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The Midlands
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Shropshire Community Health NHS Trust
How Shropshire, Telford and Wrekin vaccination programme is tackling health inequalities Shropshire Community Healthcare NHS Trust is the Lead Provider for the Shropshire, Telford and Wrekin Vaccination service and works in partnership across all health partners and with Local Authorities to deliver a highly successful Covid Vaccination Programme across its conurbation, which is both Rural and Urban.
Below are two examples of how the Trust is tackling health inequalities.
Case study 1: Project/initiative Shropshire, Telford and Wrekin Vaccination Team has come up with a novel and highly effective solution to help address low vaccination uptake in some of its most vulnerable communities, tackling health inequalities with three Vaccination Buses – Bob, Betty and Basil and targeted community engagement.
Working in close collaboration with a range of partners including both Local Authorities and the military, the Vaccination Team utilised three vaccination buses to help them to respond to the fast- spreading omicron variant during the Booster Sprint in December 2021.
The vehicles were sourced and repurposed into mobile vaccination units with changes such as privacy screens, power connections and heating added to allow NHS teams to set up the clinics wherever they parked. The buses, affectionately named Bob, Betty and Basil, have been run by a variety of staff including the Council, the military, NHS staff and volunteers.
All staff members have gone above and beyond, working weekends and holiday periods to ensure its efficient running and as part of the effort to get the vaccine to as many people as possible by the New Year.
Using a combination of data and insight – backed up by a comprehensive and imaginative communications campaign that included tailored text messages to unvaccinated patients, and calls to residents encouraging them to get their jab – the Vaccination Buses have improved access to vaccination. This was particularly effective in the county’s most disadvantaged, diverse and rural communities, significantly increasing the number of vaccinations delivered to these groups of people.
How it worked This intelligence-led approach allowed locations to be selected where Covid vaccine uptake was lowest, through community engagement either via direct contact, community-focused communications or both. Areas targeted were amongst the most deprived and ethnically diverse communities in the county.
Residents were targeted in Telford and Wrekingby:
Sending texts to residents in target areas to make them aware of when the vaccine bus was coming.
Outbound calling to residents in the lowest uptake areas.
Targeted social media messages to residents in low uptake areas.
Requests to Town and Parish Councils, ward members etc. in low uptake areas to promote via their channels
Residents were targeted in Shropshire by:
Outbound calling to vulnerable residents flagging vaccinations and other available support.
Targeted social media messages to residents in low uptake areas.
Community Outreach Team in areas of lower uptake and most vulnerable communities including minority populations,
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farming communities, and targeting working places, alongside specialist Gypsy and Traveller Team and Business support teams. Targeting large employers of our Eastern European populations by taking the bus to them and translating materials.
Impact This initiative has clearly narrowed the vaccinerelated inequalities in Shropshire, Telford and Wrekin, particularly with respect to an increase in first doses, as well as reduced the number of unvaccinated people in the most disadvantaged areas and among ethnic groups where uptake was lowest.
An impressive 85% (+49.5%) of over 18-year-olds had come forward for their booster vaccination. There was also an increased uptake of first (+1.8%) and second doses (+5.2%) of COVID-19 vaccination since the booster sprint, with 81.6% of the eligible population receiving both doses. The ethnicity gap narrowed by 0.4% for 1st dose, 1.5% for 2nd dose and 2.9% for boosters (white v all BAME groups) 1st dose deprivation gap narrowed by +0.14% (most deprived v most affluent) 1st dose uptake of people with COPD (97.1%) Also of note is uptake of vaccine amongst people who are immunosuppressed (3rd in the country), pregnant women (best in region) and people with learning disabilities and autism, with bespoke clinics being provided for these groups.
Personal case study People with learning disabilities and autism have been disproportionately affected by the Covid-19 pandemic. To help ensure that this gap was reduced in Shropshire, Telford and Wrekin the vaccination programme have co-produced a Covid-19 accessible vaccination pathway, making reasonable adjustments that aim to help increase vaccine uptake to this cohort. The challenge Recognising that busy, noisy and fast-paced vaccination clinics are not always the ideal environment for people with learning disabilities, the trust conducted stakeholder engagement. The engagement helped identify barriers to attending clinics or having a vaccination, gaining a better understanding of any reasonable adjustments or improvements that could be made to the service delivery model with the ultimate aim of increasing vaccine uptake amongst this group.
Through stakeholder engagement and research undertaken, the Trust identified there was a need for:
A point of contact to ask for any reasonable adjustments (email or phone number) i.e. long appointments, help addressing needle phobia concerns, personalised support etc.
Quieter clinics with no queuing (families, carers and health professionals) or busy waiting rooms.
