Establishing an out of hours homeless service in Bristol

In Bristol, a group of people with lived experience of homelessness is working with Specsavers and Vision Care for Homeless People (VCHP) to establish an out-of-hours clinic for individuals experiencing homelessness.

Organised through social enterprise Expert Focus, the group has been advising Specsavers Merchant Street on how best to engage and support the city’s homeless population since June 2023. Since the initial meeting, the pilot has been rolled out to 44 Specsavers practices.

OT spoke to the practice’s optometrist director, Sarah Mcgowan, and supervisor, Karin Ferrandi, about the value and the challenges involved in the project’s first year.

How did you begin building a relationship with those experiencing homelessness in the area?

Sarah Mcgowan (SM):There was an open day for VCHP, and we were invited along because we’re very close to the Big Issue head office, and very close to the Compass Centre, where they have VCHP clinics. It was a really exciting and interesting opportunity to meet lots of different people. That’s where we first met Stan Burridge, who is in charge of Expert Focus, and members of the focus group.

As a city centre practice, we see homelessness every single morning and every single afternoon, when we come to and from work. Bristol city centre is particularly affected, so we wanted to do something to help, and it seemed be perfect timing and a perfect opportunity.

We were the first practice to join Specsavers with Expert Focus. The focus group came in for sight tests and dispensing if they needed glasses, a couple of groups at a time. We went through a normal customer journey with them, and then we had a feedback session one evening after work where we put on some food.

We had a really nice feedback session, discussing where the stumbling blocks would be: what we need to look at as a business, and where the danger of losing people and putting people off would be. How could we break down some barriers?

We showed them why we do certain things from a health point of view, and why we do the diagnostics. We showed them what we’re looking for and what we need to do, and tried to come up with some solutions to see how we could make it work.

I’ve never been through any of their challenges. I’ve been in optics a very long time, and you think, ‘atually, yes – being in a dark room might scare somebody.’ Being close to someone in a diagnostics area, for instance, could set off a panic attack. There were lots of different things that came to light that I just didn’t think of.

It was very educational for us to hear the group’s feedback on how they feel about coming into any sort of clinical procedure, let alone in an optics environment, and how we could accommodate for that and make every patient’s journey better.

Karin Ferrandi (KF):We had our first initial meeting, discussing how we could be more inclusive and how we could have people coming into the practice. It was an interesting meeting, because we realised what the barriers are. These are things that, if you’ve never experienced homelessness, you are not aware of.

It was an eye-opening moment, discussing the barriers. Of course, stigma is the biggest barrier. Even if you are given the possibility of a free sight test, it’s hard to just walk into a store. That could be a daunting experience. People might stare at you, you might feel out of place, and some people might even comment. That’s something that happens, especially when someone who is homeless is approaching a public service – that’s the experience they get.

A person experiencing homelessness might have a number of worries and preoccupations, and they might not be able to keep up very well with appointments. They might not have a phone. They might not want to know if there’s something wrong, because that means that they have to reach out for further help, for example, from a GP or the hospital. So, it adds an extra worry.

Also, the price – they are afraid they will be lured into some sort of marketing process, where we give something for free because we want something from them.

Experiencing homelessness is not a label. This is not who you are. Yes, at the moment you might feel disconnected. Interpreting cost could be confusing, and you might end up having to admit that you don’t have the money to pay. That is a vulnerable thing.

Big Issue works with our big Roma community in Bristol. There is a fear, in the Roma community, of healthcare services, due to their history. That they’ve been betrayed in the past does not give an impression of the clinical environment as a safe environment. Whoever facilitates a homeless service needs to be very conscious that they are not just issuing an eye test, but that they have a duty to rebuild that trust in the clinical environment.

Whoever facilitates a homeless service needs to be very conscious that they are not just like issuing an eye test, but that they have a duty to rebuild that trust in the clinical environment

What value has establishing a homeless clinic brought to the practice?

KF: We had to learn to adjust our ways quite a lot. Not just with customers experiencing homelessness, but vulnerable people in general: to be more inclusive, and to be more attentive to people with emotional needs. Offer extra compassion, offer that extra 10 minutes for a chat, because just asking that person how they feel or how it’s going can make a huge difference.

