NHS England’s Innovation for Healthcare Inequalities Programme is a unique collaboration between the Accelerated Access Collaborative (AAC), NHS England’s National Healthcare Inequalities Improvement Programme and the Academic Health Science Networks and is delivered in partnership with each of the Integrated Care Systems within Yorkshire and Humber.
Yorkshire & Humber AHSN supports three very different Integrated Care Systems (ICSs) when it comes to health inequalities, with significant variation in terms of wealth, deprivation, and health outcomes. We have the rural, coastal and urban areas of Hull and North Yorkshire. Humber is classed as the second most inactive region in England, with notable ‘not spots’ in terms of lower severe asthma referral rates into secondary and tertiary care and rural North Yorkshire with its challenges of geography and smaller clusters of population. West Yorkshire has large urban centres, diverse population groups and communities where English is not the first language. South Yorkshire has several health issues that are higher than they should be when compared to similar regions and the national average. Population health varies widely within South Yorkshire and Bassetlaw.
It is therefore not a surprise that when we need an approach to addressing health inequalities through the utilisation of innovation, we need three different ones.
A population health round table helped to better understand the various regional activities and coordinate priorities. This is a forum that includes membership across our three Yorkshire and Humber Integrated Care Boards (ICBs) and where the AHSN gathers insights from ICB teams, regional NHSE representatives, clinicians, and voluntary, community and social enterprise organisations at place level.
Discussions with various stakeholders allowed us to narrow regional priorities down to three distinct projects:
- Pro-HNY asthma bio project: Identifying patients with uncontrolled severe asthma in parts of rural and coastal Yorkshire and Humber in areas where referral rates were lower than expected.
- West Yorkshire’s Community Based cardiovascular disease and Lipid Programme, engaging with the gypsy, traveller and Roma populations: We are working with the gypsy and traveller community in partnership with Leeds Gate and South-East Leeds GP Confederation, to better meet the populations needs in terms of cardiovascular health, point of care testing and outreach possibilities.
- South Yorkshire’s Barnsley Place cardiovascular disease and Lipid Community Project: Working to further understand a population anomaly in South Yorkshire; where the number of people experiencing cardiovascular disease in Barnsley was particularly high and needed a more innovative, outreach approach to reaching patients.
One of the key elements of InHIP is to think creatively about ways to improve the health and social care for those population groups who struggle to access the care they need. These projects provide an opportunity for the health sector to work in partnership with other stakeholders within each ICS, and in particular, an opportunity to work beyond the hospital walls. All three of our projects have enabled primary and secondary care to work together rather than in silos, as well as collaborating with the wider voluntary, community and social enterprise sectors. They will provide an insight into how health services could be delivered differently, by giving population groups the chance to access care closer to home, in community settings where they may feel more comfortable to receive health education. The challenge was how best to be innovative, and make the most impact – could our solution be sustainable?
When investigating which partners we should include within our projects, it became clear that sport, or, more specifically exercise in general, was a key player in helping address health inequalities across the whole of Yorkshire and the Humber. Sport and exercise go hand in hand with health. The healthier we are, the less likely we are to require to access health services. World Health Organisation, through its Sport for Health Programme, states that regular physical activity helps prevent and treat noncommunicable diseases (NCDs) such as heart disease, stroke, diabetes and breast and colon cancer. It also helps prevent hypertension, being overweight and obesity, and can improve mental health, quality of life and well-being.
By establishing these relationships between sport and health we can ensure that the region is building its preventative, public health approaches to clinical pathways. We can work towards producing pathways that transcend organisational boundaries, but that ultimately have the same desired outcome: a healthy population. We can move away from the purely medical approach to patient care and include an holistic approach.
By taking the time to build these new relationships, the ICSs will become more efficient, and more streamlined, with a healthier population. By targeting sport, it could be argued that we are only reaching those people who are already conscious of their health, but it is important to think wider. We should consider those who need more local activities, low level activities and more social inclusion.