Reducing health inequalities in Hertfordshire: The Purple Star Strategy

Case study summary

Hertfordshire’s Purple Star Strategy, a joint venture between the Hertfordshire County Council and NHS England, helps to improve access to healthcare services for people with a learning disability. Set up in January 2015 and using Transforming Care funding, the project supports health care providers to make reasonable adjustments that will reduce the impact of delays in diagnosis and treatment.


The Confidential Inquiry into the premature deaths of people with learning disabilities [CIPOLD 2014] identified that people with a learning disability die an average of 17 years younger than the rest of the population and a significant factor identified was delays in diagnosis and treatment. This can because a person finds it difficult to communicate, or due to issues relating to the person’s capacity to consent and the process of making best interest decisions.

The purple star strategy gives accreditation to health services which take steps to bridge these health inequalities gaps. The team works with health care providers to both quality check, educate and enable them to offer a service of excellence.

To help understand the difference health care providers can make, Hertfordshire developed a reasonable adjustment training framework called TEACH: Time, Environment, Attitude, Communication and Help.

To apply for accreditation with the Purple Star, providers need to complete the training and agree an action plan to evidence what adjustments they can make and how it would work in practice. The service is then reviewed by a steering committee to decide whether it will receive accreditation.  The accredited service also receives continuous support from a community learning disability link nurse who monitors their practice and reports to the steering committee for annual renewal.

Since the project began, a number of reasonable adjustments have been made including:

Access to GP services:

  • One of the GP surgeries focuses on building good relationships with their patients with a learning disability by explaining the purpose of the NHS health check, understanding why patients did not attend previously, and taking individual preferences into account (e.g. easy read invitation, phone call to book a favourable time). As a result, 19 of the practice’s 21 patients with a learning disability received annual health checks.
  • Another GP surgery opened a designated phone line for patients with a learning disability, autism or both that bypasses the automated machine.
  • One surgery sees patients in a place when they feel most relaxed, such as the mini bus transport provided by the residential care. This allows the GP to be truly person-centred and notice any changes quicker and react accordingly.

Access to dental services:

  • A person was given an initial assessment whilst they ate porridge. This allowed the dentist to make enough of a diagnosis to be able to make a best interest decision to use a general anaesthetic when dealing with the person’s significant dental issues.

Participation in the Improving Access to Psychological Therapies (IAPT) service:

  • A person who found it difficult to relate her feelings to emotion cards was found to be a fan of ‘Strictly Come Dancing’. To help them engage in the therapy, the therapist asked the person to relate her feelings to certain dances she had watched on the previous shows. This innovative approach helped the person relate her feelings to her actions and truly benefit from the therapy.

Find out more about the Purple Star Strategy: