Meeting and treating people where they are: Reducing health inequalities in rough sleepers

In November 2025, we were honoured to be asked to participate in the Inclusive Pharmacy Practice (IPP) Week 2025.

Inclusive pharmacy practice (IPP) is a joint initiative with the Royal Pharmaceutical Society and the Association of Pharmacy Technicians UK and 13 other national partner organisations. IPP focuses on making the workplace more inclusive for pharmacy professionals, with a senior leadership that reflects our diverse communities, to improve health inequalities in the population. It involves open conversations and meaningful actions to improve the experience of both patients and pharmacy professionals.

It is about engaging with local communities, helping to improve their health, and addressing the inequalities that people – particularly those from ethnically diverse backgrounds – can experience.

How did UKCPA contribute?

Together with the National Pharmacy Association (NPA), we delivered a webinar relating to the theme of addressing health inequalities through the prevention of ill-health.

We were lucky to have Michael Tickle as our guest speaker, talking about his work on transforming respiratory care for rough sleepers. Michael is a specialist clinical pharmacist in acute medicine, based at Nottingham University Hospitals NHS Trust.

The Rough Sleepers Virtual Ward

The Rough Sleepers Virtual Ward (RSVW) is an innovative service designed to address profound health inequalities experienced by people who sleep rough, particularly in relation to respiratory disease. Rough sleepers face multiple barriers to healthcare access, including stigma, mental health challenges, substance use, and difficulty engaging with traditional services. These factors contribute to high rates of smoking and untreated respiratory illness, resulting in a shocking average life expectancy of just 44 years, despite the UK’s universal healthcare system.

Launched in August 2024, the RSVW is a collaborative initiative between Nottingham University Hospitals, Nottinghamshire Healthcare NHS Foundation Trust, and local charities. Its core aim is to deliver targeted, accessible respiratory care directly to a high-risk, underserved population. The service operates using a “one-stop” model, allowing patients to receive assessment, diagnosis, and treatment in a single consultation. This model is supported by on-site access to pre-labelled medicines and self-check dispensing arrangements, significantly reducing delays and barriers to treatment.

Pharmacists play a central role in the RSVW, representing a shift in traditional pharmacy practice. Independent prescribing pharmacists are embedded in clinical delivery, providing medicines optimisation, prescribing, stewardship of antimicrobials and corticosteroids, and direct patient counselling. They also take on extended responsibilities, including patient admission and discharge from the virtual ward, formulary management, governance, and the development of local policies to support safe and flexible working.

Impact on health inequalities through the prevention of ill-health

The impact of the service has been substantial. Since the introduction of the RSVW, rough sleepers have experienced a 22% reduction in emergency department days, a 32% reduction in intensive care use, and a 40% reduction in other inpatient stays. Nearly 60% of patients were found to have chronic lower respiratory disease, often newly diagnosed or confirmed through the clinic. Importantly, the integration of health and social care has also led to improved housing outcomes, with several patients placed into accommodation or emergency housing.

The RSVW’s success has been recognised nationally, winning the HSJ Urgent and Emergency Care Safety Initiative of the Year. Future priorities include expanding pharmacy capacity, introducing point-of-care vaccination services, strengthening smoking cessation support through nicotine vape provision, and sharing learning with other integrated care boards.

Key learnings and actionable insights

1. Design services around patient realities, not systems
   One-stop, flexible models dramatically improve engagement and outcomes for underserved populations.
2. Pharmacists can be clinical leaders in inequality reduction
   Expanding pharmacist roles into prescribing, governance, and service design adds measurable value and improves safety.
3. Integrating health and social care amplifies impact
   Addressing housing, smoking cessation, and access to medicines alongside clinical care leads to better long-term outcomes and reduced hospital use.

Resources

Editorial article in the Lancet Respiratory Medicine
Article published in the Big Issue