Across England, tackling health inequalities remains a priority, with one particular focus on inclusion health groups – people who are socially excluded and face overlapping risk factors such as poverty, violence, and complex trauma. Inclusion health groups are a priority group within the Core20PLUS5 population cohort, which focuses on the most deprived 20% of the population and key groups at risk of health inequalities. As part of the NHS’s commitment to reducing these inequalities, all systems are asked to implement the Inclusion health framework by 2024/25, with a clear plan for doing so.

In Brighton, Arch Healthcare, rated ‘outstanding’ by the Care Quality Commission, is leading the way by providing holistic, integrated care that addresses both medical and social needs.

Their model offers crucial support to those experiencing homelessness or living in precarious conditions such as hostels or temporary accommodation.

What makes Arch Healthcare’s work stand out is its commitment to meeting patients where they are, whether that means providing medical care on the streets or creating a safe, supportive environment within their clinic. The dedication and innovative spirit of Arch’s team are driving real, measurable improvements in health outcomes and helping to close the health inequalities gap.

One of Arch Healthcare’s most innovative initiatives is its outreach service, which uses e-bikes to deliver care directly to rough sleepers across Brighton. These bikes allow the team to quickly reach people in areas that are often difficult to access – doorways, car parks, and tented encampments – providing care on the spot.

This proactive approach has dramatically increased engagement with people who might otherwise avoid traditional healthcare settings. By meeting people where they are, Arch has helped reduce A&E attendances by 9% and ensured more consistent care for individuals with complex needs.

Implementing the high impact actions of the Inclusion health framework to drive delivery, Arch Healthcare, in collaboration with Brighton & Hove Common Ambition, places trauma-informed care at the heart of its practice. This approach recognises that many people experiencing homelessness have been through significant hardship and prioritises creating a safe, non-judgmental environment. Brighton & Hove Common Ambition has been instrumental in co-producing service improvements alongside people with lived experience of homelessness, ensuring that healthcare is accessible, respectful, and responsive to patients’ challenges.

Arch Healthcare cares for over 1,400 patients, many of whom face significant barriers to accessing healthcare. The practice takes an integrated approach to service improvement, addressing not only medical needs but also housing and social care. Patients with chronic conditions like chronic obstructive pulmonary disease (COPD) have seen significant improvements. For example, the practice achieved a 52% reduction in high-dose inhaled corticosteroid usage, improving outcomes for respiratory diseases

One patient shared, “You’re all amazing and caring. I felt taken seriously for the first time in my life.” 

In partnership with Brighton & Hove Common Ambition, Arch Healthcare is also helping to shape the next generation of healthcare professionals. Together, they co-produced a homelessness and health module for medical students at Brighton and Sussex Medical School. This training, informed by people with lived experience of homelessness, is transforming how future doctors approach care for vulnerable populations.

This initiative highlights the importance of co-production in improving healthcare outcomes and ensuring that services are designed with the needs of the most vulnerable in mind.

Arch Healthcare’s impact extends into local hospitals, where their Pathway In-reach team at the Royal Sussex County Hospital helps homeless patients transition safely back into the community after hospital stays. This team is a collaboration between Arch Healthcare, the Sussex Community NHS Foundation Trust, and Justlife, following the Pathway model as set out by the Pathway charity. This service has significantly reduced hospital readmissions, with a 42% reduction in readmissions within 30 days of discharge and a 32% reduction in unplanned admissions.

For patients who no longer require hospitalisation but need further support, Arch offers a step-down service at New Steine Mews, providing temporary accommodation while they recover. This vital service prevents patients from being discharged back to the streets, giving them time and space to stabilise their health and move toward more permanent housing.

Lessons learned and looking forward

Arch Healthcare’s holistic approach to care, grounded in compassion and collaboration, offers valuable lessons for healthcare providers across the country.

By integrating medical, housing, and social care services, and by placing patients at the centre of their care model, Arch has helped improve health outcomes for some of the most vulnerable people in society.

Their results speak for themselves: 98.7% of patients feel their healthcare professional treats them with care and concern, while 95.9%report satisfaction with their overall experience.

Brighton’s model shows that with the right support, even the most vulnerable patients can experience better health outcomes. It’s a powerful reminder that when healthcare is compassionate, integrated, and proactive, it can transform lives.