Inclusion Health Conference and Toolkit Launch

On 1 May, the Nottingham and Nottinghamshire Integrated Care System hosted its first Inclusion Health Conference. The event was at full capacity, with 150 colleagues from across ICS partners joining people with lived experience of inclusion health issues, to identify ways in which we can create a fairer, more inclusive health and care system.

Inclusion health is an umbrella term used to describe people who are socially excluded, typically experiencing multiple interacting risk factors for poor health, such as stigma, discrimination, poverty, violence, and complex trauma.

People in inclusion health groups tend to have poor experiences of healthcare services because of barriers created by service design. These negative experiences can lead to people in inclusion health groups avoiding future contact with health and care services and being less likely to receive healthcare despite have high needs. This can result in significantly poorer health outcomes and earlier death compared with the general population.

The purpose of the conference was to promote a shared understanding of the magnitude and consequences of extreme inequity for people from inclusion health groups, as well as services and the health and care system. Built on the five principles in the NHS Inclusion Health Framework the conference focused on the experiences of local people from inclusion health groups and from the services that are working to support them, with an emphasis on what colleagues can do to better meet their needs.

There is already lots of positive work taking place across our ICS and beyond and we were privileged to hear from colleagues working in different areas of inclusion health:

  • Anna Tickle, Consultant Clinical Psychologist, opened the event by talking about what it means to be a person from an inclusion health group and the barriers that can prevent access to healthcare services. Anna gave a call to action, emphasising the importance of every health and care professional playing their part in creating a more inclusive health and care system.
  • Helen Johnston, Consultant in Public Health, talked about what we mean by inclusion health and the additional challenges inclusion health groups face accessing healthcare services. Helen drew on the five principles in the NHS Inclusion Health Framework to illustrate opportunities to improve health outcomes of inclusion health groups.
  • Mala Dhakk from Health and Justice East Midlands was joined by two User Voice panel members to talk about the barriers they have experienced in accessing healthcare services after leaving prison, giving delegates practical tips for how they can create more inclusive services.
  • Katie Baker, Complex Cancer Pathway Clinical Nurse Specialist at Nottingham University Hospitals, spoke about how the Trust supports people with complex needs to access vital cancer screenings, treatment and support. Katie reflected on the importance of flexibility in service delivery and remove barriers to accessing services by reaching out to people who do not attend cancer appointments.
  • SallyAnn Summers presented on the work of Nottinghamshire Health NHS Foundation Trust to developing an assertive mental health response for people experiencing mental health conditions and homelessness. SallyAnn highlighted the vital work of the Severe and Multiple Disadvantage Partnership and the importance of partnership working to effectively support people from inclusion health groups.
  • Dr Jane Turrill talked through the Nottingham City General Practice Alliance Severe and Multiple Disadvantage toolkit, which has been helping general practices in the city to better support people who experience multiple disadvantage.
  • Finally, Jane Paling presented on the work of the cross-partner Slavery Exploitation Team, discussing the prevalence of modern slavery and exploitation, highlighting how colleagues can spot the warning signs of exploitation.
  • Dr Margaret Abbott closed the event by reflecting on all the positive work already taking place across the ICS, encouraging colleagues to build on the foundations set. Margaret reflected that by getting things right for inclusion health groups, we can create a fairer, more inclusive health system for all.

In the afternoon, colleagues discussed how, as an ICS, we can improve access to essential services for individuals and groups harmed by exclusion, as well as how we can tailor approaches to prevention and early intervention.

To support inclusive practice for all, we launched the Nottingham and Nottinghamshire Inclusion Health Toolkit, built on the five principles of the NHS Inclusion Health Framework supporting partners to:

  1. Commit to action on inclusion health
  2. Understand the characteristics and needs of people in inclusion health groups
  3. Develop the workforce for inclusion health
  4. Deliver integrated and accessible services for inclusion health
  5. Demonstrate impact and improvement through action on inclusion health

The toolkit set out what good practice looks like under each of the five principles, with suggested practical actions to take and questions to consider. The toolkit is also inclusive of good practice examples from across the ICS.

A big thank you to everyone who attended on the day! It was incredible to see so many people from across the ICS come together and committing to creating a fairer, more inclusive health and care system.

You can find a full list of resources from the event here, including the presentation slides used on the day. We encourage all partners to take action on inclusion health by making use of the toolkit within your organisation and teams.

For all queries inclusion health, please contact: nnicb-nn.nottmcityicp@nhs.net

Working Together to Understand Neurodivergence and Multiple Disadvantage

Recent studies indicate that 38% of people experiencing Severe and Multiple Disadvantage (SMD) also have neurological conditions such as ADHD, autism, or brain injuries. These findings, along with insight from local partners and views of people with their own lived experiences of SMD, has driven the development of a new Neurodivergence and SMD Learning Series.

