Closing the gaps in the pavement: Theresa’s award-winning work with east Kent’s rough sleepers

Theresa Tester is a specialist nurse who works in complex care in the community in east Kent.

A friendly face at outreach centres, Theresa offers rough sleepers healthcare advice, support and referrals to the services they need. 

By opening access and building trust, her role, created just 16 months ago, aims to close the gaps that the homeless frequently fall through in healthcare.

We met Theresa, who recently won the Excellence in Inspiring Individuals Healthwatch Award, at Maya’s Community Hub in Herne Bay, to find out more.

“The biggest misconception about rough sleepers is that somehow they are at fault for their situation,” says Theresa. “In reality, people don’t realise how fragile the security of having a home is. The adage is that we are all two pay cheques away from being homeless.

“I found this out very quickly. Weeks into the job, a man I helped was working as a paramedic who attended a call to a road collision – the victim, who died at the scene, was his son.

“He lost everything after the trauma. His marriage ended, he lost his job and ended up rough sleeping. When I found him at an outreach centre he was at his lowest ebb. Losing everything is not unique to addicts or alcoholics, it can be just a set of really unique circumstances that snowball.”

Helping to pack packages of food

Theresa started life as a healthcare assistant and has had a nursing career spanning 20 years, before finding her calling in adult safeguarding. Her success in the field led to this community posting, 16 months ago.

She explains: “I have empathy and care about others, but I can stay calm and am able to see the reasons why someone might be aggressive, which is a good skill in this job.

“Don’t get me wrong, it hasn’t always been easy. When I first came into the position, I got a real gob full from clients.  I don’t blame them. Many have been let down by public services and feel society has rejected them. Think how many times you’ve passed a rough sleeper and avoided eye contact?

“I quickly realised that to be part of this community I’d need to start in the background and wait for people to come to me. It doesn’t come naturally to nurses not to get stuck in, but once you get one client in, word spreads. It took time, but slowly people started waiting for me to arrive and I became really busy, helping people at every clinic.”

Theresa with a client

Theresa holds clinics at outreach centres across East Kent where rough sleepers can drop in. The help she can offer spans anything from a referral to a hospital, GP appointment or mental health and drug and alcohol services amongst many other things.  The biggest barrier to these services, she points out, is digital poverty.

She says: “We take it for granted, our smartphones. The most anyone in the rough sleeping community has is a burner phone, if that, without credit on.  They can’t ring up and wait on the line for 20 minutes for an appointment.

“It means most people I see will usually ignore any issues that they have until crisis point, at which time they turn up at A&E.  It is my job to hear people out, work out what they need to feel better and get access to appointments to prevent the crisis.”

Theresa’s services are really starting to make a difference. People she has assisted like long term rough sleeper Richard* owe their life to her.

Richard was a carer for his parents from a young age. When they died, he was left with little support, education and ended up on the streets.  Theresa saw him at a community hub where he came to her with a sore foot. He’d also recently had a bad fall.

She continues: “As a nurse, I could see it was diabetes as his toes were purple and his eyesight was compromised which is why he fell. I was able to arrange a GP appointment, blood tests and later a consultant.

“He is now on medication he needed and is feeling better. Our meeting also enabled him to be housed in temporarily accommodation. He was in his 40s and it was the first time he had allowed anyone to help him, properly, in his whole life.”

Theresa also heads out ‘on the road’ with charities like Porchlight, to speak to rough sleepers who won’t attend outreach centres, to see if she can encourage them to seek medical help.

“Some people just can’t be reached, but you do see glimmers of change. I let the charities lead, as they’re the experts, but I’ve made some connections by offering a coffee or some hot food and a chat. It’s about not forcing it, hardened rough sleepers aren’t used to being helped by anyone and there is a lot of mistrust.”

Collecting her Healthwatch Award

From clients putting up walls, to now stopping her in the street for a hug and a thank you, Theresa has become not just a source of help, but has been welcomed into the community.

“My teenage children get embarrassed if we go into town together,” smiles Theresa. “A lot of people come up to say hello or tell me how they are doing.

“It’s heart-warming to know I make a difference, and getting a thank you from some of the most underserved people in society really doesn’t compare to anything else.”

Theresa is hoping that more roles like hers will be created in community healthcare, as homelessness is seeing a frightening rise recently.

“The life expectancy of someone on the streets is just 47, and we are seeing more people than ever losing their homes, in 2024, than we have done in decades. I regularly see whole families who lived ordinary lives, with nothing and nowhere to turn.  I am helping five different pregnant women who are homeless and need medical support, for instance.

“I feel like with more roles in the community like mine could be the turning point, where we start to see a real tangible change in the health of the rough sleeping community.

“The benefit of being on-the-ground also humanises us. It builds a trust between us and some of society’s most vulnerable people.”