Supporting joined up and equal social and health care provision and access

Healthwatch Medway work to improve the experience of being a Medway resident regarding social needs, health and wellbeing.

ICBs are responsible for developing plans to meet health needs of their local population, managing the NHS budget, and arranging for the provision of health services in a geographical area. ICBs are made up of local NHS trusts, primary care providers, and local authorities.

We continue to support an integrated working and the strategic and public informed efforts to improve social care and health for local residents with a variety of projects and ongoing listening and engagement work. More on this below.

Helping you understand and shape your experience of Integrated Care

The ICB have published various priorities within their interim strategy.

Healthwatch is committed to listen to the public experience of Health and Social Care and share those stories with decision makers as well as informing you of opportunities to shape the system.

An increasingly large part of this is understanding wider determinants of health, these are factors that affect your health and wellbeing beyond the direct care you receive.

Below we offer explanation as to what these factors that affect health and wellbeing are and how Healthwatch are working to raise your voice and ensure an equal experience across Kent and Medway of health and social care. Also ensuring, by taking your voice to decision makers shaping your experience of the place you live, that being a resident gives you the best opportunities to support your wellbeing and that of those you love.

Addressing wider determinants of health

The wider determinants of health are a diverse range of social, economic and environmental factors which influence people’s mental and physical health.

Differences in the way a system addresses these factors and how a place distributes these can bring about social inequality, an important driver of the health inequalities.

The graphic above outlines the sorts of things that variations in and uneven access to or barriers around will influence your level of health and wellbeing.

Core20PLUS5 is a national NHS England approach to inform action to reduce healthcare inequalities at both national and system level. The approach defines a target population – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement.

Action to reduce health and social care inequalities locally

Within the approach all local level NHS are able to identify their own PLUS population groups. More will be shared in the coming months as to how Kent and Medway ICB have been involved in this.

Populations that would be identified are ethnic minority communities; people with a learning disability and autistic people; people with multiple long-term health conditions; other groups that share protected characteristics as defined by the Equality Act 2010; groups experiencing social exclusion, known as inclusion health groups coastal communities (where there may be small areas of high deprivation hidden amongst relative affluence).

Inclusion health groups include: people experiencing homelessness, drug and alcohol dependence, vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system, victims of modern slavery and other socially excluded groups.

How Healthwatch addresses Health inequalities

Healthwatch has adopted a more structured approach to help those most affected by differences in the provision of and access to health and social care.

Healthwatch has worked with various groups to ensure a more equal experience for all local residents. Due to our continued commitment, we were invited to share evidence with a strategic effort called Turning the Tide.

Turning the tide

The Kent and Medway Turning the Tide Oversight Board (TTOB) brings key partner agencies together to ensure people from minority ethnic backgrounds have the same likelihood of good health and wellbeing as people from White British backgrounds, and to reduce inequalities in how health and social care is provided.

For more on what insights we shared and our work with seldom heard voices CLICK HERE

‘5’ focus clinical areas

As part of the Core20PLUS5 the ‘5’ refers to clinical care ‘requiring accelerated improvement’. They are as below.

1. Maternity – Particularly BAME communities and most deprived groups

2. Severe Mental Illness (SMI)

3. Chronic Respiratory Disease: Chronic Obstructive Pulmonary Disease (COPD).

4. Early Cancer Diagnosis

5. Hypertension Case-Finding: Minimise risks of myocardial infarction and stroke

The graphic above shows how our stakeholder initiative offered Healthwatch an opportunity to hear from a new mother. Their experience became a case study for future midwifery training.

This outcome is just one among many ways Healthwatch has listened, acted and influenced the system. Click here for full You Said We Did reports with more experiences like the above.

The Turning the Tide oversight board includes the aim;'To reduce inequalities in recruitment, retention and development of staff in the health and social care workforce’.

Our contribution of stories like this and our broader work contributing to the Allied Healthcare Professionals training and upcoming work within care homes  shows how we listen to patient voice and improve the workforce guidance.

A wedge approach to tackling health inequalities: Women’s Health

Earlier this year Healthwatch England published it’s position on Women’s Health. They outlined what they were calling for to improve and tackle health inequalities for women.

Included was this statement:

‘..we believe that tackling women’s health is not just about health issues specific to women, but about understanding the unequal distribution of wider health outcomes between men and women.’

The piece goes further to suggest that the Women’s Health Strategy for England (2022) is ‘very broad’. They call for greater clarity and an ‘implementation framework’, stating:

‘women’s experiences should be central to evaluating progress against the strategy at regular intervals’.

They called for a ‘greater focus on women’s experiences of feeling listened to by the health service’.

