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How optometrists can support their homeless patients

Specsavers optometrist, Ross Campbell, used case studies to highlight communication best practice for those experiencing homelessness

Pensive woman with brown hair posing with her son, looking very concerned as she looks through a window
Optometrist at Specsavers, Ross Campbell, opened his 100% Optical 2024 session with some sobering statistics.

England has the highest level of homelessness of all the nations of the United Kingdom, Campbell said, with 300,000 households and 125,000 children affected as of 2023.

Those impacted by homelessness are 17 times more likely to be affected by violence, while the life expectancy of someone who is homeless is in the 40s.

These are problems that have persisted for more than a decade, Campbell said.

He also noted that 80% of homeless people attending one recent Crisis at Christmas clinic needed glasses, 20% had ocular pathology that requires treatment, and 10% needed to be referred for further investigation.

A problem compounding this is the fact that many of those experiencing homelessness are not on Universal Credit, meaning they are not entitled to a free eye examination, Campbell explained.

The expectation of cost is just one of the factors that inhibits people facing homelessness from accessing eye care, he said.

Addressing the challenge

Campbell’s discussion workshop, entitled Total care – sight and homelessness, aimed to give attendees an understanding of the challenges facing homeless people and equip them with the tools to support this type of patient.

Campbell, ophthalmic partner at Specsavers in Northallerton and Swaledale and professional advancement consultant for the multiple, acknowledged the work of Vision Care for Homeless People (VCHP) and Crisis at Christmas in supporting access to eye care for those experiencing homelessness.

He emphasised that VCHP is flexible in the amount of time committed by their optometrist and dispensing optician volunteers.

Attendees then split into groups to discuss the problems homeless people face, using a fictional case study involving a patient called ‘Adam,’ who had broken his glasses and was not eligible for NHS eye care.

The groups were encouraged to consider what support services exist locally to them.

“If you don’t know, it is pretty easy to find out,” Campbell said.

He reminded practitioners that including a permanent address on an NHS form is no longer mandated, “removing some barriers of access to care.”

“If the patient is homeless, or living in temporary accommodation, you can use the address of the shelter that they’re in, or your practice address, for the NHS forms,” Campbell said. “That is now absolutely okay.”

Campbell also noted that Specsavers has out of hours clinics, designed to provide a more welcoming space to those who might find it uncomfortable to access a busy clinic during the day.

“We all get into this profession because we want to make a difference,” he said. “We want to make somebody’s life better, in a small or big way.”

Campbell added: “The impact we can make, as healthcare providers, to people in very vulnerable situations, affected by homelessness, can be massive.”

We all get into this profession because we want to make a difference. We want to make somebody’s life better, in a small or big way


Decision making and patient choice

Part two of the discussion focused on patient-centred care and the mental capacity of patients, using the case studies ‘David’ and ‘Adrian.’

Patient and person-centred can be defined as “how we adapt our routines for different challenges in these kind of clinics,” Campbell said.

This means “focusing care on the needs of the person rather than on the needs of the practice,” he added.

Campbell also pointed out that patients often do their own research, rather than relying solely on the advice of a healthcare practitioner.

“They also think about what is most important in their lives and they prioritise what is happening to them,” he said.

Campbell added: “As eye care practitioners, we have to be flexible to meet the needs of these customers and patients. We have to tailor our services to suit the individual customer, rather than the other way around.”

This might mean a patient denying a need for surgery, he said.

He emphasised how important it is for practitioners to adapt their exam examination and subsequent management to the needs of the patient in front of them.

Mental capacity is defined as “the ability to use and understand information to make a decision and communicate any decision made,” Campbell explained, adding that if a person lacks mental capacity, they are likely to be “unable to make a decision at that time.”

He also identified a number of occasions when a patient’s mental capacity might have been reduced, including in some instances of schizophrenia, bipolar disorder, dementia, learning disabilities, physical brain damage, or intoxication due to drugs or alcohol.

"Someone with social impairment is going to be unable to make a decision if they can’t understand the information about the decision,” Campbell said.

He urged practitioners to “remember the information and use that information to make a decision” and to ensure that they allow time for patients to ask questions.

Campbell closed the session by highlighting actions that practitioners could take, including volunteering with VCHP.

He also thanked attendees for taking the time to consider the eye care needs of homeless people.

“Many of you, like me, probably weren’t aware of the extent of homelessness in the UK in 2023,” he said.

He added: “It’s a complex issue. There is no one-size fits-all solution. What works for one person who is homeless won’t work for another. We’ve had time to reflect on what we can do.”

After the peer discussion, OT spoke to Ross Campbell about the issues raised.

What was the importance of your talk today?

Getting an understanding of the extent of homelessness in the UK, and the impact that has on access to care and on sight loss.

What do you think the main barriers are in healthcare communication with people experiencing homelessness, as a group?

It’s about priority. Their prioritisation is about surviving that day; where they are going to sleep that night. We did a focus group in Bristol, for people who had lived experience of homelessness, and it just wasn’t a priority for them.

Also, they told us that they didn’t know what to expect when they went into a High Street optometry practice. It would put them off. For example, they didn’t know if they would have to pay. They felt they were not necessarily welcome, and they were unsure what was actually going to happen.

Speaking to people experiencing homelessness, they tell us that they really need a steer on what is going to happen when they go into practice. Testing might include shining lights into their eyes, which might increase their anxiety. Some people who have been through homelessness have been through really challenging situations, so [it is about] understanding that, so they know what to expect when they come to see us to access sight care.

What do you hope that optometrists take from this session?

I hope that they consider the wider impact that accessing care has on individuals, whether they are affected by homelessness or not. There are a lot of barriers to care generally, like the examples in the discussion – a guy has broken his glasses, and he can’t pay for it that week. A lot of practices would send him away. I think we should just try to understand people’s individual situations a bit more, and understand the impact.

Do you think it needs to be a specific communication stream for that group?

Yes. One thing is having some help to reach out to local providers who work with homeless charities, whether that is homeless shelters, or whatever it may be. That gives practices a way to help within that situation. Most people don’t know who is homeless around them, or who is affected by homelessness.

Most people don’t know who is homeless around them, or who is affected by homelessness


What is the first practical thing that optometrists participating in this session should do when they leave 100% Optical and go back to their practices?

Understand the extent of homelessness in their local community, and what services already exist to help support people.

Were there any vital or particularly interesting conversation points that were raised during the table discussions?

One thing that isn’t widely understood amongst the optometry community, even though it has been advertised, is that you no longer need to have a fixed address. Just a reminder that people who are approaching us, who don’t have a fixed address, can use their temporary address.