Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. Reducing health inequalities is key to our strategy and underpins our purpose of turning great ideas into positive impact. In recent years this has been evidenced through our close partnerships within the NHS and the NIHR Applied Research Collaboration (ARC) in our region.
The Innovation for Healthcare Inequalities Programme (InHIP) project has been commissioned by NHS England’s Accelerated Access Collaborative (AAC) in partnership with the AHSN Network. The programme offers funding and programme support to integrated care systems (ICS) to enable the identification and adoption of innovations and technologies that address the five clinical priorities within the national Core20PLUS5 strategy – maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and cardiovascular disease.
Innovations and technologies include medicines, diagnostics, devices, and digital products approved by NICE since 2017.
Core20PLUS5 is a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system level. Core20PLUS5 populations in England suffer from poorer health outcomes, accentuated by the same patients suffering from inequitable access, experience and outcomes from health and care services and treatment pathways.
The approach defines 2 target population cohorts – the ‘Core20 (nationally defined) PLUS (ICS defined) – and identifies ‘5’ focus clinical areas requiring accelerated improvement.
InHIP has two desired outcomes:
Working closely with our ICS partners, four projects have been launched. Three aim to improve the detection and management of cardiovascular disease (CVD) including atrial fibrillation (AF) and lipid management in our Core20PLUS5 populations and the other supports the access of quantitative faecal immunochemical tests (FIT) to screen for bowel cancer.
Suffolk and North East Essex and Herts and West Essex ICSs are focusing on AF detection in our Core20PLUS 5 populations.
Suffolk and North East Essex
Suffolk and North East Essex ICS will be identifying those at higher risk of AF using a digital-first model, offering remote testing via Fibricheck, an innovative, hardware-free smartphone application that detects cardiac arrhythmias using the phone’s camera. Where monitoring suggests the potential presence of AF, patients will be offered further diagnostic assessment for 14 days via ZioXT Patch, a wire-free remote ECG monitor that collects data which is then analysed by AI technology validated by cardiac physiologists and recommended by NICE Medical Technologies Guidance (MTG) 52. Alternative detection opportunities will be offered in community pharmacy settings to those who are unable to access the digital first approach, addressing any potential digital exclusion.
Herts and West Essex
Hertfordshire and West Essex ICS will be working through primary care networks (PCNs) in their most deprived areas. They will engage with local voluntary, community, faith and social enterprise organisations (VCFSE’s) to co-develop a community outreach approach to raise awareness of AF in black, Asian and other ethnic groups through primary care settings. It is hoped that this will improve detection and subsequent management with direct oral anticoagulants (DOAC’s) where appropriate.
Lipid is the scientific term for fats in the blood, more commonly referred to as cholesterol. High levels of cholesterol is one of the most significant risk factors for CVD. Around 43% of adults have raised cholesterol in the UK which can be reduced with appropriate management, saving lives.
Cambridgeshire and Peterborough
Cambridgeshire and Peterborough ICS will be working with three primary care networks in their most deprived areas. They will offer KardiaMobile testing to people who present with symptoms of AF at their GP practice or at agreed community settings (such as food banks, places of worship and community centres). Outreach activities with PLUS communities will be supported by an outreach team including trained healthcare assistants, who will help to explain the use of the KardiaMobile device. The project is expected to be interdisciplinary and collaborative with support sought from a range of stakeholders, including GPs with a special interest in cardiology, the GP Federations, NHS Healthcheck teams, and local voluntary sector and community groups.
Nearly 43,000 people are diagnosed with bowel cancer every year in the UK. Screening aims to find cancer or changes in your bowel that could lead to cancer early when treatment is more likely to work. A FIT (faecal immunochemical test) is used to screen for tiny traces of blood in poo that may be an early indication of cancer.
Norfolk and Waveney
Norfolk and Waveney ICS is focusing on improving bowel cancer screening. They are working with community champions and connectors in voluntary, community, faith and social enterprise groups and local government to screen for bowel cancer in Core20 and PLUS groups. A targeted community outreach programme using the Quantitative Faecal Immunochemical Tests (FIT) will be used to engage people who have not responded to the national screening programme, looking to understand their reasons for not engaging and enabling proxy ordering to reach homeless populations.
For more information about our work on the InHIP programme, please contact [email protected].
The University of Cambridge and Eastern AHSN (Academic Health Sciences Network) have collaborated to create a report that sets out an approach to inequalities, outlines the inequalities in CVD across the East of England and describes how equity-focussed quality improvement in primary care could be used to address them.
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