Caroline Shulman is a clinician and researcher in homeless and inclusion health. She is co-Clinical Lead for the homeless health programme at Healthy London Partnership. She is also Honorary senior lecturer within the division of psychiatry at UCL leading on work addressing palliative care and frailty for people experiencing homelessness. She is also a Clinical Research Fellow at the homeless charity, Pathway.
Caroline qualified in Medicine in 1984 at Kings College Hospital, London, then as a GP obtaining MRCGP in 1989. Caroline's early career was spent in East Africa, working in Tanzania as a clinician following which she went to work at the London School of Hygiene and Tropical Medicine (LSHTM) in 1994-2003, based in Kenya for a number of these years. She was awarded a PhD in 2001.
Caroline returned to UK general practice 2007, where she has specialized in homeless and inclusion health, working in specialist practice for homeless people before becoming clinical lead in a multidisciplinary homeless team at Kings College Hospital, London. She started working with the Healthy London Partnership at the start of the COVID-19 pandemic, where she provided strategic and clinical support to the pan London homelessness response.
Caroline combines her clinical and research roles with a drive to improve access to high quality services and support for people experiencing homelessness who have multiple and complex needs.
Caroline was a clinical researcher, lecturer then clinical senior lecturer at London School of Hygiene and Tropical Medicine between 1992 and 2002.
Her main research interests at the time were international maternal health, malaria and anaemia in pregnancy.
She was the principal on a number of studies in Kilifi, Kenya, funded by DFID and Wellcome Trust, in collaboration with the Kenya Medical Research Institute, Kenya Ministry of Health and Oxford University addressing the importance of malaria as a contributor to anaemia in pregnancy. This included a large RCT, the result of which contributed to policy change nationally and internationally.
Following return to UK Caroline became clinical senior lecturer at LSHTM in 2001 on the Gates malaria programming, where she developed a number of further studies on malaria in pregnancy.
Caroline then took a break from research until 2015, returning to clinical work.
Since 2015, Caroline has been leading on work addressing the palliative care and needs and frailty of people experiencing homelessness, in collaboration with Pathway, St Mungo's and the Marie Curie Palliative Care Research Department. During the first qualitative phase, this research explored the growing concern that many homeless people were dying young and in unsupported, unacceptable situations. Many have a complex combination of physical health, mental health and substance misuse issues with a high prevalence of trauma including adverse child experiences. Gaps identified and recommendations from this research have been widely disseminated. Caroline and her team then developed a toolkit on homelessness and palliative care to support frontline staff. They went onto develop and evaluate a model for embedding multidisciplinary, person centred care and support for people with advanced ill health, by bringing together palliative care and multidisciplinary support into homeless hostels. Since the onset of the COVID pandemic, she and her colleagues have developed online training modules to facilitate the development of interprofessional communities of practice to support people experiencing homelessness who have advanced ill health and palliative care needs. Other work includes exploring the palliative care needs of non UK nationals who have no recourse to public funds. She and colleagues are currently working on an NHSE and NHSI funded project to develop tools to help quantify the unmet palliative care needs of the homeless population and to gather feedback about quality of palliative care support.
Caroline has also worked with others to highlight the high prevalence of frailty, multimorbidity and older age conditions occurring among the homeless population at a very young age. She has gone on to pilot tools to be used by frontline hostel staff to identify and advocate for support for people within hostels who have frailty and deteriorating health.
- Caroline supervised MSc and PhD students and taught on malaria in pregnancy and epidemiology while based at LSHTM
- Between 2008-2013 she was a tutor for 1st year medical student at UCL on a vertical module on professional development
- Caroline is involved with teaching and professional development of a wide range of clinical staff (palliative care, GP’s GP trainees, medical students), and non clinical staff (working in homelessness), on different aspects of homelessness and health
- NHSE & NHSI: Grant held by Pathway: January 2022 £19,950
- NHSE & NHSI: Grant held by Pathway: January 2021 £19,050
- Isla Foundation: Grant held by Pathway £18,260: January 2021-Dec 2021
- Oak Foundation: Grant held by Pathway: September 2018-December 2020 £337,668
- Oak Foundation: Grant held by Pathway: September 2015-March 2018 £250,130
- Gates Malaria Partnership, LSHTM: Case-control study to assess the association between malaria and pre-eclampsia, and the possible mechanisms £20,000 small project grant.
