This project aimed to increase vaccination uptake among people experiencing homelessness across Bedfordshire, Luton and Milton Keynes (BLMK). By working in partnership with trusted local organisations such as homeless shelters, day centres and food banks, we delivered vaccinations in familiar, accessible environments. The service provided clear and up-to-date health promotion, flexible clinic times and outreach-based delivery to reduce barriers to access. Through relationship-building and repeated engagement, the project has successfully improved vaccine confidence and uptake within a highly vulnerable population.
The challenge
People experiencing homelessness face multiple barriers to accessing vaccinations, including:
- Limited health literacy and lack of up-to-date vaccine information
- Vaccine hesitancy, often linked to concerns around COVID-19 vaccines, which impacted acceptance of other essential vaccines
- Competing priorities, with vaccinations perceived as low priority
- Limited ability to travel to fixed-site vaccination clinics
- Low trust in health services, requiring repeated engagement to build confidence
- Challenges delivering vaccinations safely and discreetly within public or shared spaces
To better understand these barriers, we engaged with our Off the Grid colleagues in Hertfordshire, who shared learning from similar outreach work. We also built strong relationships with Bedford and Milton Keynes Councils and Public Health colleagues, including Dr Zahid Ullah (Central Bedfordshire), who supported networking with wider BLMK multidisciplinary partners.
Project description
People experiencing homelessness are at increased risk of vaccine-preventable diseases and often have lower vaccination coverage than the general population.
The BLMK Off the Grid vaccination service was established in September 2025. The service is delivered by a small team of three qualified nurses with extensive vaccination experience. Our primary aim is to improve vaccination uptake among people who are homeless or otherwise vulnerable.
A key focus of the project was relationship-building. This involved extensive networking, telephone calls and face-to-face visits with homeless shelters and support services across BLMK. We presented the service to multiple organisations, all of whom were highly supportive and keen to engage.
Vaccination clinics were arranged at times and locations convenient for service users. Simple, clear promotional posters were provided to shelters at least one week in advance. On clinic days, we established small, discreet clinic spaces within the shelters. Using secure access to clinical systems, we reviewed individual vaccination histories and offered any missed or seasonal vaccines where appropriate.
Although some individuals were initially hesitant, we prioritised non-judgemental conversations and health promotion. By allowing time for discussion and repeat visits, many clients chose to return at later sessions to receive vaccinations.
Outcomes and impact
The project has demonstrated clear and measurable social value across the themes of health inequalities, prevention and sustainability.
Reducing health inequalities
- Delivered 158 vaccinations to people experiencing homelessness across BLMK since September 2025, a population with historically low vaccine uptake.
- Improved access to healthcare for individuals facing barriers such as unstable housing, low health literacy and limited mobility.
- Strengthened trust between homeless communities and health services through consistent, relationship-based outreach.
Prevention and early intervention
- Increased protection against vaccine-preventable diseases, reducing the risk of outbreaks within homeless settings and the wider community.
- Supported informed decision-making through tailored health promotion and repeat engagement, helping to address vaccine hesitancy.
- Seeks to identify unmet health needs during vaccination encounters, creating opportunities for earlier intervention and onward referral.
Sustainability and system efficiency
- Reduced reliance on urgent and emergency care by preventing avoidable illness.
- Delivered care in community settings, minimising non-attendance associated with traditional clinic-based models.
- Built sustainable partnerships with local authorities, shelters and voluntary organisations to support ongoing delivery.
Lessons learned
- Offering clinics later in the day was more effective, as attendance increased around lunchtime when food services were available.
- Out-of-hours and evening sessions were essential for reaching people who sleep rough or attend night shelters.
- Providing clear, simple and up-to-date information supports informed decision-making and reduces feelings of pressure.
- Repeated engagement and consistency are crucial for building trust and improving uptake.
