Tackling health inequalities is a key focus for NHS recovery from the Covid-19 pandemic – and NHS England has already set out eight urgent actions that services should take.
But to achieve lasting change, the learning from projects tasked with addressing these inequalities needs to become much more transferrable, says Professor James Kingsland, clinical lead for the Complete Care Community programme.
Speaking to Healthcare Leader two months after the launch of the programme – which is using population health approaches and multidisciplinary partnerships to address local inequalities – the former GP says that despite being successful, existing health inequalities projects are often individual, isolated and ‘non-transferrable’.
Instead, the Complete Care Community programme is focusing on a ‘consistent design and approach’ from the outset, with the aim of ensuring that learning can be adopted ‘no matter what your complex need might be, in whatever geography’.
It is hoped that the project will encourage new ways of working that will spread through healthcare systems.
‘My experience in the NHS is if you don’t build in a spread programme, ultimately your project starts to die, it decays, it finishes – and then somebody picks it up in 10 years’ time and says that was a really interesting thing you did 10 years ago,’ Professor Kingsland says. ‘And we do that exhaustively.’
Complete Care Community is supporting 19 ‘demonstrator sites’ across three regions of England, each involving one or more primary care networks (PCNs) and some spanning the geography of a local council.
The sites – each chosen by their NHS region – are focusing on areas such as knife crime, obesity, prison populations, and child and adolescent mental health.
Same approach, different need
In 2010, a review led by Sir Michael Marmot outlined six policy objectives for reducing inequalities after finding that action was required against all the social detriments on health.
But a decade on, a report marking its anniversary found that life expectancy had stalled for the first time in over a century, and for the poorest 10% of women it had begun to decline.
Professor Kingsland says this signifies that more needs to be done nationally, because as ‘much as localised projects have been very successful – they’re not having an impact across the nation’.
He adds that there is sometimes a ‘not made here syndrome’ in the NHS – the idea that a project or approach in one part of the country could not be applied elsewhere – and this is what the Complete Care Community programme is trying to change.
‘We want to make sure that if we’ve designed something in the Wirral – where I am – no one is going to say: “Oh it would never ever work on the south coast because we’ve got such different populations”.’
PCNs – as the ‘smallest part’ of the new ICS infrastructure – are operating as the anchor of the programme, Professor Kingsland explains. This ‘anchor organisation’ will provide clinical leadership as it engages with local councils and CCGs, representatives from public health and social care, and members of the communities the projects are targeting.
The Complete Care Community’s central programme management office (PMO) then works closely with clinical teams and other key contacts at the demonstrator sites – the idea being that with this relationship established, it will be easy to share specific learning between them.
Finding an approach that is sustainable and then being able to transfer that to ‘whatever your need’ in ‘whatever part of the country’ is key, Professor Kingsland adds, and if successful, then that might ‘start to address some of the issues’ raised in the Marmot review.
Finding the right staff
In the early stages of the programme, sites are currently planning their approaches. One site in Cornwall is looking to improve how it identifies people with severe and enduring mental health problems, with a focus on how they may fall out of contact with the NHS.
Another, in North East London, is looking at an increase in adolescent knife crime during lockdown. It aims to create a more preventative, multidisciplinary approach beyond a health model, Professor Kingsland says, to involve A&E, local community groups, PCNs, and possibly the probation service.
In each of the projects, Professor Kingsland says that identifying which clinical staff and organisations should be involved is a matter of ‘risk stratification’. Sites focusing on elderly populations, for example, may need to consider that some older people have not had a sensory assessment for a prolonged period due to the pandemic – so this would mean optometrists need to be factored into the make-up of the team,’ he adds.
Looking ahead, Professor Kingsland says the programme is planning to launch its second cohort in autumn this year, with evaluation from this first phase – run by the University of Central Lancashire – due to be shared in spring 2022.
He says that if you asked what is ‘the one thing that’s different about the Complete Community Care programme’, it’s that it’s building a national learning network.
‘Whether you’re looking at rural deprivation in Cumbria, or adolescent knife crime in North East London, or homelessness on the south coast of England – there must be something from the approach that we’re doing that can be transferred.’