Connect Health “Change” brings you the latest in a series of webinars to make and embed transformation in healthcare. Aimed at system leaders and clinicians across the NHS, the webinars provide practical solutions to the challenging issues we are all grappling with.
As part of the Connect Health Change webinar series, we present the Q&A summary from our panel who discuss Health Inequalities in the post-COVID world.
NHS England defines health inequalities as ‘unfair and avoidable differences in health across the population, and between different groups within society’. Inequalities arise due to the conditions in which people are born, grow, live, work and age, and influence opportunities for good health, and how people think, feel and act. It can impact people in many ways – life expectancy, avoidable mortality, long-term health conditions, and the prevalence of mental ill-health.
This webinar looked at who is most at risk, what we can do to improve health inequalities, health literacy, segmentation and coproducing interventions with patients and the voluntary sector.
Delegate feedback included:
- Range of speakers and their knowledge and passion for the subject was excellent
- Each session was short and to the point
Watch the Webinar in Full
Chaired by:
Professor Edward Kunonga, Director of Population Health Management at North England Commissioning Support
Q&A
Dr Liz Lingard, Transformation Lead (North East & Yorkshire), NHS England and NHS Improvement
Question 1: How do we balance clearing the NHS backlog as fast as possible with the national vision for reducing healthcare inequalities?
Answer: There is a real tension out in the systems at the moment but we now have integrated care systems and we need to work together to find the solutions for this. The way that we balance is to have really strong leadership and awareness of what these issues are. It’s morally and ethically the right thing to do but even if you don’t have your heart in this, it’s financially the best thing to do. So if we can change the mindsets of how we find the balance and really focus on this, we will be moving towards better ways of working and it will actually take the pressure off the healthcare system if we trust this as the direction of travel.
Question 2: In terms of recovery, how do we make sure that we don’t just ‘build back better’ but ‘build back fairer’ so everyone has equal opportunities?
Answer: I’m doing that standing on the shoulders of my public health colleagues out in the local authorities, working together and being a strong advocate and a champion for them. We have a role as anchor institutions to make this the culture of our organisations and everything we do in terms of recruiting the workforce and making sure we’ve got a workforce that’s fit for purpose as well. If we are going to build back fairer, we’ve got to also recognise that one in 10 people in our population work in the NHS so actually our workforce is facing health inequalities as well, so if we’re building back fairer we’re doing an inside out job. We can’t do it unless we’ve got strong leadership, not just meaning people who are chief execs, but everybody who is listening on this call I consider to be a leader. Take this as part of your responsibility going forward that you’re arming yourself with the information and training and skills that you need to be a champion for this to go forward.
Question 3: What do you think is the key support needed for the workforce to help reduce health inequalities?
Answer: Strong leadership as well as support from HR & OD colleagues to embed Health Inequalities training as core training for all staff, as part of induction for new starters as well as ensuring they have objectives aligned to reducing health inequalities as part of their annual appraisals. HEE and OHID colleagues are developing training materials organisations and individuals can access. But for success the greatest help the workforce can have is strong leadership to make this a priority.
Professor George Peat, Professor of Clinical Epidemiology, Primary Care Centre Versus Arthritis, School of Medicine, Keele University
Question 1: You touched on many advantages of primary care data but also several of the challenges. Is there something specific that you think would really help realise the potential of this data to help us understand and reduce health inequalities as we move forward?
Answer: Having witnessed the extraordinary response to Covid , this included a response around data, its access and integration, and use to inform policy and practice. My one hope would be that this progress won’t get lost and that will now get transferred and built on for the sorts of non-communicable diseases, such as musculoskeletal health and care. On its own primary care data has some use, but it is a far greater value when linked with the mechanics; the ability to link it are critical here.
Question 2: What’s the key lesson you have learnt from the data in changing how services are designed?
Answer: The first one is, unless you get to fairly granular levels you probably underestimate just how focused and targeted you might need to be with service targeting. At the current level, we tend to talk about things like CCGs or ICSs or local authority level data, but actually within those there are sub populations where the need is vastly different. What is not necessarily connected is that services, resource, workforce and supply follow that need. It’s a bit of a trite thing to draw attention to things like the inverse care law but I think that’s still there and it’s still very evident despite a lot of the efforts recently. The other thing that we’ve tried to do is, where there’s opportunities for the workforce to do so, expand or introduce an opportunity to do things differently that is more equity informed, for example, around FCPs in musculoskeletal care and primary care.
Question 3: I think a big challenge is, despite good guidance from NICE, MSK GIRFT etc., there is still a postcode lottery as to the types of treatment and advice people get.
Answer: Yes – equity-focussed implementation is exceptionally hard to introduce and sustain although I suspect in the absence of some of those initiatives we would see even greater variation!
Question 4: What is the current approach in engaging ethnic minority groups into health trials?
Answer: Within the NIHR there is a real drive to improve this using their INCLUDE ethnicity framework. On the grant panel I sit on, research programmes and trials must lay out their plans for engaging more diverse populations and we have public members who provide additional scrutiny of these. In practice, it’s still quite variable – some trials have genuinely maintained strong, respectful collaborations with diverse public/patient groups to inform the design of their studies. I think this is critical. In my own research we have monthly meetings with our patient advisory group but there is always more to do to build trust and genuine involvement.
