The evaluation of a two-year work programme by the North Central London Cancer Alliance to address the low uptake of cancer screening by people experiencing homelessness concludes that the reasonable adjustments piloted are relevant and replicable across London and beyond. Report authors, Homeless Link, recommended that “Cancer Alliances and cancer screening commissioning teams are encouraged to engage with primary care providers, screening centres, and homelessness services to explore how the successful adjustments in North Central London could be adapted and implemented in their areas.”
The report highlights how the project benefited from using the insights of people with lived experience of homelessness, raised awareness and upskilled healthcare and homelessness support professionals, and produced long lasting information materials. However, the evaluation also stressed that the project is about making systemic changes which will take time to result in tangible, measurable outcomes.
The North Central London Cancer Alliance began exploring how to address this particular health inequality two years ago. Through on the ground and desk research and workshops with a range of stakeholders, including those with lived experience of homelessness, the key issues were identified, and an action plan drawn up comprising four themes:
- Develop tailored resources
- Train and share knowledge across cancer screening and health inclusion teams
- Work closely with primary care and cancer screening providers
- Health promotion
Full details are contained in the evaluation report.
Making reasonable adjustments so that people experiencing homelessness could complete their tests and undergo follow up treatment if necessary was a key element developed in collaboration with primary care and screening providers. Understanding the barriers for this group of people was crucial for making appropriate adjustments.
Awareness raising sessions for homelessness support workers equipped them with more confidence and knowledge to speak to their clients and encourage them to participate in screening.
A communications campaign targeted at people experiencing homelessness who use support centres helped to spread awareness of the importance of cancer screening and steps needed for them to take up a screening invitation.
“This has been an important piece of work. Addressing cancer health inequalities is at the top of our agenda,” says Ali Malik, Managing Director, North Central London Cancer Alliance. “This project shows how much we can do to make improvements by really listening to people with lived experience and by collaborating with health and care professionals to develop a good implementation plan. We have expanded our network of partners significantly through this work and have identified how we can apply this learning to do more with other groups within our communities who face health inequalities.”
The report highlighted how the work has been positive for those who work with people experiencing homelessness, by deepening their understanding about cancer and cancer screening and by empowering them to pass on this information to their clients and their colleagues.
“This work with the North Central London Cancer Alliance has removed multiple barriers our residents face when accessing health services,” says Eloise Moller, Sport and Health Service Manager at Single Homeless Project. “It has created safe spaces to allow for continued health conversations, ongoing work around cancer screening, and vital education and training for those who support people experiencing homelessness.”
Work is already underway to scale up and share the project methods with the other three Cancer Alliances in London during 2025.
More information about improving screening uptake for people experiencing homelessness