Actioning System Change in services for Health Inclusion Cohorts in Wakefield District

Actioning System Change in services for Health Inclusion Cohorts in Wakefield District

Introduction:

The COVID-19 pandemic presented opportunities for new ways of working to meet the needs of Health Inclusion cohorts at scale across Wakefield’s Health and Social Care economy. In particular, the COVID-19 vaccination programme meant that services collectively had to make adaptations to ensure equity of access through the development of assertive outreach and roving vaccination to community settings where Health Inclusions cohorts live, socialise, or seek support.

The learning from this experience saw partners develop a population level approach to meet the needs of Health Inclusion cohorts and went on to serve as the basis for the development of health needs assessments, service specifications, and the commissioning of services to meet the need of Health Inclusion cohorts locally.

How we achieved this:

In February 2021 “Vaccine Inequalities Delivery Plan” was published for Wakefield District. It identified homeless people, Gypsy, and Traveller communities, and Refugees/Asylum Seekers as initial target groups. The programme’s partnership response to foster a problem-solving and “build and learn” approach was a key enabler of the success of the programme. This resulted in local innovation in terms of delivering vaccines to the target communities. A key element was the recognition of the importance of taking vaccines into community settings rather than asking the target group to come to healthcare settings, which many in Health Inclusion cohorts either saw as a barrier or had no pre-existing relationship with.

The delivery of a bespoke roving vaccination programme changed the perceptions of delivery staff and strategic decision makers to recognise that those generally deemed to be ‘hard to reach’ by health professionals were best served by a model designed with their access needs in mind. The provision of this support means there is now a greater reach into communities previously deemed to be ‘hard to reach'. This work helped to provide an evidence base about the extent and nature of Health Inclusion cohorts in Wakefield District, as well as their needs.

The Roving Vaccination Team was externally evaluated with a summary report published in September 2022. Gathering the perceptions of strategic decision makers, front line delivery professionals, and Health Inclusion cohorts themselves it recommended that amongst possible commissioning options for the future could include:

“A more ambitious roving health service would involve a dedicated team of staff working with marginalised groups on a rolling programme of specific health awareness campaigns, delivering specific health interventions and undertaking action research with the most marginalised communities”

Alongside this evaluation in between 2022-2023 a Homelessness health needs assessment, and a Gypsy and Traveller health needs assessment were undertaken by Groundswell and by Leeds GATE in partnership with Wakefield Council’s Public Health Team. Both health needs assessments made recommendations around the commissioning of outreach services to better meet the needs of these Health Inclusion cohorts.

Core20+5 funds became available both at ICB region and at place. Place based decisions were taken for the development of a service specification for a Roving Health Inclusion service who would complement Primary Care by providing a peripatetic Primary Care service providing health assessments, vaccinations, mental health support, and social prescribing for Health Inclusion cohorts across the district. This service was awarded to Bevan Healthcare and went live in May 2023.

Spectrum Community Health CIC were awarded Core20+5 funding to continue and consolidate WYFI+, an existing team of staff who support people with complex social needs such as homelessness, mental health, and substance use. This also included the continuation of a post developed during COVID-19, to carry out health needs assessments for homeless people and support them to access appropriate health services.

Core20+5 monies were also awarded at region for Leeds GATE to improve health outcomes for Gypsy and Travellers across West Yorkshire regions, and to Maternity Stream of Sanctuary to improve the health and social outcomes of pregnant asylum seekers in Wakefield’s Initial Accommodation Centre.

The Gypsy and Traveller health needs assessment and Homelessness health needs assessments both have active strategic and operational action plans, facilitated by Public Health and with senior strategic commitment to progress, and with a commitment to co-produce solutions and value the voices of those with lived experience.

Other key achievements:

There is improved knowledge, skills, resource, and services dedicated to the improvement of outcomes for Health Inclusion cohorts in Wakefield District. Working practices when meeting the needs of these cohorts have improved as they have become more embedded into the culture of the local Health and Social Care economy.

Having a suitably skilled and culturally aware workforce with an interest in working with Health Inclusion cohorts was important in planning and providing quality and consistent care. The model has facilitated wider partnership working and more education, skills development, and working experience regarding Health Inclusion cohorts within Primary Care, VCSE and Mental Health services. There is overall a greater and more co-ordinated ambition in decision makers to meet Health Inclusion needs through targeted work; a vision which includes partnership working, especially with those with lived experience, learning from best practice both regionally and nationally.

The commissioning of specialist services and projects to address the needs of Health Inclusion cohorts is evidence of system change in response to the needs of these groups. This system change will be embedded into future practice and commissioning considerations. Further developments continue in the undertaking of a migrant health needs assessment for all migrant communities living within the Wakefield district.

Authors:

Pat McCusker, COVID Response Manager Vulnerability and Health Inequality, Wakefield Council

Emma Smith, Head of Health Protection, Wakefield Council

Kerry Murphy, Public Health Manager (Health Inequalities and Poverty), Wakefield Council

Natalie Knowles, Primary Care Development Manager, Wakefield District Health & Care Partnership