Pioneering project | News and events

Homeless people are to be helped get vital healthcare in a unique new project aimed at tackling cancers in the East of England.

The pioneering, two-year scheme will operate in Cambridge, Peterborough, Wisbech and King’s Lynn, with specially trained Health Navigators working from health centres and homelessness services.

Led by the East of England Cancer Alliance in a unique link up with Anglia Ruskin University, the initiative recognises that people who are homeless often face significant barriers to getting basic healthcare. 

The new scheme is based on an initial pilot project called Cancerless, involving public health and clinical experts from across Europe, led by Lee Smith, Professor of Public Health at Anglia Ruskin University. It was established to help identify ways of eliminating differences that homeless people experience when accessing healthcare.

Many people who are homeless experience poor health and die from treatable conditions because they cannot access the care they need. According to homelessness charity Shelter, the average age at death was 45 for men and 43 for women – this is more than 30 years lower than the average age at death of the general population. 

The new team will aim to overcome these barriers by working with people to identify their health needs, connect with appropriate services and stay engaged with ongoing care.

The programme will place a particular focus on raising awareness of symptoms which may be linked to cancer, especially the early detection of liver cancer, which claims the lives of more than 500 people every year in the East of England. 

Across the region, around 560 liver cancers are diagnosed in local hospitals each year, with 40 per cent of these diagnosed through NHS emergency settings such as A&E departments. This compares to an overall emergency diagnosis rate of 18 per cent for all cancers combined. 

Liver cancer rates have increased by more than two-fifths (42%) in the UK over the past decade, according to Cancer Research UK. 

Professor Peter Hoskin, Consultant Oncologist and Clinical Director at the East of England Cancer Alliance, said: “The fact that so many liver cancers are diagnosed in emergency departments shows that these are being diagnosed at a late stage, when they are harder to treat, and this leads to worse outcomes. 

“This new initiative, involving Health Navigators who are known and trusted by people facing homelessness in our region, is an important and effective way to address an urgent problem.”

The initiative comes as latest figures estimate that one in 160 people in England are now homeless.

What Health Navigators will do:

• Health conversations and screenings
  Health Navigators will meet people in locations that are convenient for them. They will discuss health concerns, perform basic health checks and work with people to identify their healthcare needs. Whether helping to book and attend appointments, supporting self-referrals or encouraging self-care, Health Navigators will help enable people to receive the care they need.
   
• Health advocacy
  Acting as advocates, Health Navigators will accompany people to appointments when needed, or with consent, help communicate essential health information in discussions with healthcare providers. This will ensure that no vital details are missed.
   
• Improving healthcare engagement
  Working closely with both community and hospital healthcare teams, Health Navigators will help identify people experiencing homelessness, or at risk of homelessness, and help them attend appointments - whether in person or online - and stay engaged with their treatment plans.
   
• Health promotion workshops
  In collaboration with healthcare professionals, Health Navigators will organise workshops aimed at promoting health awareness and well-being. These sessions will focus on raising awareness of key health issues, such as early cancer symptoms, empowering people to take control of their health and seek help when needed.
   

GP Dr Damita Abayaratne who is co-ordinating the work from the Cambridge Access Surgery said: “Our aim is to actively support people across this region to overcome barriers to accessing healthcare; empowering them to get the right help at an early stage, so that serious disease can be prevented, or diagnosed and treated.

"This is a direct way to address what we know is a significant health inequality across the country. We will be charting its progress and hope it may inform models of care in other areas." 

Following on from his role as UK lead in the European Cancerless project, Lee Smith, Professor of Public Health at Anglia Ruskin University, will evaluate the impact of the East of England’s new Health Navigators. 

Professor Smith said: “We have seen some incredibly promising results from the European pilot project, including an increase in homeless clients attending screening programmes.

“This new initiative is focusing on liver disease, and this is so important as the Cancerless project identified a high prevalence of behaviours that put people at risk of cancer and multiple other chronic conditions.

“Our pilot project, which directly addressed such behaviours, involved partnerships with The Purfleet Trust in King’s Lynn and Winter Comfort in Cambridge, and it is fantastic to see this being rolled out, led by this team of new Health Navigators.”

The project is part of a national NHS England liver surveillance programme.

Professor Peter Johnson, NHS clinical director for cancer said: “Homeless people who develop cancer face particular challenges in getting help, meaning the early symptoms may not be picked up and their cancer is much harder to treat by the time it is detected.  

“This unique pilot by East of England Cancer Alliance is tackling some of the problems by reaching out to this group to offer screening as part of a national NHS England liver surveillance programme.

“The NHS is determined to make sure everybody has a fair chance of the most effective cancer treatment, and it comes after a record year for the number of diagnostic tests and checks.”

 

Liversurveillance, as recommended by the National Institute for Health and Care, is significantly associated with improved early-stage detections, curative treatment rates, and prolonged survival. But there remains variation in the quality of delivery of these services with patients not routinely being invited for surveillance or supported to attend those appointments.

In partnership with the NHS Hepatitis C Elimination Programme, liver scans are being offered to under-served communities to identify people at risk of liver cancer and ensure they are enrolled in local surveillance programmes.