Working toward equality of women’s health, wellbeing and experience of social care

Healthwatch Kent wanted to take a more structured approach to listening to your experiences of health inequalities in provision and access to social care and build its understanding of how wider determinants of health affect your wellbeing.

We have begun to take an approach we refer to as a ‘Wedge approach’ by taking an area where we have heard about inequalities, that also show up in national concerns. These are a mix of NHS England, through it’s Core20PLUS5, population health considerations such as those laid out by the King’s Fund work and also Healthwatch England. We will combine this with local strategic efforts that speak to the locally decided parts of the Core20PLUS5 as well as being influenced by what we hear from you as residents, both experiencing social care and attempting to maintain your wellbeing and as healthcare patients, inclusive of preventative .

The focus and topic of the wedge will change and won’t be exclusive to other regular or project based Healthwatch engagement or opportunities to be heard, but it will help us organise what we hear and direct our listening toward areas experiencing the most health inequalities so that we can contribute to initiatives like Turning the Tides and complement national work such as that called for by Healthwatch England.

To begin with we’ll be producing resources around various Women’s Health issues, often calling for responses to surveys to help us understand your experience and hear your stories.

Above we spoke about our work on Maternity. We have produced a resource around this issue.

For the resource outlining support for those in pregnancy and those working with children under five – including a profile of one of our Healthwatch Heroes - click here

More resources related to key women’s health concerns will follow during the months that the wedge focuses on Women’s Health.

Further work around caring for children

We began our active listening exercises within the Women’s health wedge with Kent PACT to understand mental health experiences around childcare, particularly for those with special educational needs and disabilities (SEND). A report shared combined insights from this and our work with Kent Medway Voice will be shared in coming months. Further engagement is being planned in Swale in October.

We have also begun our organising with seldom heard groups, initially the Gypsy Roma Traveller community.

For more on our work on Inclusion Health Groups click here

Women’s health hubs

Healthwatch has been supporting the work by the ICB to develop a bid submission for a women’s health hub.

Women’s health hubs bring together healthcare professionals and existing services to provide integrated women’s health services in the community, centred on meeting women’s needs across the life course. Hub models aim to improve access to and experiences of care, improve health outcomes for women, and reduce health inequalities.  

In the months ahead we will share more on how the wedge approach has enabled us to share your experiences and shape an important form of provision for a group experiencing health inequalities. Our engagement work and the stories we hear during work around the Women’s Health Hub project will also allow us to shape the local Women’s Health strategy. As we begin public engagement around this we’ll share on this.

Mental Health and Maternity

Earlier this year Healthwatch England shared the first phase of their findings around a mental health check policy within postnatal consultation that they directly contributed to making happen.

Following on from this work, NHS England published a three year maternity delivery plan, which set out improvements in line with several of our recommendations, including promised additional guidance for GPs on how to carry out six-week postnatal checks and commitments to commission the additional community perinatal mental health services promised in the Long Term Plan.

Locally we are also working with Kent Medway Voice through their Mental Health Voice to build on the Communication review that they conducted earlier in the year around common experiences of communication across the mental health care system.

One area of the Communication review that is being advanced is insight around what was recognised as the ‘Getting to know you’ phase. The first point of contact with care, where we heard from service providers, that service users can experience distress at having to communicate their needs and prior circumstances as they move through multiple access points to their care plan. A brief best practice review was discussed and Health passports from other contexts were identified as a possible way to improve the experience. This suggestion was taken to the Kent and Medway NHS and Social Care Partnership Trust (KMPT) and their Engagement Council of service users and onward to a regular meeting with Senior members of the Trust to discuss potential ways to expand on the Communication review.

The Mental Health Passports were raised with East Kent Hospitals University NHS Foundation Trust (EKHUFT) who were particularly interested in maternal mental health. With patient voice insights from EKHUFT, and from regular Healthwatch sources, we will feed into Kent Medway Voice so that feedback can be gained, initially from service providers via the Local Mental Health Network sessions in September, as to how women with pre-existing mental health conditions might be helped by such a tool. We have agreed to report back to KMPT with our findings. More will be shared in October as to how EKHUFT utilise the insight to address maternal mental health to reduce health inequalities for women.

Dentistry and maternity

We have been working across Primary Care to help understand how you believe impacts of the national Recovery plan will affect you. Through our focus on Women’s Health we are listening particularly to the experience of women’s health around dentistry. Closing in early September a survey we helped shape was distributed by Primary Care to understand how pregnant women are experiencing dentistry, particularly if they are aware of exemption certificates and also if they have had their mental health effected by distress related to acquiring an appointment for themselves or linked to gaining an appointment for their child due to previous distressing experience. We will share on this in October as the results of the survey are analysed.