Hardwiring tackling health inequalities in Herefordshire and Worcestershire

Key results

• Smoking in pregnancy is down to 4.8 per cent for Worcestershire and 3.6 per cent for Herefordshire, compared to 5.2 per cent nationally.
• Through the High Intensity User programme:
  • more than £292,000 saved through using data to target prevention work with high intensity users.
  • 32 per cent reduction in emergency department attendances.
  • 34 per cent reduction in admissions.
  • 46 per cent reduction in ambulance conveyances.

Overview

With significant variation in people’s health and access to services across the area, Herefordshire and Worcestershire ICS developed a strategic vision of ‘ensuring that tackling health inequalities is ‘everyone’s business’ through targeted prevention and embedding personalised care approaches, with the aim of reaching those groups and communities where health inequalities are greatest.   

What the system faced

Herefordshire and Worcestershire ICS provides health and care services to over 806,000 residents and 40,000 people from Powys, however access to and outcomes from health and care services are not experienced equally across its population. 

Persistent inequalities in life expectancy and healthy life years are strongly shaped by socioeconomic status, ethnicity, geography and other social determinants. In Worcestershire, men in the most deprived areas live 7.9 years less than those in the least deprived; for women the gap is 5.9 years. In Herefordshire, the difference is 5.4 years for men and four years for women.

Across Herefordshire and Worcestershire, people’s health and access to services vary significantly depending on where they live, their income, background and personal circumstances. Some communities face greater challenges, such as higher levels of long-term illness, poorer housing, digital exclusion and lower engagement with services.

These needs are especially pronounced in areas of deprivation, among ethnic minority communities, unpaid carers, people with learning disabilities, and those living in rural or isolated locations. Many of these groups experience delays in accessing care, shorter healthy life expectancy, and reduced opportunities to stay well.

What the system did

In 2023 the system partners at Herefordshire and Worcestershire ICS developed a strategic vision of ‘ensuring that tackling health inequalities is everyone’s business’.They aimed to make this vision come to life through targeted prevention and embedding personalised care approaches, with the strong belief that targeted prevention would have the most impact for those groups and communities where health inequalities are greatest. 

Starting with the ICS’s Joint Forward Plan, the system partners set the intention to drive the shift upstream to more prevention and best value care in the right setting. This continued with a development session focused on health inequalities, where all system partners agreed to implement practical actions to make the vision a reality.

To turn this strategic vision into action, the partners developed a Healthcare Inequalities Ambassador Network, comprising one individual nominated from each programme board or enabler group across the system. This aimed to achieve representation from across partners as well as clinical, management, operational and specialisms. 

At the time, there was an opportunity for each ICS to send up to two people for the national Core25PLUS ambassadors health inequalities training programme. However, the ICB requested – and was granted - 18 to 20 places for all of their ambassadors, in order to hardwire the training across the system and ensure health inequalities was a focus for all their work. 

The network launched in 2024 with 25 ambassadors, who were provided with training materials and resources and given a set of objectives:  

• To promote and ensure that everyone applies a health inequalities lens to the work of the boards or enabler groups.
• To be the voice of the most underserved at board level, putting in fair challenge and consideration to the work area.
• To support individuals to understand the nature of health inequalities, how they impact people’s lives and what actions can be taken to minimise them.
• To ensure that everyone thinks about the contribution that they can make personally to reducing health inequalities and commits to actions to deliver that contribution.
• To ensure that every ambassador has a health inequalities improvement objective agreed with their line manager incorporated in their personal development plan. 

Ensuring board-level accountability through NEDs

With the ambassador network set up, the ICB wanted to improve accountability further for tackling health inequalities at every level and decided to bring in their non-executive directors (NEDs) to support the ambassadors to unblock issues at board level where barriers might still persist.

They did this by establishing an ICS-wide non-executive director network for NEDs with an interest in tackling health inequalities to share knowledge, experience and information on local practice and escalate challenges. 

The network aims to help the ambassadors with their role of keeping health equity at the forefront of every action, working to ensure that health inequalities are integrated into board-level decision-making and are enabled to challenge, influence and question ideas.

The combination of the dedicated ambassadors and the NED network ensured every team had a clear focus on work to tackle health inequalities, which was then supported at board level. This enabled culture change, leading to better outcomes and better outputs. 

Results and benefits

Through the ambassador network, tackling inequalities is embedded into core service delivery rather than being addressed as a standalone project. There is a positive impact on efficiency, performance and quality for all patients who require NHS treatment.

As a result of targeted prevention interventions, smoking in pregnancy is down to 4.8 per cent for Worcestershire and 3.6 per cent for Herefordshire, compared to 5.2 per cent nationally. Previously, it stood at 10 per cent locally. This improvement will help to prevent health inequalities for those babies in the future, as well as their mothers. The ICB is working to develop the right metrics to measure the right outcomes, which can then be used to show impacts which will lead to long-term health improvement.

Using data to target prevention work with high intensity users has achieved savings of £292,600; a 32 per cent reduction in emergency department attendances; a 34 per cent reduction in admissions and a 46 per cent reduction in ambulance conveyances. In addition, 98 per cent of service users reported feeling better and more confident in managing their health after the intervention.