Be kind, be friendly, be attentive, and listen. I don’t want to make a division between people experiencing homelessness and customers. If we get NHS customers they get everything for free; we’re not asking for a penny. A person experiencing homelessness might be in a position where they feel vulnerable, but they are no different. Not identifying differences is something that we do daily, that is of huge value.

Everybody needs a safe space, and that safe space can be created through explaining what’s happening during a sight test, for example. Be clear about what each step of their journey is. If they feel they want to talk to you and they want to open up, don’t rush them. They might genuinely need that talk. This creates trust. Complete strangers can make a huge difference. This experience is reinforcing what I truly believe in: making something for the community and applying these values to the optical service. We can really make a difference to vulnerable people’s lives when we take that extra care.

SM: The whole store has taken that on. It has given us so many insights into how we treat everybody. It has opened our eyes to how we have worked before, and how we will work in the future.

It has given the team a lot of pride, in that we are now much more community-focused. Being a city centre practice, it has been very hard to work on a community project, because it’s quite a transient demographic. Having a focus on working with local communities and making a difference has been really empowering.

We’re actually living out the values of Specsavers – changing lives through better sight and hearing – rather than just saying them. From a business point of view, we are making a difference that is tangible.

From a business point of view, we are making a difference that is tangible

Did you come across any challenges that you have needed to address during the first year of the clinic?

SM: It has been very challenging. There have been lots of hurdles internally, in trying to get clinics booked and in getting them filled. Working with the focus group has helped with those questions: how can we get people to come into our environment? How can we make it safe? How can we make it advantageous to them to come in?

We’re still working on that. Looking at the out-of-hours teams page, you can see that clinics are quite successful on some days, and then on others, fewer people turn up. I do think it’s about getting the message across that we’re here, we’re safe, we’re open to you, we’re not going to charge you anything. But also, you do need to come in, because it’s a health thing and we want to help you.

KF: Our biggest challenge is trying to involve and engage clients to come in. The fact that they often live transient lives means it is challenging for them to reach out and for the clinic to set a stable routine.

For the future, the pathway we want to walk is to be more out there in terms of outreach. Outreach is very important. The more people who know about the service, the more people will come, and the more free clinics we will establish. Clinics that offer free services do work. But it takes time. It has to be there all the time, and clinic users need to hear via word of mouth. The more people we can see, the more people are going to spread the good news, and the more people are going to turn up.

We have to engage a lot at the moment. We need volunteers to be out there, spreading the message that we are here. Classic media platforms don’t really work – it needs to be more one-to-one engagement. We have to provide a compass point, which is a physical person, not a portal. It is not a form. We need to prove that we are human.

SM:We were explaining to Stan [founder of Expert Focus] about the NHS contribution, and how it works with Specsavers. It’s difficult enough for the team to understand every offer that we have, and how the NHS vouchers work, let alone a member of the public. There’s a lot of work that we need to do around what is covered, and what is available. We need to clarify that message, to make it easier for people to understand.

Karin has written a long document for Stan to take away. It shouldn’t need to be that long – it should be an easy snapshot, for anybody to look at and understand that they can go in and get a free sight test, check their health, and know what they’re entitled to.

We did come up with some pre-test forms for our Big Issue clinics, that anybody who wanted to come and see us could fill in. If they felt that they didn’t want to give the information over to an optometrist, who could be potentially seen as somebody authoritative, or who might tell them off, we’d have that information beforehand. We worked with our optometry team and came up with a form to give the optometrist all the clinical information they’d need, without having to ask it. That worked really well.

Do you have any advice for those who might open a homeless clinic in the future?

SM:Don’t be disheartened if nobody turns up on the first one. Keep going. Tie up with every homeless charity you can find in your area, because there are so many, and sometimes they don’t talk to each other. Get your team to do all the training that they need to do. I’m lucky with our team – they’ve done the Specsavers internal training modules on sight and homelessness modules and their vulnerable people training.

Reach out to the local VCHP branch or Big Issue office, to see if they can do any outreach. The outreach has benefited us so much in terms of information and understanding, and they’ve even come in to do training with us.

KF: In the clinics, make sure things are easy and simple to understand. Make sure people know that it is a safe space. We have to make sure that all the information, all the entitlements and all the procedures, are easily legible. When people walk into a store, we need to provide them with all the tools to make an informed decision and to feel empowered and in control of their care and their intervention. Big projects and big social changes don’t happen overnight.