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By Myrte Elbers, Reducing Inequalities Lead at Bradford District and Craven Health and Care Partnership.

“Invisible.” “Surviving.” “Out of control.” “Challenging.”

These are some of the words that I have heard from people and communities that we, as service providers holding the cards and the cash, sometimes class as ‘marginalised’ ‘hard to reach’ or having ‘complex needs’.

I have been lucky enough to work on inclusion health since I first started in the Reducing Inequalities Alliance team last year. This blog intends to capture a few key things I have learnt over the last 12 months.

What is inclusion health?

Inclusion health groups are those most socially excluded, experiencing multiple interacting risk factors such as poverty, trauma, stigma and discrimination. This includes people that are homeless, vulnerable migrants, Gypsy, Roma, Traveller people, sex workers, in contact with criminal justice, victims of modern slavery, dependency on alcohol and/or drugs.

Why is it important that we have a specific focus on Inclusion Health?

These groups can face mortality rates around nine times higher than the rest of the population. For example, the life expectancy of a homeless person in the UK is on average 30 years less than the average British person. This is unacceptable and avoidable.

Making the effort to visit one of the many groups supporting inclusion health communities in our district shows us how real and important it is that we focus on inclusion health when it comes to the health and care they receive.

I visited Project 6 in Keighley where people recovering from substance use were sharing their stories and views, as part of the Bradford District and Craven Health and Care Partnership’s ‘Listen In’ engagement programme. The group talked about the stark contrast in how primary healthcare had treated a male versus a female patient: the male was experiencing a mental health crisis and addiction and repeatedly visited the GP surgery in person to ask for help. He was considered ‘a nuisance’ and the surgery struck him off. By contrast, the female patient broke down in tears in front of the GP and she received a referral to New Vision Bradford, a substance use treatment provider. Isn’t it interesting how gender and emotions can influence the care you receive?

Small big things

A colleague from Bevan Healthcare, an inclusion health GP practice in Bradford, mentioned that “the small things can be the big things”. That’s as simple as a welcoming smile, taking time to listen and build trust, treating a patient as a person and with respect and treating people as you would expect to be treated.

The practice adopts a trauma-informed approach which places empathy, compassion, and humility at the centre of all healthcare provision. The male patient that I mentioned earlier is now a patient at the Bevan practice and has nothing but positive things to say about their care.

What works?

The evidence tells us that the following works when working with inclusion health groups (and before you say “it’s all common sense” – yes, I agree, but it’s still hit and miss in many health and social care services):

  • Taking a person-centred and trauma-informed approach
  • Providing ease of access such as outreach, walk-in, in-reach services
  • Adopting a flexible attitude and approaches in delivery
  • Taking a targeted, co-ordinated approach in planning / multi-disciplinary approach in delivery – to address all needs (e.g. transport, housing, benefits)
  • The involvement of people with lived experience in planning and delivery

Over the past 9 months, I have met so many compassionate and dedicated staff in the NHS, Council, and voluntary and community sector in Bradford District and Craven, across Yorkshire and nationally. Just like people experiencing multiple disadvantage, who find peer support and mutual aid hugely beneficial, for us as professionals working in this field, it is vital to have the support of peers.

In a time of financial scrutiny, we need to remember that changes don’t have to be costly, we share common challenges. Obstacles can be overcome through partnership working, and small actions often make a big difference.

View more inequalities blogs below or on our Reducing Inequalities Alliance webpage. To write a blog about inequalities work you’re involved in, please email ria@bradford.nhs.uk

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