Médecins du Monde has been running projects in Europe to help vulnerable groups for 20 years.  Given that Médecins du Monde in Europe had found that there are people who have difficulty accessing healthcare, Médecins du Monde UK decided to explore these issues in the UK and started a needs assessment in 2003.  MdM UK wanted to identify if there are people in the UK who have difficulty accessing healthcare and, if so, why and what can be done.  

What took place:

• Interviews with 37 community organisations in London working on health issues or working with vulnerable groups
• Focus group discussions with the clients of organisations
• Face-to-face interviews with homeless users of a day centre
• Accompanied outreach face-to-face interviews with street sex workers
• Consultations with local healthcare professionals
• Snapshot, anonymous survey of general practices in two boroughs – Tower Hamlets and Kensington – to identify the extent to which their lists were closed to new patients
• Work with the local Primary Care Trust (PCT) in Tower Hamlets
• A survey of Praxis’s service users around access to healthcare and to assess the level of support for the services proposed by Project: London.

Conclusion:

• Social inequalities in health between wealthier and poorer groups have widened since the 1970s.  Recent data confirm that the gap continues to widen and within London these inequalities are pronounced:  there is a difference of six years in average life expectancy at birth between the best and worst boroughs in London.  The discrepancies with the health situation of marginalised groups is even more marked:  rough sleepers aged between 45 and 64, for example, have a death rate 25 times that of the general population.
• There are vulnerable people in the UK who need help to access healthcare.
• There are a variety of different, sometimes complex, reasons why people may need help to access healthcare: 
  • People with chaotic lifestyles, such as those living on the streets or working in the sex industry, have difficulty fitting in with the way that mainstream health services are organised. They face administrative barriers, such as the need for an address (even if they are homeless). At the same time, their own health is often not a priority and people in such situations would benefit from outreach services who go to them, rather than requiring them to turn up at a given time.
  • Another group that has trouble accessing healthcare is migrants, and people who are perceived to be migrants. A lack of information or understanding about how the NHS works, and confusion about who is entitled to NHS care, are common problems. People who have not grown up with the NHS do not easily understand how to enter it or how to use the health system; others need information in their own language.
• Médecins du Monde UK decided to base its project in East London primarily because the organisation is based in East London and it was logical to start working within its own local community.  It also makes sense because of the high levels of deprivation in East London, the poor health that always accompanies such deprivation and the strain that this places on health services.  However, Project: London is open to people from all over London.
• Many initiatives from government, NHS and voluntary organisations already exist to help improve access to healthcare for marginalised groups.  Médecins du Monde UK sought to find a way to support these efforts, while drawing on the experience of Médecins du Monde’s European network.