REDUCING Health inequalities THROUGH PERSONALISATION

Making the link between personalising care and reducing health inequalities

Reducing health inequalities is a fundamental part of the NHS Long Term Plan and the ICS Strategy – but what does it mean? It means giving everyone the opportunity to lead a healthy life, no matter where they live or who they are. We know from the data that people from marginalised backgrounds have worse experiences of care and treatment – and that is what we are tasked with changing.

What do we know already?

The World Health Organisation states that factors such as stress, unemployment, debt, loneliness, lack of education and support in early childhood, insecure housing and discrimination can impact 30-55% of the health outcomes that people experience.

• People with learning disabilities die 15-20 years earlier than the general population, as do people with severe and prolonged mental illness.
• One million people over the age of 65 report being lonely. Social isolation affects people of all ages, leads to poorer health, higher use of medication, increased falls, and increased use of GP services.
• Clinicians and people routinely overestimate treatment benefits by 20% and underestimate harms by 30%.
• Only 40% of adults report that they have had a conversation with a healthcare professional in their GP practice to discuss what is important to them.
• Only 7% of adults have been given (or offered) a written copy of their care plan.
• Only 55% of adults living with long-term conditions feel they have the knowledge, skills and confidence to manage their health and wellbeing on a daily basis.

Source: Universal Personalised Care, NHS England

We also know that:

• One in five GP appointments are about issues wider than health, especially for people living in areas of high deprivation.
• Individuals living with multiple long-term conditions, disability, frailty or who live in ethnic minority communities are bearing the brunt of the widening gap in health inequalities.

LGBTQIA+ individuals are at higher risk of depression, suicide and substance use:

Research has shown that acute distress relating to discrimination, concealment and/or rejection sensitivity causes LGBTQIA+ individuals to be at higher risk of ‘internalising’ mental health disorders. This act of internalising leaves LGBTQIA+ individuals at increased risk of depression, suicide, and substance use, compared to their cis-gender, heterosexual counterparts. As this article shows, mental protection can be developed through Creative Health provisions.

To tackle inequality, we need to pay more attention to those at the greatest risk of poor health. Making healthcare more personalised means that people can access health and care services that are more tailored to their needs, make sense to them, and focus on what really matters in their lives. We empower local people to make healthier choices that support their own health and wellbeing. This ‘healthy’ state of being should be experienced fairly by all our communities. We want to ensure that people living with an existing disability or long-term condition can live as well as possible through access to the right advice, treatment, care and support.

The evidence that personalised care contributes to reducing health inequalities

From Universal Personalised Care: Implementing the Comprehensive Model

 

1. Most individual long-term conditions are more common in people from lower socio-economic backgrounds, and multiple conditions are disproportionately concentrated in these groups. The evidence shows that levels of knowledge, skills and confidence to manage their health tend to be lower for people with lower incomes and lower levels of education. When people are supported to increase their knowledge, skills and confidence they benefit from better health outcomes, improved experiences of care and fewer unplanned admissions. People in lower socio-economic groups can therefore benefit the most from personalised care, as it focuses on people with lower knowledge, skills and confidence, and better supports people with multiple long-term conditions as part of the ‘specialist’ tier of interventions in the Comprehensive Model. 

To find out how to use Personalised Care and Support Plans with patients and carers, use our 'How to...' information page and resources.

1. A systematic review found that shared decision making interventions significantly improve outcomes for disadvantaged people. Personalised care also tailors shared decision making to health literacy. It ensures staff develop health-literate decision support materials and tailor their conversations to take account of low health literacy by using specific techniques, such as “teach back”, building on the health literacy toolkit.

To find out how to develop and implement Shared Decision Making with patients and carers, use our 'How to...' information page and resources.

1. Social prescribing and asset-based approaches complement this to tackle inequalities through improving access to community support. Health literacy and self-management support (including structured self-management education programmes and health coaching) are critical to empowerment as they increase peoples’ capacity to use health information effectively and to identify the issues that most affect their wellbeing. Between 43% and 61% of working age adults do not understand health information. Social prescribing contributes to reducing health inequalities by increasing involvement with local communities. Social prescribing enables general practice to identify people who could benefit from additional voluntary and community sector support and refer them to link workers, based in local social prescribing connector schemes. Link workers spend time with people, build rapport, hear what matters most to people and, based on the person’s priorities, connect them to community groups. Most local social prescribing schemes also have volunteers who provide a ‘buddying’ role, physically introducing people to community groups, ensuring they are comfortable and included. 

To find out how Social Prescribing and Supported Self Management approaches improve outcomes for patients and carers, use our 'How to...' information page and resources.

1. Increasing people’s level of choice and control, including through PHBs, can enable the system to respond to different backgrounds, for example by supporting children and young people who are faced with considerable health inequalities, such as looked after children, 45% of whom will experience mental health difficulties compared to 10% of all children. PHBs also enable people to choose their own personal assistants who are more aware of their culture or religion. Peer support and strategic co-production can also help to support people from different cultural backgrounds.

To find out how PHBs and Enabling Choice improve outcomes for patients and carers, use our 'How to...' information page and resources.

Read pp30-32 of Universal Personalised Care for the full text and sources.

 

Social Prescribing and the reduction in health inequalities

A good illustration of how this is happening is Social Prescribing which can demonstrate its value in linking people to community-based services that provide coordinated, integrated, and proactive care.

Watch Jason's story to find out how social prescribing created a wider opportunity for Jason, who had suffered from mental health problems and being unemployed for 30 years:

Green social prescribing in Nottingham is connecting people to nature-based activities and supporting people with mental health problems:

 

Full information on the different personalisation approaches available and how to use them to support the reduction of health inequalities in Coventry & Warwickshire is available here.