‘Saviours’: how community health and wellbeing workers are helping to tackle health inequalities in England

Across the country, there is a growing army of dedicated community health and wellbeing workers (CHWWs) who are playing a pivotal role in helping people who live in some of the country’s most deprived and under-served communities access vital health and care support. Complementing other important programmes across local systems, the CHWWs initiative is paying real dividends, helping to improve the lives of many who are sometimes at risk of falling through the cracks.

As part of my role as National Director for NHS England’s Healthcare Inequalities Improvement Programme, I often get the opportunity to travel up and down the country to see first-hand examples of good practice that are helping to reduce health inequalities. On 27 March 2024, I saw first-hand the tangible difference CHWWs are making, during a spring visit to north and southwest London. I started the day at the Portman Early Childhood Centre in Westminster and ended late afternoon following a tour of the Doddington and Rollo Estate in Battersea.

There are certain general commonalities across estates – their populations are diverse, and their communities are afflicted by high levels of deprivation, including poorer health outcomes, social isolation, substance dependence, and mental health issues. All these combine to make the role of CHWWs so vital.

CHWWs are embedded in the heart of their communities. Recruited locally, trained, and paid, they provide day-to-day health and social care support to residents in small, defined geographies of around 100-150 households. They serve whole estates, knocking on every door, and building trusting relationships that connect marginalised communities to the health and care they need.

They are employed by a council, integrated care board or primary care network. They are integrated into the local GP practice and immersed in the local community and voluntary sector, uniquely positioning them to integrate health, social care and voluntary sector at the household level.

Their approach to healthcare is proactive. Residents in their allocated area are visited at least once per month, enabling the CHWWs to identify problems as they arise and resolve them before they become larger issues by leveraging their relationships with relevant professionals or local services. It is a cogent example of important, deliberate action to narrow the health inequalities gap.

The CHWWs initiative is a relatively new model. It is based on the Brazilian model – called the Family Health Strategy – which has been running successfully at a national scale in that country since the early 1990s.

Evidence has shown the model in Brazil has led to sustained improvements in hospital admissions, hospitalisations and mortality for chronic diseases, as well as improvements in immunisation and screening uptake.

On my visit, I was moved by the stories of residents who shared the profound impact CHWWs have had in their lives.

One went as far as describing her community health and wellbeing worker as her “saviour”, thankful for the support Rhianna, from Battersea Fields Practice, has given her as she tries to navigate a new life in the UK. The resident, who moved to the country with her family about a year ago, speaks little English and has benefitted from Rhianna’s support with housing applications and seeking employment.

It was also inspiring to hear from Rhianna who spoke passionately about her work. She has been working as a CHWW for the past 6 months. Before this, she pursued a degree in chemical engineering and worked as a data coach. But her passion for holistic health, nutrition, and wellbeing prompted her to pivot into this “fulfilling role”, where she can make a tangible difference in people’s lives, using her diverse skillset.

The first initiative of this kind in London was launched in Westminster in 2021 amid the Covid-19 pandemic.

An evaluation report on the Westminster initiative, published in July 2022, has concluded that there is good experiential evidence that CHWWs are effective at befriending, counselling, mediating, building trust, relationships and rapport, and connecting people to support services.

Among other things, this has helped with medicine compliance, immunisation and screening uptake and low-level social prescribing.

These initiatives are constantly adapting and improving to meet the operational requirements in a UK context, with many more opening up across the country.

Since 2022, there have been other pilots across the country including in Calderdale, Bridgewater, Cornwall and Oxford. There are now over 100 CHWWs around the country serving 20,000 households in deprived areas.

If you are interested in finding out more, please contact Marcus McAlister, Programme Manager, National Association of Primary Care via email

Dr Bola Owolabi

Professor Bola Owolabi (MRCGP, MFPH Hon, FRSPH) is Director of the National Healthcare Inequalities Improvement Programme at NHS England. She works as a General Practitioner in the Midlands.

Bola has particular interest in reducing healthcare inequalities through integrated care models, service transformation, and using data insights for quality improvement. She has spearheaded NHS England’s Core20PLUS5 approach to narrowing healthcare inequalities.

Internationally, Bola was a member of the Danish Ambassador’s Tour De Health – a ten nation healthcare policy leaders’ summit. Additionally, she was the UK representative on the Commonwealth Fund/Academy Health Tour 2023, exploring equity in national health policy across the United States, Australia, New Zealand and Singapore.

She was previously National Speciality Advisor for Older People and Integrated Person-Centred Care at NHS England, where she led the Anticipatory Care workstream of the National Ageing Well Programme. She collaborated with teams across NHS England and the Department of Health and Social Care as part of the Covid-19 pandemic response.

Bola is an alumna of Ashridge Executive Education/Hult International Business School and holds a Masters degree with distinction in Leadership (Quality Improvement). She also received an NHS Leadership Academy Award in Executive Healthcare Leadership for Clinicians.

Bola is an Honorary Professor at the Institute of Applied Health Research, College of Medicine and Dentistry, University of Birmingham. She is also a Vice President of the Royal Society of Public Health (RSPH).