Background
Kent Community Health NHS Foundation Trust (Kent Community) is one of the largest community health providers in England, providing a range of services across Kent, East Sussex and London – reaching a population of 3.6 million people. In Kent, there is a 25-year gap in life expectancy rates between the most and least deprived areas. East Sussex has an increasingly ageing population – with projections that by 2026, 24% of the population will be aged 65 to 84, placing an increasing demand on healthcare services. The region as a whole is bordered by the sea, meaning that there are many coastal communities within the trust's patch, which are known to experience greater barriers accessing health services and disparities in outcomes.
Reducing health inequalities is central to Kent Community's organisational We Care strategy, which places a focus on prevention and tailoring interventions for those that face barriers accessing services. The trust has set a specific target to 'achieve less than a one percent gap in missed appointment rates between the most and least deprived communities' between 2023 and 2028 as part of their overall strategic commitment.
To underpin this work, as of 2023, the trust has employed a dedicated health inequalities team within the public health directorate. The team carries out several health inequalities projects, including providing health equity audits of clinical services, overseeing interpreting and translation services, and managing the delivery of the public health bus. The team's work is underpinned by a healthy communities steering group, delivered in collaboration with local voluntary, community, faith and social enterprise sector (VCFSE) organisations. The group meets quarterly to discuss relevant inequality issues, but its primary focus is reducing inequalities for ethnic minority communities. One of the main functions of the group is to share information about local outreach opportunities and identify inclusion health groups. The trust has co-designed and co-created resources alongside VCFSE organisations through this steering group.
Public health bus
Kent Community previously used external mobile health units to provide services in community settings – recognising the benefits of meeting people where they are at, rather than expecting patients to travel into services, particularly for those experiencing multiple barriers when accessing services in traditional clinical sites. These barriers include geographic isolation, limited mobility, and socio-economic challenges, which prevent many from accessing timely health interventions. However, the use of external buses on temporary occasions was expensive and resource intensive, largely due to difficulties co-ordinating the use of external buses. In 2023, the trust launched its public health bus to bring the option for community outreach in-house.
The trust engaged with communities to understand community need for outreach services and how the bus would be accessed by different groups. They also worked with staff to understand how their service would use the bus in practice. This engagement period was carried out over a couple of years to make sure that the bus was well-designed and well-known among potential users. The process ensured that the bus is user-friendly and highly accessible for those with varying accessibility needs.
By developing the bus in-house, the trust was able to adapt the space to meet the different needs of clinical and non-clinical services. The main use of the bus is in delivering NHS health checks, immunisations, sexual health services and health visiting services. Services outside of public health can also use the bus. For example, the oral health team have provided mouth cancer screening at local supermarkets and the recruitment team have attended local careers events.
Improving access to services
The mobile nature of the bus means that the trust is able to provide preventative services within community settings, enabling earlier access to support. For example, the bus has been used to provide blood pressure checks in local supermarkets, and to provide developmental reviews in playgroups and nurseries. Elsewhere, the bus has travelled to pre-existing events in their patch, such as Canterbury Pride, Dover Regatta and Medway Riverside Festival – providing opportunistic encounters with members of the community. Information about where the bus will be and what services will be operating from the bus are shared via social media, a monthly events newsletter, and through service leads directly promoting to patients.
One benefit of the bus is that health services can reach communities that do not typically engage with NHS services. For example, Kent Community has worked with its rough sleeper service to provide podiatry and dentistry services to homeless communities via the bus, situated in a central car park in Folkestone. The trust has returned the bus to the site on a number of occasions and noticed an uptake in services among the community – with trust and word-of-mouth spreading among homeless individuals in the area. The trust has also targeted Gypsy, Roma and Traveller communities by regularly taking the bus onto a local traveller site to provide health checks. Other targeted work has included using the bus to provide health checks to former coal mining communities and fishermen. The trust recognises the need to build rapport and trust with these groups to enable effective use of services – which has been built on the early engagement with communities and by increasing the visibility of the bus within settings over time, allowing recognition of services to build.
Working in partnership
There is also huge value in working alongside VCFSE organisations to support the delivery of services offered by the bus. For example, in reaching communities of fishermen, the trust has worked closely with the Fishermen's Mission, a charity that is already well known among many of the men. Working with the charity the trust better understood the needs of the group, which included wellbeing and loneliness concerns alongside a need for podiatry services (owing to the nature of the work, with their feet being regularly in contact with water). The trust also has positive relationships with local authorities in their area, who invite the bus to attend council-delivered events in the area. These relationships ensure that the public health bus is well-connected to relevant services and resources in the area that patients can be signposted to.
The bus is constantly adapting, based on feedback from staff and service users. The trust recently added bi-fold doors, via funding from the trust's charity, to enable some services to provide a private observation room when needed. The new feature also enables the bus to now be used as one continuous open space – allowing the trust's school health team to use the bus for children's sight tests. In addition, the bus has been fitted with solar panels, via an £8,500 grant from the NHS Greener Fund, ensuring the bus is a low-cost and sustainable service for the trust.
Impact
In the first year of being operational (2023), the public health bus saw a total of 1,000 patients on board and by October 2024, there have been an additional 1,400 users. The bus is fully booked by trust teams and services for five days a week for most of the year, extending to six days during the summer period – though the trust acknowledges that there is less uptake of the bus over the winter months.
A key benefit of the bus has been the opportunity to combine preventative interventions within clinical services. For example, the oral health service has combined with the trust's smoking cessation services to raise awareness of the harms of smoking. Also, the diabetes service provides blood glucose testing alongside blood pressure checks. It is hoped that these initiatives will prevent the onset of ill-health for some patients and encourage patients to engage with primary care services, where previously they were not known to be using these services.
The public health bus has been really well-received by community members and in 2024 it was awarded a Healthwatch Recognition Award by Healthwatch Kent for the specific work delivering health checks in communities. The regular presence of the bus at community events has helped establish Kent Community as a trusted healthcare provider within communities.
For more information about Kent Community's Public Health Bus, please contact: kentchft.publichealthbus@nhs.net
More information about the public health bus can be found online at: kentcht.nhs.uk/service/public-health/public-health-bus/