Tackling Health Inequalities: Involving children and young people in a Strategic Health Assessment to identify population health needs

Tackling health inequalities is one of the key ambitions for NHS-Led Provider Collaboratives for specialised mental health, learning disability and autism services. Programme Director Dorian Cole explains how children and young people were key in developing a Strategic Health Needs Assessment (SHNA) to highlight what North Central and East London CYP Provider Collaborative needed to focus on.

North Central and East London Children and Young Peoples’ Provider Collaborative (NCEL CYP PC) serves a very diverse population with 60% of the children and young people within the Provider Collaborative’s local area being from black or other ethnically diverse communities. As well as significant diversity, the PC also covers an area that has high levels of deprivation.

The NHS-Led Provider Collaborative is responsible for identifying health inequalities within their local area to inform how they develop and tailor their services to increase access, improve experience and ensure service users achieve the outcomes they need and deserve. Using a Public Health Strategic Needs Assessment methodology as the foundation, the NCEL CYP PC carried out an assessment into the mental health of their local children and young people. Recognising the purpose of the exercise was to better serve the young people in the local area, involving young people in the planning and design of the methodology was essential. This is standard of NCEL CYP PC’s approach, which has embedded expertise by experience leadership throughout its operational model to ensure the voices and perspectives of people who have experienced mental ill health and accessed NHS services complement the expertise of professionals to drive service improvements.

One of the Collaborative’s Experts by Experience said: “The Collaborative is actually giving you a chance to be part of the decision-making process for service users and families and carers. You get a chance to speak to management and not made to feel belittled. Everyone is on an equal footing. You are acknowledged and made to feel important.”

Working with the public health team at East London Foundation Trust, the NCEL CYP PC worked with experts by profession and experts by experience to design the approach. By triangulating data from multiple sources, the project team ensured that the findings were robust and using mathematical statistical tests ensured the results were reliable and significant. Young people worked alongside the public health team, meeting weekly to co-produce the data collection. When it came to interpreting the qualitative data, the experts by experience were instrumental in analysing the information and identifying emerging key themes.

Young Person 2: “I feel that I am making a difference in the lives of young people by understanding their experience of the unit environment, and highlighting how it is important that the units are run in such a way as to aid their recovery.”

Once the final report had been written, experts by experience co-presented the findings from the Strategic Health Needs Assessment (SHNA) with the research team to the NCEL CYP PC’s Partnership Group, which includes 200 representatives from health, social care, local authorities and the education sector. The findings in the report were backed up by credible data, enabling the Provider Collaborative to identify health and social inequalities and name them in such a way that multi-agency partners, including integrated care systems (ICSs), could work together to identify what actions needed to be taken across the different levels of a complex health and social care system to resolve them.

This report has allowed the NCEL CYP PC to work with partners to identify evidence-based, key priority areas for action for the next three years, which will inform both the clinical and operational strategy to ensure vulnerable children and young people receive the care and support they need and deserve. These actions will require whole system and multi-agency engagement and will be driven through the use of a methodology developed by the Institute of Healthcare Improvement (IHI) called the Triple Aim QI process. The focus for year 1 will be on reducing the disproportionate use of Mental Health Act and Psychiatric Intensive Care Units (PICUs) for black and other ethnically diverse young people; and reducing the disproportionate admission rate to General Adolescent Units (GAUs) for white female young people by offering alternative community treatments such as Dialectical Behavioural Therapy (DBT).

Young Person 3: “It has given me a voice and helped me to make a difference to be involved.”

Reflecting on how the Provider Collaborative model has supported this project, Dorian Cole explained that it has been instrumental in encouraging different providers to collaborate rather than compete. Collaborating to combine their local understanding of health and social inequalities has created a powerful report that has been embedded into the local ICS’s transformation plans for children and young people’s mental health. The involvement of children and young people in the development and design of the report has ensured that the results and messages are much more powerful.