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A regional approach to tackling health inequalities

Yvonne Thomas explains how West Midlands SHA plans to reduce health inequalities at a local PCT level

Yvonne Thomas explains how West Midlands SHA plans to reduce health inequalities at a local PCT level

When West Midlands SHA put together its strategy for the next five years we set out ourselves seven specific challenges.

Two of these challenges relate specifically to health inequalities.

The first is that while West Midlands achieved dramatic results in terms of reducing waiting times and premature deaths from cancer and heart disease, health inequalities during the same period increased.

The second challenge is to spend more on prevention in light of the substantial evidence that investment in prevention will produce enormous benefits.

There are several reasons why the areas of self care and prevention have not achieved their potential in the NHS. These are:

- they are perceived to have a low evidence base

- they have often relied on reporting inputs and processes to justify investment rather than focusing on health outcomes

- this perception has been used to justify investment only in small ad-hoc, piecemeal short term projects or pilots

- over the last ten years there has been a major disinvestment in the specialised health promotion workforce in the NHS so the numbers of workers involved in this area is low

- NHS financial systems do not incentivise prevention and potential providers of such services are not encouraged to provide it.

The regional advantage

As an SHA we have been able to take three fundamental actions to address some of these traditional problems around prevention services

  • increase demand for lifestyle risk management services
  • increase supply of lifestyle risk management services
  • Built capacity within PCTs to commission lifestyle risk management services

Increasing demand

Increasing demand for services makes them more cost effective and sustainable.

For clinicians to refer to prevention and lifestyle services they need to have confidence in their effectiveness and this is why we have made the development of services our focus, because:

- services are evidence-based

- they enable commissioners to deliver public health outcomes

- they can be monitored

- we can make explicit what's required from the providers

We are also striving to make some services available universally to all patients with extra support for patients in deprived areas who need additional resources (financial and personal) to stay the course (see fit for life example below).

Increasing supply

Our aim is to make the process for potential providers much easier and so encourage them to come forward.

To this end we aim to be explicit about what we want them to provide and are developing a local regional tariff that providers will be able to use in their business cases.

As already mentioned the number of health promotion staff has dramatically reduced over the past decade.

As an SHA we have been able to locate and draw on this scarce resource of health promotion staff to work collectively on behalf of all PCTs to develop standards, operating protocols and data and performance management systems (to date for local stop smoking services and health trainer service) that can be integrated into the commissioning process/cycle by individual PCTs at a local level.

The regional tariff is being developed as a pilot on behalf of the Department of Health.

This is looking at the time and costs involved in working in particular health promotion areas and also weighting those figures for individuals who are more at risk.

So for example with smoking, there wlll be a higher tariff supporting pregnant women or people with multiple lifestyle factors so providers/commissioners can incorporate those figures into their business plans.

We are also working to make benefits more explicit for commissioners by coming up with a guide on when ‘returns' on a lifestyle service investment will become apparent, which again can be used in business plans by commissioners/providers.

We are also holding provider open days where potential providers can come in and meet us to learn more about the types of services our PCTs are looking to commission so they can build their services accordingly.

Building PCT capacity

To create ownership of the service development and to involve PCTs at the beginning, a PCT chief executive was appointed to head up a team to look at each of the seven challenges and chair the accompanying board made up of clinicians and administrative staff, and patient representatives from across the PCTs.

We anticipate that the work the SHA has done to fuel the supply of providers will make PCTs more aware of what services are available and their potential benefits.

Yvonne Thomas is director of partnerships at Walsall PCT and former public health consultant for health inequalities at West Midlands SHA.

Case Study - Fit for life

Patients want to take responsibility for their health. All the research from national studies down to our own local MORI polls suggests this.


Fit For Life is an online package that provides tailored feedback to the individual about their health status and the action they can take to make improvements. It takes patients to a menu of services within their PCT that can facilitate this.


The Fit For Life assessment is available to all patients in the West Midlands. But to address health inequalities the package has targeted postcodes built within it. So patients living in area with a shorter life expectancy are offered the services of a health trainer who will work with them one-to-one to help them achieve their goals.


We know there are individuals who want to change their lifestyle but don't have the resources – financial or personal – to sustain those and that's why the health trainer has such an important role to play in closing that gap even though the service is a universal one.


Fit for life is to promote self care and better use of the NHS - though the NHS doesn't always have to be involved.


GPs can refer patients into these services and we are bringing in a range of providers.


This can be of help to GPs who case-find at risk patients because they too can access the menu of services within their PCT to find out where to signpost patients to.


As we come to know who's using the site and for what purpose it will be possible to provide feedback to health professionals on what the current hot topics are for the general public. The site already links to national sites which report and review the latest health headlines and can inform professionals about the validity or otherwise of newspaper coverage of health issues.

Health inequalities

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