A campaign to encourage people experiencing homelessness to take part in the national cancer screening programmes has been launched by the North Central London Cancer Alliance (NCLCA). The campaign “Your Health First” will be depicted by artist Sam King on the pavement outside Mulberry Junction, a day centre for people affected by homelessness, in Tottenham on 12 September.
Booklets, posters and pocket-sized cards have been produced to give people experiencing homelessness more knowledge and understanding about bowel, breast, and cervical screening in three steps – get registered, get screened, get your results. These will be available at eight homeless support centres where key workers have had briefings or screening awareness sessions to help them support their clients in making decisions to take up their cancer screening invitations.
People experiencing homelessness have a significantly lower uptake of cancer screening than the general population. Just 37% of eligible homeless women attended breast screening in the previous three years, compared to 62% of women in permanent, stable accommodation.1
The North Central London Cancer Alliance, which coordinates cancer care improvements with partners in Barnet, Camden, Enfield, Haringey, and Islington, has been working with homelessness services, healthcare workers and people experiencing homelessness to understand the reasons for the low uptake.
Barriers identified include the lack of a permanent address to register with a GP, past traumatic experiences, stigma about their circumstances, rigidity in healthcare appointment times and language differences.
Chris, aged 63, who experienced homelessness linked to addiction issues, was a consultee in the campaign development and features on a poster. He said:
“I assumed I’d already destroyed my health and that if I went for tests, it would be bad news. If I had anything fatal, who cares? But eventually I plucked up the courage to complete my bowel screening, thinking: what have I got to lose? And actually, it was fine. The test came back negative. I’d say to anyone experiencing homelessness – maybe you think it’s a waste of time or you don’t care about yourself. But you might be amazed – the damage is probably not as much as you think. Think logically – you’re more likely to get the help you need if you’re engaging with your healthcare. Get it over with – it’s one less thing to worry about.”
The campaign is part of a wider project to tackle the low uptake rate among this group of people in North Central London. Cancer screening awareness sessions have been run for key workers to equip them with more information to help their clients. GPs and people experiencing homelessness are being reminded that GP registration is possible if an alternative mailing address can be provided – this could be the GP practice. Reasonable adjustments are being trialled to accommodate the specific needs of people experiencing homelessness. These include screening services receiving trauma-informed practice training, flexibility with appointment times and pre-test support. Booklets about cancer screening, especially for people experiencing homelessness, have been developed in partnership with Groundswell, a homelessness charity, and the four NHS Cancer Alliances in London. These are available in English and 15 other languages.
Ali Malik, Managing Director, NCLCA, said: “Improving survival rates, a focus on early detection and reducing health inequalities across the North Central London population are among our key strategic objectives. Therefore this campaign is an important element of our work. It has taken a lot of development work with many partners to understand the issues and to design ways of addressing them. Our hope is that our local work will lead to a London-wide adoption of the approach and that we will see better uptake of screening among these members of the population. Screening is crucial for early cancer detection.”
Monika Zerbin, Rough Sleeping Programme Lead, Haringey Council, said: “Early cancer screening is crucial for people experiencing homelessness, especially rough sleepers in Haringey, who often face late diagnoses that lead to tragic outcomes. By prioritising early detection, we can save lives and ensure that everyone, regardless of their circumstances, has a fighting chance against this devastating disease.”
Dr Jasmin Malik, GP and North Central London Health Inclusion Clinical Lead, said: ”Screening and early detection increases the likelihood that cancers can be treated successfully. However, many people experiencing homelessness wait for their health to deteriorate to the point of late and often end stage cancer diagnosis, or emergency admission before seeking help. We have a role in primary care to support the health of the local population regardless of their circumstances. This is an important project which we hope will make a real difference, providing people with the knowledge, confidence and reassurance to take up their screening invitations.”
1 The Unhealthy State of Homelessness 2022: Findings from the Homeless Health Audit, published by Homeless Link.
Campaign information is available at smallc.org.uk.
Further information for health and care professionals is available on this website.
Our partner organisations in North Central London