The Test and Learn Outreach with Health Specialism project aims to improve the health outcomes of people experiencing homelessness by embedding specialist nurses within frontline outreach teams. We know that vulnerable individuals experiencing homelessness and rough sleeping often struggle to navigate traditional healthcare systems due to stigma, instability, and circumstances that mean they may benefit from high levels of support, so this project also aims to improve healthcare access for this group of people .

As the lead on this project I’ve had the privilege of meeting with Lauren Pollitt, a nurse with the outreach team in Oldham, whose proactive, person-centred approach exemplifies the project’s goals. With the full evaluation still pending, this interim reflection highlights early learning from the field, particularly how the presence of a nurse can transform engagement with health services, improve housing outcomes, and encourage system-wide thinking to achieve long lasting change. 

A nurses perspective

For Lauren, providing healthcare to people experiencing homelessness is more than a job. Lauren describes her current role as uniquely rewarding because it allows her to build genuine, long-term relationships with people who have often been let down by traditional systems.
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Lauren's nursing approach prioritises trust, flexibility, and persistence, a distinct shift from conventional clinic-based care. She finds deep personal satisfaction in supporting individuals at their own speed, commenting that “This doesn’t feel like work.” Instead of dictating care, Lauren empowers people to make their own decisions, thereby gradually restoring their trust in health services with each interaction. Lauren consistently reminded me throughout our conversation that “every contact counts”.

Barriers to care

Building trust and relationships was a consistent theme in my conversation with Lauren as she reflected on the barriers that exist preventing people experiencing homelessness from accessing the care they need. 

Lauren explained that prejudgment remains a major issue - be it from healthcare professionals, emergency services, or the general public - often leading individuals to avoid settings like A&E altogether. She reflected on speaking with one person who repeatedly discharged himself from hospital due to the discomfort and stigma he felt, a common story that speaks to a wider culture of exclusion.

Lack of continuity was also a gap that Lauren identified. With no fixed address, unreliable phone access, and differing routines, many individuals fall through the cracks after initial contact with services. Lauren sees her role as an opportunity to bridge this gap; walking the streets to find people, following up on appointments, and making sure no one is forgotten.
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Finally, the current format of rigid service models was also a barrier recognised by Lauren. Standard 9-5 appointments don’t fit the reality of life on the streets. Lauren advocates for more flexible, drop-in clinics and street-based interventions, even suggesting that if a blood test needs to happen at the side of the road, it should. Her approach is grounded in the belief that healthcare must meet people where they are, physically and emotionally, if it's to be truly effective.

Wider System Thinking

Lauren’s role as an embedded nurse doesn’t just improve individual health, it has ripple effects across the wider system. Her close collaboration with local outreach teams brings immediate health expertise to outreach efforts, allowing staff to respond more confidently to healthcare needs such as wound care or managing chronic conditions. Together, they identify issues early and offer joined-up support that might otherwise be missed.

Importantly, Lauren’s input can directly influence housing decisions. In one case, she worked with a GP to provide evidence of a client’s deteriorating mental and physical health, which led to their housing priority being increased. This kind of advocacy ensures that people with severe health needs aren’t overlooked in the allocation process if their health needs have changed since their original application. This is a clear example of how frontline nursing can shape better, fairer outcomes far beyond the clinic.

Looking Ahead

This case study only reflects the impact of a single nurse in one area of this Test and Learn project. There are another 7 local authority areas across England who have also embedded nurses in their outreach teams, providing healthcare to people rough sleeping in their local area.
The Centre for Homelessness Impact has partnered with Change Grow Live to deliver this project and Cardiff University is undertaking the evaluation with a full report due in 2026.
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