Dedicated time slots or personalised appointment times, with plenty of advanced notice to allow for forward planning.
A requirement for vaccination clinics in
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settings that are familiar to people with learning disabilities and autism. Alternatively, if possible, taking the vaccine to people rather than asking them to come to vaccine centres. Social stories to explain what will happen. Accessible information throughout with short clear instructions, using threeword sentences.
The solution After listening to patients with learning disability and autism, their carers and experts, Shropshire, Telford and Wrekin Covid-19 vaccination service made the following changes:
An email helpline was made available for patients/carers for initial discussions with the Covid-19 vaccination service.
Establishing accessible clinics – two clinics in familiar settings were made available, one in Shropshire and one in Telford and Wrekin.
Each setting had a dedicated room for an accessible vaccination clinic with its own entry/exit, dimmer switches, good acoustics, temperature control, sensory equipment etc.
Clinics are appointment only, with plenty of time per appointment to allow time for reassurance/discussion and ensure no queues/social distancing etc.
Promotion of clinics was done via local authorities, local voluntary and community organisations, local family and carer networks by sharing a communication toolkit and flyers etc. Clinics also promoted on social media, media and the ICS/CCG website.
Targeting communication with tailored information through a range of media including films: > Mary, Elliot and John share their experience of the impact of vaccination at Oak Tree Farm and the benefits of the COVID vaccine > Josh shares his experience of having the COVID vaccine > Short video to talk people with Autism through what will happen during their Covid- 19 vaccination
THE IMPACT Knowledge and feedback from service users, carers and/or specialist groups has been key to shaping the vaccination delivery model. Examples include bespoke clinics for people with learning disability and autism which were designed from engagement and feedback from service users.
This adaption and constant evolvement of the programme has ensured Shropshire Community Health NHS Trust are always improving patient experience and maximising uptake.
Examples include bespoke clinics for people with learning disability and autism which were designed from engagement and feedback from service users. This adaptation and constant evolvement of the programme has ensured the trust is always improving patient experience and maximising uptake.
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South Warwickshire NHS Foundation Trust
Addressing Health Inequalities in Pulmonary Rehab South Warwickshire NHS Foundation Trust is passionate about addressing health inequalities in their service provision and have recently been allocated national funding from the Respiratory Network to support this.
Data showed that only 10% of those discharged from hospital with a diagnosis of COPD accessed pulmonary rehab, this triggered a review by the Physiotherapy department to better understand the reasons for this. Using the QOF data which looked at rates of COPD per 1000 population, derived from the Trust strategy unit review of respiratory care and equity of healthcare provision undertaken in March 2021, it was noted there was a significant difference in prevalence within the Stratford district with higher rates in the population residing in more rural areas.
This led the team to consider that historically pulmonary rehab had been delivered in population hubs which may have been difficult to access from a rural area, thus increasing health inequalities when accessing services. Given the current cost of living crisis and rise in fuel rates, this has the potential to impact further on access.
The model subsequently developed by the physiotherapy team seeks to address this issue, using a two pronged approach. Firstly, the team will go into GP practices offering 1:1 consultations with those identified as requiring pulmonary rehab – baseline tests such as lung function tests could be performed and this approach would also give the patient the opportunity to ask any questions and address any concerns to improve uptake of pulmonary rehabilitation. Secondly, the pulmonary rehab classes would be located within the PCNs either in GP surgeries or local community premises, bringing care directly to the individuals.
This multi-faceted, person centred approach is an excellent example of how the Trust are seeking to address health inequalities in South Warwickshire by using data to identify a need for its population and develop a strategy and plan to address it.
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Warwickshire’s Integrated Single Point of Access (iSPA) South Warwickshire NHS Foundation Trust operates an iSPA, a telephone and email service where patients, carers and all health professionals can ring in and refer to services.
The iSPA has been on an incredible journey over the last 3 years and is a shining example when an organisation thinks differently and is willing to try new things, it can overcome challenges and deliver innovative solutions.
Pivotal to the success of the service has been contact centre manager Riyaz Kathawala; Riyaz joined the Trust in 2018 from a banking background and set about revolutionising the service by introducing quality measures similar to those seen in the banking sector’s contact centres and helping to build an environment promoting a sense of belonging for the team.
