Making health services work for deprived populations in the North East

The North East of England is home to over two and a half million people; over a third of which live in the 20% most deprived areas of England.

Evidence shows that those living in the most deprived areas face the worst health inequalities and the national NHS England Core20PLUS5 approach identifies this population group as a key cohort requiring focused attention.

In the region, healthy life expectancy is around 59 years. Almost 70% of adults are classed as overweight or obese and the number of adults who smoke, including pregnant women, is higher than the England average. Fewer adults living in the North East achieve the weekly recommended level of physical activity or eat five portions of fruit and vegetables a day.

Healthworks believes that everyone should have the same opportunity to live in good health. As an organisation we are committed to reducing health inequality and supporting people to overcome challenges and barriers to good health.

Together with partners across public health and the NHS, we develop new initiatives and services to meet emerging need and support people living in poverty in our region.

We deliver a range of projects, activities and interventions which support people of all ages to lead a healthier life. These include increasing physical activity and improving mobility, healthy eating, smoking cessation and managing diabetes and other long-term conditions. These programmes are largely delivered in areas where there is a greater dependence on health, social care, and other services due to factors including low income, unemployment, lack of education, poor housing and child poverty.

One of our key areas of focus is supporting the NHS by delivering a number of pre-habilitation and rehabilitation programmes to help people experiencing conditions including cardiovascular disease – one of the five areas of clinical focus outlined in the Core20PLUS5 approach.

A twice weekly exercise class for people who are recovering at home following a cardiac event takes place at community venues in Byker and the city’s West End; areas which have high levels of deprivation. Health improvement practitioners employed by Healthworks deliver the clinically supervised sessions and participants are closely monitored by cardiac nurses and the cardiac rehabilitation team from Newcastle Hospitals NHS Foundation Trust.

As part of this, a weekly education session provides advice on stress, healthy eating, behaviour change, medication, exercise for life and how the heart works. This helps individuals to identify and act on issues that impact their health and wellbeing, and supports longer term, positive life-style changes. The classes offer participants the opportunity to build their fitness in a safe, supported, environment and makes it easier for those living in the area, who may be experiencing financial difficulties, to access this vital service. It also encourages participants to build connections in their community which will support them to continue to access services in the future.

The programme supports approximately 200 people each year and most participants show an improvement in their cardiovascular endurance within six weeks. Participants are then supported to progress to an exercise for life class which helps them maintain their wellbeing.

We are also running a research project with Northumbria University and Newcastle Hospitals NHS Foundation Trust, looking into the benefits of a 12-week virtual exercise and behaviour intervention for patients with Peripheral Arterial Disease (PAD). As of November 2022, 30 participants have been referred to the rolling programme which is seeing positive early results including participants reporting they feel fitter and stronger. The service is currently being evaluated as part of a randomised controlled trial.

A number of other exercise programmes are available to NHS patients via Healthworks. These include a class for people experiencing long-term knee, hip or chronic back pain; a leading cause of sickness absence in the work environment.

Older people who have had a fall or who fear falling can also access a free 27-week community-based fall prevention service. The structured exercise classes focus on building strength, improving balance and increasing confidence to help people manage in their everyday lives.

As well as realising improvements associated with specific conditions, these programmes have had additional health benefits for participants including reducing anxiety and loneliness, weight loss, and improved mental wellbeing. Our practitioners are also able to refer to our other services, for example smoking cessation. We often find participants increase in confidence and independence and they tell us they’re now able to get out of the house more and do things they enjoy and want to do.

These programmes can play a real role in helping to relieve pressure on NHS services by improving people’s health.

We were delighted to recently welcome Dr Bola Owolabi, Director of the National Healthcare Inequalities Improvement Programme, to Newcastle to see firsthand the amazing work happening with the NHS to help narrow healthcare inequalities and improve access, experience and outcomes for people in the region. You can take a look at a short film from her visit here.

Going forwards, we have a number of plans to further support health in our region. We have recently been commissioned by the Northern Cancer Alliance to drive improvement in cancer outcomes through earlier diagnosis and improved uptake of cancer screening and prevention. This will involve developing, planning and coordinating learning events for primary care professionals on interventions to support early cancer diagnosis as well as providing analytic support to help them understand local data and health inequalities around screening, prevention and early diagnosis. We also will undertake work to raise cancer awareness within the community, delivering interactive sessions at local organisations and groups, creating a number of window displays and hosting community cancer champions courses in targeted areas to equip local people with knowledge which they can share within their community.

In addition, we will be delivering a number of groups across Newcastle, Gateshead, North Tyneside and Northumberland to support people to improve their overall health and wellbeing while waiting for surgery. The groups are aimed at people who are overweight or obese, who have diabetes, who smoke or who misuse substances. People attending the groups will be offered referrals and sign posting advice for services to help with wider issues which may be impacting their health, for example help to access local physical activity provisions, money management services, debt advice, housing and benefits.

Integrated working makes a huge difference to reducing health inequalities. Charities like Healthworks provide a real opportunity for the NHS to reach and engage with underserved communities; ensuring equitable access, excellent experience and optimal outcomes for all.

Photograph of Paul Court, Chief Executive, Healthworks

Paul Court joined Healthworks as their Chief Executive in October 2019. Paul supported the development and formation of Healthworks over 27 years ago and since then has worked at a senior level across the NHS and Newcastle City Council, shaping policy and practice to improve outcomes for disadvantaged communities including children and young people. Previously, Paul has developed and led Sure Start services, been a researcher influencing national policy, NHS board member and a long serving Grant Committee member for BBC Children in Need. Paul is a current volunteer Director for Swim England North East.