How understanding communities helps us tackle health inequality in Leicester

Sadly, health inequality remains a pressing issue. This urgent problem sees people face varied health outcomes depending on the social group they belong to. Factors such as income, race, or disability can influence whether people can access services quickly or at all, stay well whilst on waiting lists, or receive optimal standards of care once within a service.

This is why University Hospitals of Leicester NHS Trust (UHL) embeds health equality and inclusion in all we do. Most importantly, our first step is to listen and collaborate. This year, we held our first health equality summit in partnership with the University of Leicester in July. The event brought over 200 UHL and system colleagues together with community leaders to look at the specific picture of health inequalities in our city and co-design solutions together. As well as national and local expert speakers, the summit featured a community-led panel discussion and a number of 'inspiration through action' sessions, featuring live projects already underway.

Addressing inequality

Nationally we know that black women are around four times more likely to die in childbirth and pregnancy, and local data tells us that black women are far less likely to present to healthcare services in the early stages of pregnancy. To address the problem, a new UHL project has been designed to improve black maternal health outcomes, which we were also pleased to share at a recent NHS Providers webinar. This project, intending to close the inequality gap, is being led by our consultant midwifery team, who were able to share examples of the local engagement they are carrying out with women and pregnant people to identify barriers and intervene earlier.

Community outreach

Another showcased project involves outreach from our head and neck cancer team into diverse communities to address cultural factors in the development of certain cancers. For example, chewing betel leaf is a common cultural practice among many South Asian communities in Leicester, with many people largely unaware of the links to mouth cancer. The power of senior clinicians meeting with people in their own community spaces to relay this information and promote healthy behaviours is evident. As one participant said, "it means so much when you come to us".

Beyond data

Data often gives us the 'what', but patient and community perspectives will bring the much-needed 'why'. What was clear from the discussions is that community insight is the other side of the data coin. For example: 'Why is this group not booking their follow-up outpatient appointments?, 'Why is this group over-represented in our emergency department?', 'Why are we not reaching this group with advice that should help them to access care sooner?' The idea of these sessions was to demonstrate what is possible when you start with an interrogation of inequalities data and a collective will to make change happen. However, it would be naïve to suggest this is all you need.

Colleagues told us that they often struggle to make room for this vital work because of the intensity of operational pressures and the weight of administrative burden in their day-to-day. While we aspire to make equity day-to-day business at UHL, we know that this is far from reality. As leaders, we need to remove barriers for those closest to the issues to affect change in their services, and often that means giving people time. This is why ongoing digital transformation and increasing our focus on becoming an employer of choice are so vital to creating equity.

Working in partnership

Partnership and power-sharing were big themes of the day. We worked with the UHL Health Equality Partnership (UHEP) – comprised of over 50 community leaders and grassroots groups – to design the agenda. Without this involvement, the summit would have omitted topics such as cultural competence in healthcare and the role of health literacy. The UHEP plays a vital role in sense-checking our engagement and validating priorities. It is deliberately dynamic and flexible, reflecting the population we serve and the significant demands on community groups' time and energy.

A key next step will be working with the UHEP to develop a community charter that establishes the principles for partnership working across UHL – including the recognition that when communities share their views with us, they are sharing invaluable expertise we could not get anywhere else. It is great to see NHS Provider's report on co-production and engagement with communities as a solution to addressing health inequalities, which highlights the case for involving communities in the design and delivery of services.