Physical health


The health issues of participants within this sample are complex, often involving multiple intersecting physical and mental health conditions. Service closures and restricted healthcare provision negatively affected a significant proportion of participants across sites. A lack of non-emergency dental appointments was particularly distressing to five participants within this study, three described the impact of toothache on their quality of life, whilst two spoke of needing new dental plates, the absence of which adversely impacted their self-esteem. Interview data also captures a digital divide, between participants with regards to healthcare access during the pandemic.

Physical health

Several individuals spoke of experiencing chronic pain, with two reporting the inadequacy and/or inaccessibility of sufficient pain management treatment:

I feel it in my body like, my legs, I just can’t get, I’m in pain, I’m in pain constantly (…)  I just, just get on with it, aye, what’s the point, because nothing’s going to happen, I’m no going to get nothing else (M, 56)

The reported physical health of interviewees, suggests many are vulnerable of severe complications were they to contract COVID, not least, the three diabetics within the sample:

Like usually anything to do with my diabetes, I’d have to wait a few days to see someone (…) I keep getting DKA (Diabetic ketoacidosis, a complication of diabetes which occurs when blood glucose levels are consistently too high). (F, 38)

Similarly, roughly one third of interview participants reported having diagnosed respiratory and/or cardiac conditions:

Yeah, I’ve had 2 strokes, 2 heart attacks, sepsis on numerous occasions now. (M, 46)

Changes to healthcare provision

The majority of participants found access to everyday medical services was much more difficult after the onset of pandemic restrictions, with this report below being a common understanding of services’ revised measures:

Well no, because they’ve no been open, [specialist homeless practice] wasn’t open for ages, they were taking emergencies, but you would have to be dying to get, to go along. (F, 37)

Others felt further restricted by the need to use technology such as phones and the internet to access services, this was especially where participants did not own a phone. One participant described having to discuss personal medical issues in the reception of her hostel:

And it’s like, when I did, it was, they were phoning down the stairs, so I’m sitting in the middle of everybody, I’m no wanting to sit and talk about my health problems in front of all the staff and all the people in here. (F, 44)

One woman spoke of the absence of mental health support during the pandemic, suggesting accessing these services was even more challenging that those which focus more on physical health complaints or drug treatment:

Yeah, that was even my bigger barrier, because mental health were the worst ones to try and get a hold of (…) same as my therapist, I couldn’t get a hold of my therapist for the first 3 months in lockdown. (F, 47)

Several interviewees reported having no need to see a doctor between lockdown and data collection activities, whilst two individuals, who reported having good relationships with their local practice, suggested having unhindered healthcare access, when required:

If I’ve needed to see a doctor and that, I had, I found that there’s been no problem with anything like that, you know, maybe you phone up, and they’re quite booked up, but you will get an appointment, and if it’s an emergency, then aye, you will get seen that day, you know, if it’s deemed like serious enough. (M, 38)

Dental care

A major concern for many participants was dental care, particularly for some who had their teeth removed and were waiting for dental plates. One participant attributed their increased drug use to coping with tooth pain and further suggested that even when they finally had access to services their options were extremely limited.:

I suffered from bad toothache, which again, when I suffered from toothache, I only knew one way to get, to get rid of the toothache and that was use (…) I used a lot, and then I eventually phoned the dentist, and I got put, I got emergency appointments, but they were only taking teeth out. (M, 32)

Three participants within the dataset reported waiting extended periods for dental plates with each noting the impact this has had on their self-esteem and in relation to other people:

Yes, dentists is the worst, I, I get the, I got all my teeth out just before lockdown, the next week the whole country went into bloody lockdown, so I’m still waiting on my, my replacement teeth (…) hopefully within the next month (…)  you’re no conscious of it, when you’re, you’re using sort of thing, but when you stop using and you’ve to start talking to people and leading normal life and things like that, it becomes more important sort of thing, your self-care and things like that, you know, because a lot of that goes out the window, when you’re using, you know. (M, 49)