19 May When public services meet lived experience

Most health and care services are designed around ‘typical’ residents. Our lived experience research shows where that model breaks down and how small, practical changes can remove barriers for people with the greatest needs.

The importance of pets to people who sleep rough is well understood among homelessness teams and other frontline workers. For some, their dog is their only companion, and they will prioritise their pet’s welfare over their own.

But public service systems can struggle to accommodate this reality. If someone sleeping rough misses GP appointments because their dog is unwell, they may be barred from further appointments for persistent no-shows. This just makes it even harder to get help before they reach crisis.

A Roma-speaking patient may feel reassured that an appointment includes a Roma-to-English interpreter. But that can turn to dismay if the interpreter comes from a country where anti-Roma prejudice is common, then mistranslates, or adds derogatory views. Experiences like these can spread, fuelling distrust.

We have heard similar experiences of distrust from Irish Travellers when describing encounters with public services.

“The [frontline worker] said, ‘Oh, are you Irish Travellers? I can tell by the way you always take up the corridor.’ And she said, ‘No, I won’t be letting you in,’ and she walked off.”

Many local services are designed around an ‘average’ user: English speaking, with the financial and social resources to navigate systems (often online). For people facing the greatest barriers, those same services can be full of extra hurdles, even though their needs are highest.

This is especially true in services dealing with sensitive issues like sexual and reproductive health. Clinics in prominent locations can be convenient, but for some including those from socially conservative communities, being seen there is a barrier:

“I can’t go to a clinic on the high street where everyone can see me, especially the aunties. It’s too public and embarrassing as people will think I have an infection!”

This is about more than stigma: it’s also perception, privacy, and cultural norms. We have heard from Latin American residents in an inner-urban borough who grew up without family conversations about sexual health, making it daunting to approach a GP or clinic; so they turn to Google. We have also heard from UK-born young people who found their access to advice ended abruptly after leaving school or college, leaving social media to fill the gap. In both cases, avoidable gaps lead to misinformation and delayed care.

Lived experience research is resource-intensive but so is delivering good care. Though in-depth discussions with people who don’t fit the ‘normal’ template we can pinpoint practical changes that can reduce barriers to access.

For people sleeping rough, that might mean more flexible GP access: protected walk-in slots or outreach booking support, plus exceptions to automatic bans for missed appointments.

For language and trust barriers, health navigators and community organisations can support safer, culturally competent pathways e.g. to make trusted recommendations for interpreters. This helps build trust and prevents harmful experiences spreading by word of mouth.

For sexual and reproductive health, access can extend beyond specialist clinics: providing outreach, community venues, and discreet options that protect privacy. This can help reduce avoidance, address language barriers, and better reflect different cultural attitudes to sexual health.

Get in touch
We’d love to talk with commissioners and providers who want to use lived experience research to improve access and build trust. If you’re interested in our recent work, or want to explore a project in your area, please get in touch.

Image by JR Clark on Flickr (Creative Commons)