The team now take up to 10,000 calls a month, have implemented a text messaging facility which saved between 2-3,000 outbound calls a month, and in 2019 were joined by the Integrated Care Coordination team (ICC) who clinically triage all of the community services who require an urgent or same day response. Both teams promote a change culture which has seen them be instrumental in supporting the out of hospital programme team with rolling out telehealth monitoring initiatives including MySense and DOCOBO, which have given us the opportunity to reach service users in a different way during challenging periods. The iSPA and ICC teams have supported the enrolment of more than 2,000 patients in care homes onto the DOCOBO app, giving care homes both more options in terms of how they connect with us and a way for them to quickly alert our services, their GP or the ambulance service if they are concerned about a resident. The iSPA is also supporting the roll out of DOCOBO at home with an initial cohort of 200 patients, enabling them to enter their own sats which are then monitored daily by the ICC team so the correct level of interaction can be actioned by offering trusted clinical advice or allocating directly to a clinician to complete a visit if required.
The iSPA team are keen to continue to bring in more interactive services and systems to provide a smart and efficient service and ultimately offer an improved and differentiated way of accessing our services for our population.
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University Hospitals of North Midlands NHS Trust
Keep Stoke Smiling The Keep Stoke Smiling campaign has been running since 2018 to combat the levels of tooth decay seen in young people across the region.
In 2021 a pilot campaign was run as part of Keep Stoke Smiling to create a fizz free culture within schools in the region.
The UHNM Charity and Stoke City Community Trust partnered together to distribute thousands of tubes of toothpaste kindly donated by Colgate.
Through education, over a 10-week period both charities set out to provide young people and the wider community within Staffordshire key information they need to make their own decision on what food and drink they consumed, and how it can have a positive impact on their dental health for life.
The first part of the project was focused on educating Key Stage 2 pupils in North Staffordshire schools about the importance of dental health. This was achieved through workshops in local schools led by UHNM Consultant Orthodontist Karen Juggins. Toothpaste was also delivered to several charity groups, including The Macari Centre, House of Bread in Stafford and Foodbank Stoke who all support the most vulnerable members of the community.
In just 10 weeks 33 oral health workshops were delivered in 25 partner schools, distributing bags to over 2,000 young local people. These figures would have been significantly higher without covid restrictions.
Each child completed post workshop surveys which proved they understood all the oral healthmessages with common comments being:
‘I am 100% never, not ever “going to drink red can coke”.
‘I am always going to “spit and not rinse”
‘I am never going to take coke or lemonade, or milk to bed.’
Teaching resources were left in every school and all classrooms had a QR code poster for easy access for teachers to be able to explore further information or download resources.
Adrian Hurst, Head of Community at Stoke City Football Club said: “We use a variety of the Football Club's assets and interventions to help transform the lives of (young) people both on and off the pitch.
“We have really enjoyed delivering the pilot KSS project and the Trust would welcome a further discussion on how we can continue to provide key health education messages in the future.”
The campaign has been so successful that it is now being replicated more widely across the country with Keep Britain Smiling. The campaign uses social media platforms - Instagram, Facebook, Twitter, Youtube and Tiktok - and celebrities such as Peter Crouch to get its message across.
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Case study - Project SEARCH Project SEARCH UHNM is open to any young person aged 18-24 with an Education, Health and Care Plan (E.H.C.P). Prospective students are identified by local education providers, or can apply independently. Students work in non-clinical support roles, such as portering, retail, catering, domestics and transport.
UHNM provide a classroom base and staff facilities, where students are based Monday to Friday, with their teacher and job coach. Students spend 45 minutes every morning studying functional English and preparation for adulthood.
After completing their initial UHNM and departmental inductions, students spend from 10am – 3pm in their supported internship placements, with their ‘buddies’ from UHNM and Sodexo; these are staff who have been specially selected to help students learn the job roles, and model expected work behavior. Interns and buddies are supported by Newfriars staff throughout the week.
Interns return to the classroom base each day from 3pm-3.30pm, for a de-brief, where they can reflect on their day and discuss their progress, or any concerns they may have.
Interns complete three different work placements over the academic year (one per term), and
are greatly supported by their teams and supervisors onsite.
Since the start of the programme in 2018, UHNM has supported 26 young people with special educational needs and disabilities on-site, including through the difficulties of the pandemic and subsequent educational lockdowns. So far, 17 students have graduated, with a further 7 on the current programme.
Whilst the majority of students have successfully secured paid employment, UHNM has also supported others into further education or voluntary roles, according to their personal circumstances.
William Nock, one of the youngest porters in the trust, took part in Project SEARCH with his twin brother Conrad.
Louise Durose, Portering Manager, said: “As a result of the Covid-19 pandemic, William saw his internship interrupted back in March, but he returned to site in June as a fully-fledged member of staff. He has worked throughout this difficult time and has had such a positive impact on all who have come to know him. We have seen his confidence grow and develop over the last few months, along with his general ability and his interpersonal skills. He is a bubbly, caring and compassionate member of staff and a pleasure to work with.”