Dr James Prentis, Consultant Anaesthetist, Freeman Hospital, Visiting Fellow Northumbria University
Question 1: If you had a clean sheet of paper, what would be your waiting list strategy for 2023?
Answer: I don’t think we need to do things differently, I know that there’s a massive backlog and we need to get going as much as we can do in the hospitals and essentially we’re trying our best. What this means is that whilst those patients are waiting, we can actually intervene and do something that’s going to improve their perioperative journey. For example, if we can improve someone’s diabetes, that’s going to get them off insulin, that’s not only good for us, it’s good for the long-term health of the patient, it’s good for primary care. What we’re doing is using surgery as the sort of golden moment of behaviour change and, from that, the initial work that we’re doing seems to be the cause of people being far more likely to engage with secondary care with one of our consultants or one of our team ringing them up.
Question 2: What difference does having a 3rd sector organisation deliver the intervention vs NHS? What training do the staff have that are doing the work? What advice would you get for currently established / establishing prehab services?
Answer: The patients are in the community – we have tried prehab within our hospital setting and could get no one to attend. That is due to our geographically area – no one will attend an exercise session 3x a week if they have to travel >100 miles. However, we are different to other hospital settings. The 3rd sector organisation – we’re already doing this for primary care so we just link in. My advice, find what is out there and think out of the box – establish links with primary care, public health don’t do it alone.
Question 3: Are you an exception in your workforce?
Answer: There are some colleagues who probably don’t agree that we can make any difference, but anaesthetics is changing into perioperative medicine. It’s a brand new speciality and we’ve got the opportunity to make a difference and have this as one of the key agendas moving forward. Building on my previous answer around the golden moment for behaviour change, it will not only impact on periodic outcomes but also long-term health readmission rates, GPs under pressure and we can do something about it. There are lots of other people involved, we’ve got people in every tribe of every trust in the North East who are going to be taking on the waiting well project. It’s exciting times, it’s new so it’s not everyone but we’re getting there.
Kerry Page, Project Development Manager, Keighley Healthy Living
Question 1: In some places, being referred to the voluntary care sector for pain service support by their GP is not the norm. How accepting were patients of this type of contact and what did the GPs think?
Answer: In terms of patients, the idea of community health linking with their medical health and the realisation that they could be helped, not necessarily to come off medication but, to reduce medication or manage better day to day was kind of a new concept. It was rare that patients understood that because people are so medicalised and they’re looking for that medical answer. Another side of this was that some of the GPs who worked with the voluntary care sector were really surprised at how professional we were and what we could offer. There was a process even within their surgeries or their teams to build confidence and to work with us and get used to us. Some feedback we received from a GP is – the contact with community health helped de-medicalise pain for some of the patients in line with NICE guidelines. He said that it offered a great opportunity for their appointments to extend care and that it was more sustained care that they were receiving day-to-day. They had patients who used to ring eight to six times in a week. One woman was so anxious about her condition, but after she met a few friends and started going to a social in our group and she stopped phoning the clinical indicators. There’s this massive piece of support for medical practitioners to dip into which this GP was talking to his teams a lot more about.
Question 2: What’s the best way to keep patients empowered and engaged in their care?
Answer: One of the reasons the two small pilots across North Yorkshire and Bradford have generated so much interest is because they were fairly unique in trying to take some of the theory, knowledge and data and thinking – what does it all mean for real people who face inequalities in their day-to-day lives. Working with people with chronic pain has been such an eye opener to me, I feel very passionately about it which is why I’ve gone and spoken to people across the country about the incredible results of this pilot. All I can do is try to head turn clinical settings and medical professionals to that benefit of linking with the VCS and community health. The pathway that works for people to tackle health inequalities is not rocket science, it’s really common sensical, basic actions that can be taken if we invest time in engaging people who face health inequalities. Going forward, we’re going to see what parts of that pathway are transferable to other areas and scalable and then to again try and raise awareness of the outcomes. This is not going to happen overnight but at least we can get people thinking about a different way of working. GPs, PCNs and ICSs have to start thinking about the community sector as not being the third sector and instead working more collaboratively. There’s real gaps in the academic research, there needs to be more robust evaluation about some of these outcomes and the clinical settings need to jump on board with getting some of the data proving that’s of a better quality than they were able to achieve in six months, we can really shine a light on what this can achieve.
Linda Hindle, Deputy Chief Allied Health Professional Officer and Engagement Lead for the Emergency Services, OHID (Office for Health Improvement and Disparities)
Question 1: How have AHPs responded to this framework?
Answer: It’s been incredible! I thought when we developed this that it was a bit of a niche area but the amount of teams that have taken this on board to have discussions within their team meetings, to look at how they can redesign their service to incorporate it into their strategies. Breaking it down into individual components has helped people who had had an interest but didn’t really know where to start working on this agenda which is wonderful.
All speakers – What is the one thing you would change to improve Health Inequalities?
Liz: You’ve heard from a range of speakers today, seek these people out who are in your area, whether they’re the experts, the patient groups, the trusted groups, the people who are delivering great interventions, like Kerry explained. They’re all within your own patch, seek them out and collaborate!
George: Use data to inform your actions but be critical of the data and keep pressing for more equitable data.
James: Just do something!
Kerry: If we want to really engage people with MSK and pain and tackle health inequalities, let’s really open up areas and listen to what they say will help them alongside their medical care.
Linda: We’ve all got a role to play so, however small it is, just see what you can do to make a difference.
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