working in Bevan Healthcare that are on the payroll salaried, who have lived experience. So they may have come to us homeless, being a patient registered here. Then they’ve come through being supported and they’ve volunteered, they’ve been in the wellbeing centre, and then through their own merit when vacancies have become available they’ve been helped and supported by the staff in the team to complete applications.

You mentioned people who you’ve supported through the years, you’ve now started working for Bevan, could you tell us a bit more about Dominic on the street outreach team and his story, which was in the local news

Dominic’s someone who was a former paramedic and very well qualified, had a very responsible job not only as a paramedic but in the coordination of services as well. He had some challenges in his life, mainly related to addiction and through that he lost his job, he lost his registration. He was on the verge of homelessness when he came to us. He was supported by various agencies within Bradford that we were part of. Dominic came to us and was supported through his recovery, his continued recovery.

We then had a position vacant for someone to drive our street health outreach vehicle that at that time was a 28-year-old caravan, that did the job. It was fantastic. We loved it. And we needed somebody just 10 hours a week to drive for us and we knew about Dominic obviously, we knew that he’d been a paramedic driving ambulances. He was doing really well. He needed a job, he really needed to get back into work. We offered him 10 hours with additional support around his needs at that time. And it has resulted in two, three years on now – he has regained his registration as a paramedic with our support. He’s now on a university course, postgraduate course, to expand these skills. And he leads the Leeds street health outreach as the street health practitioner. He’s amazing and he did that, not us.

So broadening it out a bit. One of the main groups you work with are people who are experiencing homelessness and we’ve seen this massive increase in homelessness in the last in the last 10 years or so, of all kinds, be it rough sleeping or people in temporary accommodation.  What are the main barriers do you find for people who are homeless when it comes to accessing health care? And how do you go about addressing those through things like the street outreach teams?

The street outreach teams crucial. On a local level, we always knew that as welcoming as Bevan House was, where we’re based in Bradford, and the organisation being as welcoming as we are and, as flexible as we are – we always knew there were people out there that just couldn’t actually get through the front door here, whatever reason what’s going on in their lives. That was our real drive to start the street health outreach team – street medicine out on the street as you’ve described it for meeting people in their own reality, starting with what is their needs, not ours. We may look at somebody even in the surgery that wanders through the door or on street outreach and think “oh, my goodness, your chest sounds horrendous, you may have a chest infection.” Their priority at that time is probably not that, so we always start our questions with “what is it that you need from us today?” 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 Healthcare Street Outreach van social enterprise uk piece

One of the main things for people who are homeless or are experiencing homelessness is their mental health so they may not have the energy or the capacity to walk through a door. They might not have the correct paperwork even though now you are not allowed to turn anybody away from general practice who’s seeking to see a doctor or a nurse or a health practitioner.

And I think other things about access is, often a lot of practices now you’ve got to have a telephone. If you don’t have a phone you can’t ring in to make an appointment or be triaged just or spoken to somebody. You know 17% of people in this country at the moment are in digital poverty, have no access whatsoever to a phone, a tablet, a computer. Well, if you think our lives run on digital stuff at the moment – you are immediately excluded. And I think just sometimes behaviours of primary care staff or secondary care staff that is a block to access to primary care as well. And as I’ve said people’s confidence – they’ve had a bad experience, why would you go back in? It’s that fear of being judged as well. “I don’t look, right, I don’t smell right. I’m not wearing the right clothes. I look dishevelled”

And the system, the way the system is set up for patients to access practices is a barrier, that is a barrier there is no doubt about it. So whether you’re homeless, elderly, have mental health problems, learning disabilities, it’s all about maybe not having the right things online, if you’ve got a computer, maybe it’s just information that you don’t understand numeracy, literacy, language – that’s a big thing. And for our asylum seekers understanding the concept sometimes of Western healthcare and medicine, culturally understanding how the NHS works.

Moving on to your work with refugees and asylum seekers. How do you engage with those groups? I think the one thing anyone who has worked to support these groups realises is just how bureaucratic and complex the whole immigration system is in general but the asylum system in particular. I can only imagine what it’s like if you’re actually having to go through system. What is the deal with access to services for refugees and asylum seekers? How do you make sure that people can access the services that you use if you’re seeking asylum?

We can’t do any of this work, whatever we do, whichever particular group we’re engaging with, we can’t do it on our own. Collaboration and partnership working is key and collaboration is part of our values as well. Whether that’s working with statutory, voluntary, faith groups, you know, right across the board, other social enterprises.  Because we have this health and wellbeing model, particularly in Bradford, we have a wellbeing centre, so we often have other organisations come in like Bradford Action for Refugees. We’ve got a great relationship with the local law centre where there are solicitors that do pro bono work around asylum papers. We’ve got a really great bank of volunteers through McKenzie friends, that’s a church organization, who actually support asylum seekers with getting their paperwork together and helping them go to court and, and present their cases, so this work is multifunctional with a whole host of people and medical aspects. Sometimes it’s just writing the supporting letters to help people through the asylum process. But the asylum process is incredibly complex, as you said, and it’s inhumane, it’s inhumane. People left hanging for a decision for a long time, and then they become destitute if they’ve had a refusal. They may be stateless or they don’t have a passport to go back to a country –  it’s a horrible, horrible process to go through and extremely stressful for people that have been through a terrible time to start with.

