Narrowing inequalities in waiting lists in Leicester

Achieving health equality is a founding principle of the NHS and a key priority for us at University Hospitals of Leicester NHS Trust (UHL). In June 2022, I was proud to join the trust as Director of Health Equality and Inclusion; a new role with board accountability for addressing health inequalities.

Serving a vibrant and diverse population, UHL provides acute care and treatment for over a million people across Leicester, Leicestershire and Rutland (LLR), and the surrounding counties. Within a mile and a half of our main hospital, 27 different languages are spoken and the 2011 census identified that almost 50% of the population of Leicester city was of ethnic minority heritage, a statistic which is reflected in the make-up of our workforce. As such, our colleagues are ideally placed to help us connect with our local communities and act as a gateway to our services.

Many people living in Leicester and the broader LLR system live in areas of significant deprivation and poverty; there are high rates of smoking, obesity and harmful alcohol use, in addition to multiple chronic health problems. Our population has a lower-than-average life expectancy and more years lived in poor health. They also currently face some of the longest waiting times for treatment in England; one in ten people in LLR are currently on a waiting list at UHL.

Increasingly evidence shows that from first contact to intervention and discharge, inequalities influence interactions and outcomes at every step of the patient journey. Addressing healthcare inequalities will require a proactive and intentional approach. We have taken a number of steps towards equitable access for all and to make sure those living in the area have excellent experiences and achieve optimal, individualised outcomes. Understanding our population is fundamental to this and relies on having good quality, robust data available. In addition to local data, national tools such as the Healthcare inequalities improvement dashboard, bring together healthcare inequalities data in one place to provide actionable insights on which meaningful interventions can be based.

One of the most tangible examples of where our approach is working well is our pilot Did Not Attend (DNA) Programme for respiratory services. Chronic respiratory disease is one of five clinical areas requiring accelerated improvement within the national Core20PLUS5 approach and our programme has been designed to improve access to our services and the efficiency of outpatient capacity use. Using local data, the trust identified that many of those not presenting at appointments (DNAs) belonged to deprived communities and/or were of ethnic minority backgrounds. To address this, a team of volunteers and colleagues proactively contacted patients from population groups identified as being more likely to DNA. This is in order to offer support with travel costs and car parking, as well as longer appointments where needed. Initial results have shown a significant difference in attendance for those contacted. DNA rates among this group were less than 1% compared to 50% for patients who were not contacted.

In 2021/22 there were over 4,000 DNAs in respiratory services alone at UHL: the majority affecting patients from the lowest indices of multiple deprivation. The economic case for improving equity and inclusion within our services is clear. However, the priority for UHL is improving the quality of our services for patients; enabling those in greatest need to access the services and clinicians which are most likely to benefit them.

The work of this pilot is easily transferrable to other services. We have started to analyse our waiting lists by deprivation and ethnicity, and we are working on how we can improve access to elective care for patients with a learning disability. Conversations on how to reach inclusion health groups including Gypsy, Roma and traveller communities, through partnerships with colleagues in community and voluntary sectors, are also active and ongoing. We are also actively engaging with local faith and community groups to explore how services can be adapted to improve access for people from Black African communities.

The journey to health equality will not be without challenge due to the scale and complexity of the issue and will be impossible without compassion. Our workforce is consistently stretched and exhausted, and the impact of compassion fatigue cannot be underestimated. If we are going to tackle health inequality, we have to also care for those we employ; our dedicated UHL Staff Wellbeing Service aims to provide staff with access to support tailored to their personal and professional needs.

Within my first week in the job, it was clear to me that a huge amount of powerful work is already happening to tackle health inequality at UHL and there is an appetite and will to continue to learn and improve. We must make every contact count.

Our focus for now is on building on the progress that we have made to date, understanding the needs of our population, being truly responsive, and supporting our teams to deliver the best care possible.

Photograph of Dr Ruw Abeyratne, Director of Health Equality and Inclusion, University Hospitals of Leicester

Dr Abeyratne is a consultant geriatrician and recently joined University Hospitals of Leicester as their first Director of Health Equality and Inclusion. She has a personal and special interest in workforce wellbeing and is an active member of the Midlands’ Charter Board.

Dr Abeyratne has campaigned for improvements in organisational approaches to addressing discrimination and is involved in regional work to tackle inequalities in the workplace as well as being a certified health and wellness coach.