This life saving-clinic is helping homeless people breathe better – and reducing strain on the NHS

The cruel reality of homelessness is that even preventable illnesses can pose a major threat – and respiratory conditions would perhaps not be the first risk that comes to mind.

But illnesses like chronic obstructive pulmonary disease (COPD), asthma, lung cancer, pneumonia and tuberculosis are among the main reasons people experiencing homelessness are more likely to die in their forties. Life on the streets, as well as increased likelihood of substance misuse and smoking, can lead to a decline in lung function, and many of the aforementioned conditions.

But when University of Leicester professor of respiratory medicine Dominick Shaw looked to see if there were any dedicated respiratory clinics to help people experiencing homelessness, he drew a blank. With street homelessness on the rise, he decided to do something about it.

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Working with University of Nottingham’s Dr Andrew Fogarty, Nottingham University Hospitals and homelessness charity Framework, professor Shaw launched a drop-in respiratory clinic in August last year.

When he started examining the lungs of people experiencing homelessness, he learned just how bad homelessness and the lifestyle behaviours that surround it are for people’s health – and the impact it has on the health service.

“The degree of disease out there is shocking. The lung age of these people is in their seventies and eighties,” professor Shaw told Big Issue.

“There is a high proportion who have been in ITU (intensive therapy unit), a high proportion who have had emphysema, pneumonia.

“The healthcare utilisation for these people when they go to hospital is massive. This is not a bleeding-heart liberal ‘I need to do something’, it’s also: Can I make a difference in terms of admissions? Can I save money in the system by stopping them from getting admitted in the first place?”

The clinic runs once a month at the Nottingham Wellbeing Hub. Before each session, Framework frontline workers head out on to the city’s streets to meet potential clients and offer them a £5 food voucher as an incentive for attending the clinic.

Once they are there, they receive a full respiratory examination with an onsite pharmacist, nurse and two consultants on hand.

Patients receive observations including sputum culture, blood sampling, lung function testing, X-rays and CT scans. Typical treatments available in the clinic include inhalers, antibiotics, steroid treatments and nicotine replacement therapy.

“What I realised was that my ability to do good depends upon my ability to influence and change medical outcomes,” professor Shaw told Big Issue. “It shocked me when I found out that the average age of death for a rough sleeper in the UK is about 45. It’s just shocking. The average age of death [in the UK] is 85 or 86.”

The hub is part of the Nottingham Recovery Network which means rough sleepers can access other healthcare treatments for drug and alcohol addiction, mental health and even help with housing.

The respiratory clinic utilises electronic records so patient data is kept on a live virtual ward, meaning that healthcare providers across the primary, secondary and third sector can co-ordinate care.

That integrated healthcare approach led Sandeep Nagra, a clinical nurse specialist and Framework’s service manager for its Rough Sleepers Drug and Alcohol Treatment Team, to describe the intervention as “one of the best things I have ever seen”. 

Treatment at the clinic has had a big impact on Ross Nixon’s life. The 46-year-old has been sleeping rough for three years after leaving prison and struggling with his mental health. The clinic was able to diagnose him with severe asthma and show him how to use his inhaler correctly. It’s been transformative.

“It’s amazing. I feel so much better. It’s like I’m a different man. Before I could only walk so far and I would get out of breath. They talked to me and I went in and I’m glad I did because I feel so much better,” said Nixon. “I notice the difference when I’m sleeping. He said my breathing was much better. I was worried about sleeping in case my breathing would stop.

“It’s really good. I’m just lucky I’ve got workers around me that show me lots of love. They help me with everything, they’re amazing, brother.”

While the project is still in its early stages, the response has been “phenomenal”, professor Shaw said. 

He plans to demonstrate the clinic’s ability to save money on hospital admissions before looking to scale
up the service to other parts of the East Midlands.

“The feedback that we’ve got from both Framework and the service users has been phenomenal,” said professor Shaw. “It acts as a way to get them on to the right pathways not just for respiratory health but for social housing, for mental health, because it acts as a sort of focal point.”

More widely, Asthma + Lung UK have called on the government to prioritise respiratory health in the new 10-year health plan for the NHS.

Sarah Sleet, chief executive at Asthma + Lung UK, said: “This respiratory clinic is a brilliant example of how different agencies can work together, showing how a ground-up approach can have real impact for people experiencing homelessness, who are more vulnerable to lung conditions and have much worse outcomes than the general population. Sleeping rough leads to poor immune systems, smoking rates are higher for this group, and accessing basic health care can be incredibly difficult.”

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