So ours is a really multifunctional multidisciplinary approach to supporting asylum seekers and refugees. And then once you get your refugee status, it’s a thing then of being able to get housing. You leave your accommodation within 28 days.

There’s always a barrier, this benefit system that you need to get on as well. Our refugees, the majority are desperate to get into work and I still think it’s a disgrace that we have highly articulate qualified refugees that may have been, I can think of them being teachers, accountants, legal executives, doctors, pharmacists, civil engineers, we got a chap that was a civil engineer in Syria and we find them trying desperately to get a job and cleaning in Primark, what a waste of resource. Very articulate, great people ready to join the workforce.

People just don’t realise how the system is stacked against you

And often these people, you know that they are subject to modern-day slavery, and coercion, gangs and extortion of money. They don’t talk about that (the media).  Do they talk about what’s happening to them and the horrendous experiences that they’ve had, probably being smuggled into this country or sent over to be picked up by somebody that’s a gangmaster, you know, elsewhere and exploited? It’s just so wrong.

We can’t really not talk about the pandemic and the effects that it’s had. Could you tell us a bit about how Bevan responded to COVID, how it’s changed how you work?

Oh, my goodness, obviously at the beginning, you know, everybody was a bit chaotic, wasn’t it? It was all just bang. We knew what was coming January, February, just reading the medical journals, from our good friends the epidemiologists and virologists that work around homelessness at UCL, Andrew Haywood in particular. There were academic papers out about what was about to happen and told it, you know, you really need to be prepared for this and it’s not gonna be a walk in the park.

Andrew Hayward, then at the beginning of March predicted at least 20,000 deaths. It’s horrendous that it’s well over that, you know, it’s more than doubled. So we needed to respond and we needed to respond fast. We’ve got a vulnerable population with a population that was living out on the streets. You know, you’re told to isolate, stay in but if you have nowhere to go, how do you do that? It was a massive effort working with the local authorities to get what they called then ‘everyone in’ – placed into emergency accommodation that turned out to be right across the country hotels that weren’t being used. So there was that aspect of the work.

Then there were things about that we needed to do – health needs assessments on everybody that went in. We also had the challenge that we had families that were then locked down. We’ve in Bradford alone, at the practice, 800 children, which is a lot of children in a vulnerable position that we’re no longer getting free school meals. It was as simple as that. Families already on the poverty line, you know, in deprivation and hungry, so children weren’t being fed. So along with other organisations, we worked with, we mobilized a huge amount.  I’ve actually spoken to the wellbeing staff and the social prescribers – they’ve made over 1000 calls alone just to check in with people to see how they are. We purchased across the organization about 500 phones, just small phones, that we put £10 credit on and gave them out to people that did not have a phone because it would be their only means of communication of ringing in for help.

We’ve given out lots of food parcels, activity packs for children, clothing, activities in the hotels for people that had been homeless as well, you know, to keep them occupied. We have OTs in the team –  we’re a multi-functioning team, so the OTS have been out. We have never stopped working, we never stopped working the practice, and we’ve continued to go out with the district health bus as a team, going to the hotel sites, where we knew our patients were. The street sex working women were a group that we were concerned about – some of them might still be out working because of their addiction or been at home working at home. So we’ve had a huge drive to keep those women safe as well.

The other thing that’s been really important, has been looking after the team, their health and well being. There’s been a lot of anxiety, staff have been out here working, engaging with patients. They were worried about their own safety despite PPE and the challenges of that. Something that we did that was really simple across every site that we worked at – we provided food every day for staff as there was nowhere initially for them to go out. But apart from anything else, we didn’t want them going out as they were working so hard. So initially, we had a chef working in the wellbeing centre that was out and he was putting on a fabulous lunch every day.

And when he went back to work now we have food permanently in the kitchen in the fridge. So staff can just go up and make themselves food out of the fridge-  soup. sandwiches, bagels, baked potato Wednesday, very popular!  There’s a lot of baking has gone on with staff. And so we’ve continued to feed the staff and we have worked very closely with Rob, who’s part of our team, a consultant clinical psychologist that has provided individual or group reflective practice and sessions for staff so that we have been able to maintain their wellbeing and their mental health as well. So there’s been a lot of care for the patients but there’s been equally a lot of care that we put in for the staff as well.

So finally a fun question, what’s been your proudest moment of the of your time at Bevin? That’s probably an impossible question to answer, but if you could...

No, it isn’t. It isn’t. I’ve had so many moments that have been, I think my proudest moments have been how engaged the staff are with the work and they have the same aspirations for the patients that we do, and they follow the culture and values that we have, those core principles and our principles and values, they believe in it. I think the proudest moment I’ve had is seen staff coming here that have been maybe homeless, had challenges in their lives with mental health, had challenges with some sort of disability, that have come to work for Bevan.  People who may have had really crappy childhoods themselves managed to do as well as they can at school and started here –  we’ve got members of the team that started here, doing a basic admin role and now a couple of them are on training associate programs and studying for a degree at the University with the support of the organisation as well. And to see them grow, to see people like Dominic come through, you know, they’re my proudest moments.