This week’s blog comes from Beth Kirby, Senior Programme Manager - Inclusion Health for NHS West Yorkshire Integrated Care Board.
Hello my name is Beth.
“If integrated care cannot tackle inclusion health, we should all be worried”
I lead on inclusion health in the Improving Population Health Programme for West Yorkshire Health and Care Partnership. This week I wanted to share what has been happening since I joined the team in July 2023, and how you can get involved.
So, what is inclusion health?
Inclusion health is not a new concept, but it is not widely used or understood. Sometimes it is confused with wider concepts of inclusion and diversity or obscured within a broader focus on inequalities.
Inclusion health is an umbrella term used to describe people who are socially excluded, who typically experience multiple interacting risk factors for poor health, such as stigma, discrimination, poverty, violence, and complex trauma. You may have heard them referred to as the ‘Plus’ groups in Core20PLUS5. They include:
- People experiencing homelessness
- People with drug and alcohol dependence
- Vulnerable migrants, people seeking sanctuary and refugees
- Gypsy and Traveller communities
- Roma communities
- People in contact with the criminal justice system
- Victims of modern slavery
- Sex workers.
Before working at NHS England and then joining NHS West Yorkshire Integrated Care Board, I worked in inclusion health for six years. Others who have worked with marginalised communities will recognise the sense of urgency and motivation we can draw from that experience, often holding in mind people we met along the way.
The case for action is stark
People in inclusion health groups tend to have poor experiences of healthcare services because of barriers created by service design. Negative experiences lead to people in inclusion health groups avoiding future contact with services and being least likely to receive healthcare, despite their high needs. When they do access services, people can be labelled as difficult or complex and potentially excluded for being “too hard to help”. This results in significantly poorer health outcomes and earlier death among people in inclusion health groups compared with the general population:
The new NHS England Framework for Inclusion Health calls for the delivery of integrated and accessible services for inclusion health groups. This means finding the right balance between making mainstream services accessible to all and providing specialist provision for excluded groups. Without action, we will continue to see excess mortality and poor health outcomes.
What is happening in West Yorkshire?
Inclusion health groups require an explicit, tangible focus and integration across health, housing and social care. West Yorkshire Health and Care Partnership (an integrated care system) has been set up to do this – to operate systematically and consistently to realise rapid health gains. If we get service design, delivery and underpinning approaches right for the most marginalised, we get it right for all - but operationalising this can be very challenging. We have been working hard in West Yorkshire to understand how our system can do this.
After work in the autumn, the West Yorkshire Inclusion Health Unit was established. It has cross-sector membership from West Yorkshire’s five places (Bradford District and Craven; Calderdale, Kirklees, Leeds and Wakefield District) across health, local authorities, the combined authority, and academic partners. The Inclusion Health Unit offers the opportunity to work together to better understand and meet the needs of inclusion health cohorts, ensuring joint resources are used effectively by planning and delivering together, and sharing learning across boundaries.
There are three main objectives:
- Support and strengthen West Yorkshire’s five Places in their inclusion health work
- Respond to key ‘at scale’ priorities, designing and implementing collective solutions to challenges
- Act as a critical friend to other programmes/mainstream provision.
What have we learnt so far?
Key to the development and momentum of the West Yorkshire approach is relationships and system working across West Yorkshire and place. So much inclusion health must happen at place, with an intimate knowledge of local populations. Any scaled approach must be informed by local insight, and I have been heartened by the appetite and support for collaboration for inclusion health across all partners.
We have managed to initiate work, support existing projects, and bring a focus to condition-specific programmes. Examples include:
- working with Leeds Gypsy and Traveller Exchange to provide mental health support, suicide prevention and a health access service across West Yorkshire
- supporting vaccination hesitancy clinics to increase uptake of MMR for people seeking sanctuary cross West Yorkshire
- expansion of the Leeds Homeless Dental Pilot to additional populations
- initiating research into the models of care delivery to people in street-based sex work.
What next?
The Inclusion Health Unit will share its leadership function with a Community Board, led by people with lived experience and voluntary community social enterprise partners supporting inclusion health groups across West Yorkshire. To develop this meaningfully, dedicated time and resource is required, and over the next six months we will be working closely with West Yorkshire Power of Communities team and Healthwatch to do this.
We are also excited to be one of seven integrated care systems selected to be part of the national NHS England and Pathway Inclusion Health Leadership Programme, which starts in March and follows on from their Beyond Pockets of Excellence piece.
We all have a role to play
Perhaps you could take a moment to reflect. How well are inclusion health groups served or considered in the service or programme you work in? Could we do more? Please reach out to me if you would like to chat this through.
We are establishing a Community of Practice for Inclusion Health, inviting colleagues across the whole system, at all levels with an interest in inclusion health to join. We’re offering all members the opportunity to join the National Faculty of Homeless and Inclusion Health conference via livestream on 13 and 14 March. Please email Valerie.Mzizi@nhs.net to be added to our membership!
Thanks for reading.
Beth
Hello, my name is Ali.
We came about following the national Serious Violence Strategy published in 2018 which allocated funding to 18 areas, now 20 areas most affected by serious violence. In 2019 securing this Home Office funding support, we established the West Yorkshire VRP and gained further resources to focus on tackling serious violence. Over the last five years we have been a catalyst for partners to come together to develop our understanding of serious violence and test approaches to respond to the underlying causes, put in place protective factors to reduce incidents and respond where necessary through enforcement.
What else has been happening this week?
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