In an informative panel discussion at Chamber’s Midlands Integrated Healthcare Seminar, professionals across healthcare services spoke about an equitable approach to delivering services nationwide. The experts shed light on the practical ways to improve engagement in diverse communities and suggested how doing so can reduce healthcare access inequalities and boost healthcare outcomes.
Held in partnership with IQVIA in Birmingham, the panel featured:
- Catherine Pollard/Chair – Senior Director, Strategic Operations, Moderna
- Amanda Sullivan – Chief Executive, NHS Nottingham and Nottinghamshire ICB
- Professor Bola Owolabi – Director of Health Inequalities, NHS England
- Khudeja Amer-Sharif – Chief Executive Officer, Shana Womens Centre
- Dr Natalie Darko – Director of Inclusion, Leicester NIHR Biomedical Research Centre
- Dr Ginny Ashman – Vaccination Programme, Clinical Lead
- Professor Matt Brookes – Clinical Director, NIHR CRN
Time to Act
Amanda Sullivan kicked the panel discussion off, saying that her driving motivator has always been to address health inequalities across integrated care systems. Ever since beginning her role at the Nottinghamshire ICS she said her focus had been to stop “just commentating on inequalities and start addressing them.”
Amanda spoke about repurposing the analysts within the analytics and intelligence units in her ICS to understand the granular details of individuals who need more support.
She said: “We have tried structurally to hardwire tackling inequalities into how we work.”
Nottingham ICS is one of the Accelerator Sites for CORE20 PLUS, making them one of the key players within NHS England to develop and share good healthcare inequalities improvement practice across the ICS. The ICS funds a Health Inequalities and Innovation Fund which, Amanda shared, will be a crucial resource to offering targeted intervention to individuals with severe multiple disadvantages. These individuals, especially in the Nottingham and Coalfields areas, suffer with mental health issues, addiction and homelessness and so by placing funds into services that desperately need support the ICS have worked to target disadvantage and inequality in a practical way.
Funds have also been allocated to local charities who, as a result, are now able to play a continued role in the delivery of services for the disadvantaged. Another key focus for the ICS is the Family Mentor Scheme, which concentrates on offering individuals in communities in and around Nottingham a better start in life.
Integrated Neighbourhood Teams are also being invested in to mobilise community assets and redefine how health systems work more successfully in partnership.
Amanda said that fuel poverty had been a particular concern in terms of those with unequal access to services, and so the ICS and partners used analytics to locate at-risk households of over 65s with long term conditions. They were then able to offer a group of 5000 people increased benefits, fuel poverty payments and debt management payments, which made a difference to uptake.
Another focus when it comes to tackling inequalities for the ICS is targeting diseases that have the biggest impact. “We are building our capabilities and partnerships to have much more bespoke ways of working to tackle some of the wider determinants of health but also the biggest disease burdens as well.”
As well as increasing funds to aid timely interventions and access to much needed services, Amanda said prevention is also key.
Measuring Improvement
Catherine Pollard raised the issue of making reforms and measuring changes when there is such uncertainty around funding. In response, Amanda shared that they have committed to increasing the Health and Equalities Investment Fund every year, and embedded this in their Integrated Care Strategy and NHS Future Plans to commit to improvement long term.
Speaking about measurement and sustaining investments, Professor Bola Owolabi, explained how it is necessary to be more specific. She said: “I think there is a reframing exercise to be done to say that investment in reducing health inequalities is not necessarily measured in years. This is measured in the reduction of diseases in the Core20 population and an easing of pressure on health care services.”
In terms of sustainability of funding, Professor Bola said that strong leadership is key. She referenced Amanda’s skill at leading and about using the healthcare inequalities adjustment funds that are already allocated in every ICBs baseline allocation.
“We need courageous leaders to say to the system that the money is there – let’s use it for what it is intended for.”
Research Inclusivity to Reduce Inequality
The panellists spoke about the role research can play in producing better health outcomes and lowering inequalities. Moderna’s Catherine Pollard said that research has shown that areas and organisations who are “research active” tend to have better health outcomes.
“We know that healthcare outcome disparities across the country are often perpetuated by the types of people participating in research. So (we need to think) about how we can do research that is inclusive.”
The Director of Inclusion at Leicester NHR Biomedical Research Centre, Dr Natalie Darko said there were a lot of practical things we can do. She shared that the most important thing currently is to educate people about the distinction between equity and inequality. She spends a lot of her time talking to those conducting research and urging them to take a more individualised approach, instead of assuming that all people in one area are the same.
An equitable approach is to recognise that multiple things affect different people in the same area and so thinking and working in silos, and delivering research in a similar fashion is not helpful.
“We need to work in a coproductive way to move closer to an equity approach.”
Adding to this point, Matt Brookes, Clinical Director at NIHR CRN, said that investment is being put into the up-skilling of researchers working in the recruitment of research participants in order to improve inclusivity. Another important focus needs to be the community connection, Matt added, saying that research findings need to be fed back into the communities in order to “win the hearts and minds of the people.”
The panel agreed that funding needs to be prioritised, specifically in deprived areas, and Khudeja added that community leaders, such as herself need to be linked into the participant recruitment process in order to overcome community stigmas and taboos around certain conditions. Once communities understand the benefits of participating then they are more likely to join.
“Community leaders are the gate openers. It is about the importance of contribution and trust.”
Avoiding AI Entrenching Bias
The panellists also discussed the importance of connecting and communicating with the big tech companies to raise awareness about the risk of using AI to research and explore health inequalities. Professor Bola Owolabi shared how she had spoken with Google’s Chief Health Officer and it was already on their radar about how to deal with algorithms and AI-related biases.
Alongside AI, Amanda mentioned how digital inclusion is also something to focus on because more people are now connecting with health services via digital means. Without a proper understanding of how to use these services, it can affect the equity of access to them.
A Multi-Pronged Approach
The speakers on today’s panel agreed that a multi-pronged approach to tackling inequalities across ICS areas is imperative. By utilising the funding that is already earmarked for tackling inequality, a real impact can be made when it comes to reducing pressure on the health services. Connecting with communities in order to make research more inclusive is also key. The panellists agreed that we are on the right track, and it is exciting to see the change that is already being made to ensure an equitable approach to healthcare.
Watch the full video here: