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East Riding of Yorkshire: Reducing the systemic barriers experienced by inclusion health groups

The vision for inclusion health in the East Riding is to reduce health inequalities through ensuring equitable access to services and targeted engagement to marginalised communities. This means working proactively with groups at higher risk of poor health outcomes to raise awareness of healthcare and facilitate access to it, so that everyone has an equal opportunity to achieve positive health outcomes.

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The Challenge

East Riding of Yorkshire Council covers a largely rural area which includes the towns of Bridlington and Beverley. Just over 20,000 residents live in localities which are in the 10 per cent most deprived areas of England, with most of them in parts of Bridlington, Withernsea and Goole. 

Data shows clear inequalities in health outcomes associated with deprivation level. For example, life expectancy for male residents in the most deprived ward, Bridlington South, is 72 years – nine years younger than for those living in the least deprived ward, South Hunsley (81 years). For females, the difference between the most and least deprived wards is five years. Bridlington South also has the lowest percentage of population reporting good or very good health, at 70.2 per cent (compared to 86.6 per cent in the least deprived area).

East Riding of Yorkshire’s Inclusion Health Service was launched in response to the impact of the COVID-19 pandemic on communities. It brings together council services including public health, leisure, libraries and housing, as well as partners such as the Humber Teaching NHS Foundation Trust, the Food Poverty Alliance, the food bank network and other community groups and organisations. 

An important asset of the service is the Inclusion Health Vehicle, which provides outreach for residents who experience barriers in accessing primary health care. It visits community venues, food banks and rural areas to provide health protection and health promotion support, including: 

  • healthcare equity and access to health services 
  • health promotion, education and effective communication 
  • screening and early identification/response to health conditions 
  • addressing the wider determinants of health to reduce early onset of harm and protection of health 
  • protecting the vulnerable 
  • creating healthier communities. 

The Inclusion Health Service, including the specialist vehicle, is run by Humber Teaching NHS Foundation Trust, which holds the contract for the council’s integrated addictions and inclusion health service. 

The service has had success in its outreach work with communities including homeless people, drug and alcohol users with chaotic and non-engaging presentations, prison leavers and people seeking asylum. It was set up quickly and reactively in response to the pandemic, without a full needs assessment being in place. So, in 2023, East Riding of Yorkshire Council’s public health team began work on an inclusion health needs assessment, due to be completed in November 2024. 

System mapping

A key part of the needs assessment is a system mapping exercise which is being done with HEY Smile Foundation, a Yorkshire-based infrastructure charity. This initially involved mapping the services – including council services and the voluntary, community and social enterprise sector (VCSE) – and the links and pathways that are in place. It has helped to identify what is missing – particularly in terms of data, pathways, and inclusion health groups that are not as well supported. 

Chloe Singleton, Public Health Officer at East Riding of Yorkshire Council, said: “We built up the pathways that we know exist and essentially overlaid the VCSE network onto that, with the idea of looking at where the links are, what are the ‘hotspots’ of work, and which inclusion health groups this work is concentrated around.” 

Consultation is underway with staff from the council, the inclusion health service and VCSEs. This will add insight on their understanding of the need, the strength of connections between services and the gaps in provision. 

This system mapping was stage one of the needs assessment and has provided an understanding how the system currently works. Stage two will incorporate a ‘lived experience’ element through consultation with service users. “We would like to get it to the point of reflecting the actual experience of someone working in or using the services within the system,” Chloe Singleton said. “What is their pathway, what’s their ease of access, what are the systemic barriers. It will be a really useful tool then to further engage with partners across the authority.” 

This lived experience will help to influence change across the statutory services to reduce barriers and make health and wellbeing services more accessible and equitable. 

Stronger pathways

Mike Nicholson, Public Health Lead for Addictions and Inclusion Health, said: “Many organisations and groups are already working with inclusion health groups. We need to ensure that people are being proactively supported into the relevant healthcare services. It’s about joining all that work up, creating stronger pathways, building new relationships and providing learning opportunities – not just for the VCSE sector but for the public sector as well.” 

With support from the Humber and North Yorkshire Integrated Care Board and with ‘inclusion health’ a shared strategic priority for public sector partners, further work is underway to improve the healthcare experience for inclusion health communities. This might include having inclusion health ‘champions’ across the system and a possible e-learning platform. 

The needs assessment work will culminate in recommendations which will influence wider health and care strategies in the East Riding. They are likely to include recommendations on strengthening the organisational connections and pathways and improving data sharing. An inclusion health strategy is also planned. 

Contact

Mike Nicholson, Public Health Lead, Addictions and Inclusion Health: [email protected] or Chloe Singleton, Public Health Officer, Healthcare and Systems: [email protected]