You may have heard the saying ‘change happens at the speed of trust’. Through our joint work in Leicester, we are finding that trust – whether building it, rebuilding it, or sustaining it – is vital, particularly as we strive to improve access to health services for people in our most underserved communities.
Mita was a participant at a recent health workshop we ran at the Shama Women’s Centre in Leicester. The team at Shama provide a safe space for women from a range of cultural and social backgrounds to come together to share their stories, learn together and support one another. At our ‘Access to Cancer Services’ workshop, Mita told us that she had received a bowel cancer screening kit in the post and thrown it out, unsure what to do with it or why it was important. After our workshop, with information delivered from a trusted source, in a safe environment, she was ready to order a new kit for herself and share this with members of the community too. This is the difference between equality and equity. We are technically giving people the same access to services (equality), in this case by posting everyone a home bowel cancer screening kit. But differential levels of trust, knowledge and confidence in healthcare prevent people from taking those services up. Focusing on these gaps through authentic partnership in health education and literacy will enable eventual equity of access to NHS services.
The Shama Women’s Centre is one of three Core20PLUS5 Connector organisations in Leicester. Connectors are community partners working alongside the NHS to reduce health inequalities among our 20% most deprived (Core20) population and other groups experiencing poorer-than-average health outcomes (Plus) across five clinical focus areas determined by NHS England. There are stark differences in health outcomes among the Leicester population. People in the least deprived areas of the city live on average 10 years longer than those from the most deprived, and people from minority ethnic backgrounds are significantly less likely to access services such as cancer screening.
In a city famed for its cultural diversity – Leicester is one of the first ‘plural’ cities in the UK, where there is no single ethnic majority, according to the 2021 census – it is not enough to recognise the intersections between for example, deprivation, ethnicity, gender or disability in how people access healthcare. It is imperative that we understand and act on these intersections if we are to remove systemic barriers and address injustice in healthcare experiences and outcomes. This is impossible without true collaboration and co-production with our communities.
The Core20PLUS5 framework underpins our approach to addressing health inequality. We are continuously learning and we recognise three additional principles that enable progress:
- Partnership is key: the formal establishment of our Integrated Care System (ICS) and Integrated Care Partnership (ICP) brings together key partners to address the factors that impact on health inequalities, or the wider determinants of health, many of which are far removed from the health service, such as housing and employment. Alongside people and communities themselves, partnership with Local Authority Public Health teams, the voluntary and community sector and local Universities is critical.
- Data matters: good data tells us where to start. We are driven by our data in order to target resources and interventions most effectively. For example, UHL recently identified that men from Leicester’s South Asian communities are significantly less likely to attend cardiovascular outpatient appointments than white .Using this data as a starting point, we have recruited a team of South Asian language speaking volunteers to call patients to understand more about why this is so. It is only when we combine data with human insight in this way that we can start to co-produce the interventions that will make a difference where it is most needed.
- Action matters: Health inequality is an urgent problem demanding proactive intervention. The Shama Women’s Centre provides a range of practical support for women, through early interventions including health education and signposting to key NHS services to help improve health outcomes. Increasingly, the NHS is an active partner in this, helping to promote Shama’s services to both patients and colleagues and co-produce health solutions that meet the diverse needs of the local population, in particular women from Black and Ethnic Minority groups. UHL has over 30 live projects tackling elements of health inequality. Interventions underway range from colleague training to service development. Last year, UHL became the only NHS Trust to be granted a place on the prestigious International Health Institute (IHI) Pursuing Equity programme, cementing our commitment to addressing racial injustice in healthcare.
The recent opportunity to host Dr Bola Owolabi and showcase some of our community projects in action was an important opportunity to take stock. We recognise that we cannot solve everything overnight, but we remain committed to our belief and goal; incremental steps to build trust will enable us to become an organisation where health equity is how we are, not something that we do.