Lancashire Teaching Hospitals hosted a two-day workshop earlier this month with the NHS England and Institute for Healthcare Improvement (IHI) Core20PLUS5 accelerator sites, focusing on reducing healthcare inequalities in our communities.
The international IHI team and colleagues from the National Healthcare Inequalities Improvement Programme at NHS England joined the learning session, as well as LTH Chief Executive Kevin McGee, with other executives and speakers contributing to the event from the seven accelerator sites from each region of England - Lancashire and South Cumbria ICS, Cornwall and Isles of Scilly ICS, Humber and North Yorkshire ICS, Nottingham and Nottinghamshire ICS, Surrey Heartlands ICS, Mid and South Essex ICS and North Central London ICS.
The vision for Core20PLUS5 is to achieve exceptional quality healthcare for all, through equitable access, excellent experience and optimal outcomes. The aim for the Core20PLUS programme (20 being the most deprived 20% of the population, and 5 the focus clinical areas requiring accelerated improvement) is to reduce health inequalities in our communities in maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension case-finding.
The main approach is to work with the local community, to listen to their thoughts and concerns, to co-produce the improvement work and strategy, and learn together with other like-minded systems as innovative approaches are tested.
Lancashire Teaching Hospitals Chief Executive Kevin McGee and Andrew Bennett, Director of Population Health, Lancashire and South Cumbria Integrated Care Board opened the event, sharing the ambition for our local improvement through collaborative working. Pedro Delgado, the Vice President Institute for Healthcare Improvement, then spoke about the importance of the programme.
Pedro Delgado, the Vice President Institute for Healthcare Improvement, then spoke about the importance of the programme:
“The challenge historically has been, firstly, the focus on inequalities is a big, tricky area – where do we start? Secondly, it’s the difference between equality and equity. If we go for equality, we give access to everyone similarly, but there are populations for whom the starting point is just not the same. For instance, the 20% most deprived populations and population groups should identified locally such as ethnic minority communities; people with a learning disability and autistic people; people with multiple long-term health conditions; other groups that share protected characteristics as defined by the Equality Act 2010; groups experiencing social exclusion, known as inclusion health groups coastal communities (where there may be small areas of high deprivation hidden amongst relative affluence). That’s why closing the equity gap using targeted and disproportionate approaches is a precondition to equality.
“Core20PLUS5 Accelerator teams are taking a very different approach, going to these populations proactively and asking ‘what matters to you? How can we design our improvement work together with you to achieve best possible health and care?
“We are trying to show what different approaches there might be to truly close the gap so we can, at some point, do equality properly, because we’ve done equity.”
He added: “What we’re trying to focus on, firstly, is the refinement of the accelerator teams’ aims and theory of change – the drivers and ideas to get to the intended aim.
“Secondly, testing those ideas that will get you to the aim rapidly for learning and refinement And thirdly, measuring processes and outcomes, what we’re learning, and what adjustments need to be made in daily work to get to measurable improvements.
“The ultimate question teams are asking of themselves is - are our improved processes improving our outcomes? That’s what we’ve been trying to focus on to get a sense from teams of where they are in their theory of change and ability to test, and their agility to do it daily, and where they are in terms of measuring and learning.
“The last couple of days have been a lovely way of providing examples of what may be working well for others and having teams exchange knowledge and reflect on some of the challenges. That’s been the essence of our time together.”
Rebecca Cave, Strategy Programme Manager at the Royal Cornwall Hospital, was one of the delegates, and appreciates a more focused approach to reducing the health inequality gap:
“The Core20plus5 framework was released by NHS England as a structure for how we tackle health inequalities, so it gives you direction on how to ‘chunk up’ your population, who to target, where to look, and also flexibility in terms of local need.
“The Core20 part is looking at the 20% most deprived in your local population, and the 5 areas are specifically linked to the NHS long-term plans for cardiology, maternity, mental health etc. And the plus bit is those populations specific to your areas, so for me, in Cornwall, we want to focus on traveller communities, because that is our largest minority population.
“The framework, with the support of this programme, puts programmes and interventions in place that are going to deliver change for those people.
“We’ve been talking about health inequalities for years, and the idea of the framework, coupled with this programme, is we get doing some doing, get some learning out of it, and then look at how do we roll that forward. We’ve not previously had that direction.”
LTH’s Director of Continuous Improvement Ailsa Brotherton felt the sessions were hugely informative:
“I’ve learnt an enormous amount, the benefits of appreciating colleagues and saying thanks for the work that they do, and what inequality looks and feels like, if you are born into a family or community that is disadvantaged.
“We have focused our work on understanding social injustice and how we, as leaders, can plan and think very differently about how we work and how we offer services to the communities that we serve, in a way that our improvement work is undertaken through the lens of understanding and reducing health inequalities.
“We have also focused on the importance of going out to meet our local communities, connecting well on a human level and understanding what it is like to walk in the shoes of people who live in the communities that we serve – not making judgements or decisions based on our view of the world, but taking the time to really listen and understand what matters to people so that we can redesign our services to reduce health inequalities.
“We are working initially on improving early cancer screening as we know from our analysis of the data that some of our local communities are presenting when they have later stages of cancer and we have an opportunity adopting improvement science through an inequalities lens to work with our local communities so that they access regular screening, are aware of the symptoms of caner and access cancer care early.
“One of the important lessons I have learnt is that this doesn’t take resources or money, it takes humility and a willingness to listen, and then to provide our services in the way our local populations want them to be delivered.
“The Core20PLUS5 programme is really important for us, we’re applying this robust improvement methodology, starting an inch-wide, mile deep, focusing our work with one local community in St Matthew’s, at the same time as capturing our learning and planning how we will scale up this work across our ICS to reduce the health inequalities that have existed for many years across Lancashire and South Cumbria.”
Andrew Bennett, having opened the event, is looking forward to putting the learning from the event into practice:
“We were delighted that the Lancashire and South Cumbria system was chosen to be part of this programme. We are very consciously trying to capture our learning from this programme and planning how we will scale up this work across our ICS to reduce the health inequalities that have existed for many years across Lancashire and South Cumbria.”
Dr Aoife Molloy, Senior Clinical Advisor for the Healthcare Inequalities Improvement Programme, who works in Infectious Diseases at the Royal Free Hospital London, added:
“It is really encouraging to see the accelerator sites progressing their projects with such thought and care as they get to know each other and learn within their teams and across England how to improve healthcare inequalities locally.
“I am delighted this work has moved from ideas to actions and I am impressed with the trust and collaboration between workshop participants. I believe this work will bring focus, traction and impact to improve outcomes and address unfair and avoidable healthcare inequalities."
And Abdul Hamied, Deputy Director Strategic Partnerships, National Healthcare Inequalities Improvement Programme, closed:
“We also learnt so much from the great work and leadership that is in place to support the healthcare inequalities and service improvement agenda. And we have taken away some learning for us as a national team (along with IHI) on how we may build upon this for the remaining period of the Connector programme and more."
