Health inequality encompasses unequal access to health care, and with that comes unequal access to a healthy life. In the UK an estimated 4,667 people were counted as sleeping rough across England on a single night in autumn 2024. The official rough sleeping snapshot was up by 20% on the 3,898 people counted in 2023 and is 164% higher than 15 years ago.
Those living on the street face even more complicated threats to their health, both in terms of illness, and in terms of access to health care. Three quarters of homeless people quizzed in a 2014 Homeless Link survey reported a physical health problem. 80% of respondents reported some form of mental health issue, while 45% had been officially diagnosed with a condition. 39% said they take drugs or are recovering from a drug problem, while 27% have or are recovering from an alcohol problem. 35% had been to A&E and 26% had been admitted to hospital in the six months before they took part in the survey.
A key challenge is being unable to keep medication safe and dry. Medications which get wet or soiled are wasted. They cannot be used, putting the patient at risk; they leak into waste systems contributing to pharmacological pollution and they need replacing, causing difficulty to the patient, and bringing extra financial and carbon cost to the NHS.
A simple understanding of better resource use can confront such preventable inequalities head on. This quality improvement project considers waterproof medication (meds) bags for such patients, offering benefits which are social, environmental and economic (see disclaimers).
You might like to create SMART goals for your project eg over a 3 month period, how many street homeless patients can your practice or PCN offer reusable meds bags? How many dry powder inhalers and other medications are these patients prescribed which may now have been saved from becoming unusable? When reaudited after 3 months, what is the reduction in medications issued compared with before the bags were offered?
How to carry out this project
Secure a micro-grant
Work with local community organisations to secure micro grants to develop the project. A quick option might be the local umbrella organisation for community sector organisations. Your social prescriber or health coach may be able to help here. An alternative would be to contact your Public Health team in your local council who might have small pots of funding. A key person would be a member of the homeless person support service, whether within the NHS or the Council.
Decide who will help you
Decide who you would like to work with inside and out your practice, perhaps by asking at a practice or PCN meeting.
Decide stakeholders
Decide who other stakeholders might be (eg local college; local community hub; local mental health, girls, women or homelessness charity).
Co-design the project
Co-design your project with the stakeholders – this can be more straightforward and simpler that you think, as they will probably be very keen to work with primary care.
Metrics of success
Decide what your metric of success might be (how many distributed; other partnerships developed; positive feedback received etc).
Order and distribute bags
Once funding is secured, order the bags (see video clip in box below), decide the best way to distribute them.
Review the results, summarise learning, share with practice team + decide if any changes are needed to improve the process. Decide when to re-audit again to ensure the change has lasted e.g. 2-3 months and use theProject Monitoring form to keep track. Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.
Start small. Work with a relevant group or stakeholder - there are many people working with vulnerable people outside the practice. They will probably bite your hand off to work with a health professional!
How to scale this project up or down
Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members.
Use shared expertise at Primary Care Network or Cluster and locality meetings to ensure all practices can learn from each other in your area.
Collaboration is key. Make contact with local community organisations, hubs and initiatives who support patients and could collaborate to optimise support such as distributing insulated cups, reusable sanitary products (or information) or waterproof pouches to the most vulnerable community members.
Offer impact evidence to your ICB/ Health Authority Lead for Health Inequalities and/or Climate/Sustainability to see how well it could be factored into ongoing commissioning.
Case study
Cornwall worked to create a new conversation around reusable products and has links to those projects here:
Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost savings and other benefits. This project may help with CQC evidence submission (see disclaimers).
