When Victoria Rowell got a job as lead nurse at a new health project for people sleeping rough she began to fulfil a pledge made to her teenage self. 

At 16 years old, after her parents moved abroad, she’d become one of the “hidden homeless”, living and sleeping at friends’ homes, the kind of accommodation known as “sofa surfing”. 

“I thought: right, as soon as I am able to, I'll make sure I help people who are in this situation,” she says.

Now, after more than a decade as a qualified nurse, she is finally fulfilling that pledge. In her new role, Ms Rowell will run a nursing team to help people sleeping rough with health problems in eight local authority areas from Oldham in Greater Manchester to Croydon, south London.

Each nurse will accompany their respective council’s outreach team, officers who have already been engaged to help people sleeping rough to move off the streets. And while it’s not uncommon for healthcare professionals to be part of such teams, Ms Rowell’s nurses are unique in one important respect. They are part of the Health Outreach Project, one of eight “Test and Learn” projects which are being co-ordinated by the Centre for Homelessness Impact, a What Works Centre, and funded with £15m from the Ministry of Housing, Communities and Local Government.

The street health care project is managed by Change, Grow, Live, a national health and social health care charity. Like several of the other projects, it will be subject to a randomised control trial, a scientific means of evaluating how well something works. These kinds of “gold-standard” trials are more common in medicine than public policy. But it’s hoped that the strength of the evidence they offer will be compelling enough to shape official and political choices on where money to help people sleeping rough is spent.

“It is very important to me to do something I am very passionate about,” says Ms Rowell. “I’m hopeful that the health outreach and wider Test and Learn projects will help us understand the evidence, inform policy, and change the way services are commissioned. That’s what I am looking for.”

Her nurses are due to start meeting people sleeping on the streets in late January after several weeks of induction. This initial training will cover the services they will provide, such as care for nasty and complex untreated wounds, sexual health advice, vaccinations, and support for addictions, including how to administer life-saving medicines for a suspected overdose. But it will also include training from people who have themselves experienced homelessness.

Care on the streets

Ms Rowell hopes these lived experienced sessions will “break down some of the barriers” and help her team understand and handle major and subtle differences between care in a clinic and care on the streets. 

“There’s sometimes a compromise to be made and an understanding to be had that rough sleeping and homelessness is beyond tough,” she says. “For example, some people use the word f*** for “very”. They might say, it’s f***ing sunny outside. There’s nothing bad meant by that. It’s how someone expresses themselves. But in a hospital environment, there’s zero tolerance for swearing,” Ms Rowell adds.

As well as building relationships with people sleeping rough and offering care, the outreach nurses will keep records to track how well their interventions work. Over the 18-month run of the project, they’ll note down: how their patients are feeling; how well their health needs are met, and where they are living and sleeping, among other things.

The same information about people sleeping on the streets will be recorded by officials in seven separate “control” areas where outreach teams operate without health professionals onboard. These two sets of data will be collected, collated, and compared by academics at Cardiff University, according to the rules of a randomised control trial.

While her nurses’ attention is fixed on the health needs of people sleeping rough, the main question the academics are interested in is: does a nurse in an outreach team increase the chances of people coming off the street? With the cost of this single project expected to top £1m, they will also assess whether it’s a good use of public money.

Ms Rowell experienced homelessness for two years before she got back on her feet, into nurse training, and up to this point in her life where she can finally fulfil that teenage pledge. She is personally in no doubt a nursing service will improve the lives of people sleeping rough. “Meeting people where they are at for whatever need they have at the time is effective,” she says. 

But her “dizzy heights” hope for all of the projects is that they will inform Government policy and choices about where public money is spent. “To be involved in something like this is a real privilege,” Ms Rowell says. “But whatever happens, it will help us further understand the difficulties people face and what we can change on the ground and that’s what’s important to me.”

Keith Cooper is a freelance journalist 

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