- Gates Malaria Partnership, LSHTM: Trial to establish the health impact, acceptability and cost effectiveness of alternative antimalarial interventions in preventing malaria and anaemia in pregnant women in The Gambia: 2002-2005 £330,023. Grant Number ITDCVG27:
- DFID, HP ACCORD: R6141: 1994 -1998. Prevention of malaria and anaemia in pregnancy: £399, 725.
- DFID, HP ACCORD: R5676: Sept-Jan 1993. Preliminary study on causes of anaemia in pregnancy, and development of intervention £19,970
A full list of publications can be found on Caroline's research gate profile:
Hudson, B. F., Flemming, K., Shulman, C., & Candy, B (2016). Access to palliative and end of life care for people who are homeless: A systematic review of qualitative research. BMC palliative and supportive care. 15:96 DOI 10.1186/s12904-016-0168-6
Shulman, C., Hudson, B.F., Low, J., Hewett, N., Daley, J., Kennedy, P., Davis, S., Brophy, N., Howard, D., Vivat, B., & Stone, P (2017). End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care. Palliative Medicine;0(0):0269216317717101.
Hudson, B.F., Shulman, C., & Stone, P (2017). 'Nowhere else will take him' - Palliative care and homelessness. European Journal of Palliative Care;24(2).
Hudson, B.F., Shulman, C., & Brophy, N. (2017). Time to link palliative care and homelessness services. Inside Housing. http://www.insidehousing.co.uk/time-to-link-palliative-care-and-homeless...
Hudson, B. F., Shulman, C., Low, J., Hewett, N. Daley, J., Davis, S., Brophy, N., Howard, D., Vivat, B., Kennedy, P. &, Stone, P. (2017) Challenges to discussing palliative care with people who are homeless: a qualitative study. BMJ Open 2017;7:e017502. doi: 10.1136/bmjopen-2017-017502
Shulman, C., Hudson, B. F., Kennedy, P., Brophy, N., & Stone, P. (2018). Evaluation of training on palliative care for staff working within a homeless hostel. Nurse education today, 71, 135-144.
Raphael Rogans-Watson, Caroline Shulman, Dan Lewer, Megan Armstrong and
Briony Hudson (2020) Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel. Housing Care and Support 23; ¾: 77-91 DOI 10.1108/HCS-05-2020-0007
Armstrong, M; Shulman, C; Hudson, B et al, The benefits and challenges of embedding specialist palliative care teams within homeless hostels to enhance support and learning: Palliative Medicine, Mar 29 2021 https://journals.sagepub.com/doi/full/10.1177/0269216321100631
Armstrong M, Shulman C, Hudson B, et al. Barriers and facilitators to accessing health and social care services for people living in homeless hostels: a qualitative study of the experiences of hostel staff and residents in UK hostels. BMJ Open 2021;11:e053185. doi:10.1136/ bmjopen-2021-053185
- Marie Curie website: - Co-written summary and links to our work and a live presentation https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/equality-diversity/homeless-people
- Pathway Conference 2020 recorded presentation: early findings on imporving access to health care by twinning community palliative care teams with hostels https://vimeopro.com/narrowcastmedia/pathways-from-homelessness-2020/page/2
- Film on homelessness and health (aimed at health care providers) https://www.youtube.com/watch?v=SdBP0hfkODU
Reports contributed to:
- Care Quality Commission & Faculty of Homeless and Inclusion Heath (2017). A second class ending. Exploring the barriers and championing outstanding end of life care for people who are homeless. Co-authored in the capacity as members of Faculty of homeless and inclusion health https://www.cqc.org.uk/sites/default/files/20171031_a_second_class_ending.pdf
- Tenancy sustainment team health report: Morbidity and mortality among people with a history of rough sleeping; M Corners, B Rice, C Shulman, B Hudson https://thamesreach.org.uk/wp-content/uploads/2020/01/TST-Executive-Summary.pdf
- The Faculty for Homeless and Inclusion Health (2018). Standards for Commissioners and Service Providers. 3rd Edition. Pathway. London. https://www.pathway.org.uk/wp-content/uploads/Version-3.1-Standards-2018-Final.pdf
- Homeless link, Hospice UK and Marie Curie report – care committed to me (2018). https://www.hospiceuk.org/docs/default-source/Policy-and-Campaigns/briefings-and-consultations-documents-and-files/care_committed_to_me_web.pdf?sfvrsn=0