Healthier lives in Leicester: why tackling health inequalities sits at the heart of our new trust strategy

Richard Mitchell, Chief Executive of University Hospitals of Leicester NHS Trust (UHL), discusses tackling health inequalities in Leicester and the surrounding region, which hosts one of the most diverse and dynamic populations in England.

At UHL, we are proud to serve one of the most ethnically and culturally diverse populations in the country. Over 95 languages are spoken here, and Leicester is the UK’s first ‘plural city’ where there is no single ethnic majority.

Such is the strength of the city’s diversity, that colleagues who choose to join us from all over the world tell us that Leicester begins to feel like home very quickly.

While we celebrate our population’s diversity, we recognise the added complexity this brings to an already challenging environment. Population health data is stark and driven largely by deprivation – there is currently a 12-year life expectancy gap between the most and least deprived wards in our area.

When you overlay demographic data and lived experiences, it is clear there are a number of interconnected factors at play with no simple fix. The notable differences in the ways people access and experience care demand that we are increasingly bold about the role we play as an integrated trust.

That is why we have placed a commitment ‘to embed health equality and inclusion in all we do’ at the heart of our new strategy (UHL website), Leading in healthcare, trusted in communities (YouTube).

But what does this mean in reality?

The first step we took was to appoint a director for health equality and inclusion in 2022, providing accountability and visibility for the agenda at board-level. Under Dr Ruw Abeyratne’s leadership, we now have more than 30 live projects in our health inequalities programme at UHL – driven by data and experience and overseen by an internal health inequalities steering group.

A recently formed health equality partnership, made up of community leaders and representatives, will provide valuable check and challenge on strengths, gaps, and any equalities considerations we might be missing as the programme evolves.

Our Core20PLUS5 connectors are vital to this. The Core20PLUS5 framework is central to our approach, and the connector organisations have been doing phenomenal work to drive up awareness of the five clinical areas, especially cancer. In a visit last year, we were proud to showcase some of their work with under-served communities to Professor Bola Owolabi, Director of NHS England’s National Healthcare Inequalities Improvement Programme.

We have also recognised our role in responding to the complex needs of our dynamic population – which should be the business of every partner in an integrated care system.

Developing strong relationships with community partners and voluntary, community and social enterprise (VCSE) organisations means we are rebuilding trust in communities. We believe this will improve equity of access, outcome, and experience.

As an example, following a brief pilot, all patients living in the most deprived areas of Leicester (indices of multiple deprivation 1 and 2) are now contacted via telephone prior to a planned appointment.

The opportunity to remind patients of their appointment and offer support to attend has led to a consistent improvement in access, eliminating the gap in non-attendance between our most deprived patients and the trust average. In addition to the clear benefits for patients, this has important implications for the efficiency and productivity of our services, too.

In the last year, as published in our inaugural prevention report, UHL colleagues have worked with community and primary care partners to support 3,000 people to quit smoking, and 1,450 people with alcohol-related conditions, primarily as referrals from inpatient settings and our emergency pathway.

We have identified clear actions which focus on the underlying causes of chronic ill health and inequity, and we are changing the foundations of service provision to meet people’s needs in a holistic way.

Importantly, this includes our growing workforce, who are of course part of the communities we serve. Our colleague-facing smoking support service opened in October last year, and we have already received positive feedback from people who have been helped to make a lasting change.

This is part of a growing raft of work to support the wellbeing of the 18, 000+ people who work at UHL, and to meet our goal of becoming a great employer for all.

The next step is to operationalise our new strategy, ensuring that the intent to embed health equality in all we do becomes action right across the organisation. This means creating a social movement that everyone can connect with and see their role in.

The task is an urgent one, and we are always keen to talk to other providers, partners and systems to share and receive learning on what works:

Richard Mitchell is Chief Executive of University Hospitals of Leicester NHS Trust, having been appointed to this role in October 2021. In October 2023 he was also appointed Chief Executive of the University Hospitals of Northamptonshire NHS Group.

Richard chairs the East Midlands Acute Providers Network, where the 8 acute providers across the East Midlands come together to improve clinical services and to strengthen recruitment and retention. He is also Chair of the East Midlands Cancer Alliance and the Midlands Regional Talent and Leadership Board.

Richard is proud to work in his local hospitals, and he and his family live in Leicestershire.