The overall aim of this learning series is to:

  1. Create free training resources so that colleagues and services are more aware of neurodivergence and SMD
  2. Support services to work in a neurodivergence affirmative way

Learning Series Webinars

Working together with colleagues with expertise from across the system, the Nottingham SMD Partnership, Changing Futures and the Nottingham Practice Development Unit (PDU)* have so far delivered four successful webinars:

  • Overview of neurodivergence and SMD: a foundational session on neurodivergence in the context of severe and multiple disadvantage
  • Speech and language: focusing on adjustments to communication for autistic people
  • Neurodivergence in prisons: insights on help for neurodiverse people in prison settings.
  • ADHD deep dive: a detailed session on ADHD led by an academic researcher with their own lived experience

Several further events are also currently planned:

  • March: Psychotherapeutic Assessment Approaches in the Diagnostic Assessment of ADHD for Adults with Severe Multiple Disadvantage (SMD) by Lisa Murphy and Emma Telling, Change Grow Live – event link
  • April-June: webinars on homelessness, neurodivergence diagnosis, and perceptions of autism in service delivery.
  • November: a whole day learning event with interactive workshops and presentations.

Neurodivergence communications toolkit

A new toolkit is now also being developed to support staff in delivery roles to improve their communication with neurodivergent individuals. This toolkit will help staff to capture the communication preferences of individuals making it easier for them to get the support they need.

Get involved

All colleagues across the system who can benefit from improving their knowledge around neurodivergence are encouraged to attend. All webinars are free to join.

Find out more about upcoming opportunities to connect and learn more about neurodiversity and SMD.

*The Nottingham Practice Development Unit (PDU) is a shared learning platform for all partner organisations and colleagues interested in improving their ability to manage and respond to the needs of people experiencing severe and multiple disadvantage (SMD).

Find out more about what’s on offer here.

Health & Wellbeing LIVE Series 2

The first episode in our new series of Health and Wellbeing LIVE is now on YouTube! Health & Wellbeing LIVE is a video series that discusses some of the pressing issues across the Nottingham healthcare system with key players from across the network.

Dr Andy Foster was joined by our own Tim Guyler, Executive Lead for PBP and Director of Strategy and Integration for Nottingham University Hospitals NHS Trust. They spoke about the challenges and opportunities ahead in 2025 and the importance of continued collaboration across services.

Make yourself a brew and set aside 20mins to watch, or put on in the background podcast-style while you get on with your day.

This is the first episode of the new series, with loads more fascinating discussions lined-up over the next few months. Subscribe to the Nottingham City Place-Based Partnership YouTube channel to get notifications when new episodes are ready to watch.

Catch up on the first series here: https://youtube.com/playlist?list=PLwNbplchUN43hyP0zAXc8alpGgH5Ap836&si=cqD7-P2sULaxeWHG

Support continued for people experiencing severe and multiple disadvantage in Nottingham City

The Nottingham City Place-Based Partnership is delighted to learn that the government’s Changing Futures programme, which was scheduled to close in March 2025, is to be extending for a further year. Changing Futures has been at the core of the PBP’s severe and multiple disadvantage* (SMD) programme since 2022, supporting people experiencing extreme health inequalities in Nottingham.

As part of the Spending Review settlement covering 2025/26, the government has announced £10m is to be allocated to support the continuation of service provision across the 15 participating areas. Nottingham is to receive just under £650k of this allocation.

The Nottingham City PBP’s SMD programme has been successful in stopping the revolving door of the same services spinning for hundreds of people, improving health outcomes, helping them to recover, sustain tenancies and get back into employment. It has also delivered financial efficiencies across sectors including, health, social care, housing, police and criminal justice, reducing demand pressures and empowered staff to challenge traditional ways of working.

Last year, the Nottingham City PBP secured just under £1.5m in recurrent funding from the Nottingham and Nottinghamshire Integrated Care Board’s Health Inequalities and Innovation Fund enabling the continuation of core services previously funded under Changing Futures. This announcement from the government allows continuity of the wider programme of work provided in Nottingham since 2022, enabling partners to continue to make progress in transforming the lives of people facing extreme health inequalities.

To learn more about our work to support people experiencing severe and multiple disadvantage, watch this episode of Health & Wellbeing LIVE.

* People who experience SMD (co-occurring experiences of homelessness, problematic substance use, mental-ill health, domestic and sexual violence and/or abuse, and offending) are amongst the most vulnerable to poor health outcomes within our population. The challenges they face substantially increases their exposure to chronic health problems, shortened healthy life expectancy, and significantly premature death.

Primary Care and Severe and Multiple Disadvantage Collaboration Project – Access to Healthcare

People experiencing severe multiple disadvantage (SMD – co-occurring experiences of homelessness, substance use, mental-ill health, domestic and sexual violence and/or abuse, and offending) are amongst the most vulnerable within our population to health inequalities and premature mortality.

The challenges they experience in their lives (e.g. due to mental-ill health, trauma, addiction and homelessness) and barriers to accessing preventative healthcare (e.g. due to stigma, exclusions and other reasons) often result in earlier onset of chronic health conditions and longer-term reliance on emergency and more resource intensive interventions (including repeated A&E attendances and unplanned admissions to hospital). People working in healthcare also often encounter difficulty meeting their needs, managing missed appointments, and working to address issues beyond their remit (e.g. housing) – and where clinical interventions are provided, they can be frustrated by people returning to situations that present a persistent risk to their health.

Over the last year, people with lived experience of SMD from Changing Futures Nottingham have collaborated with the Nottingham Practice Development (PDU) and the NCGPA Centre of Excellence to raise awareness and understanding of the key issues and challenges in access to primary care. A range of resource have now been developed across this partnership to help support improved engagement and outcomes from primary care, including:

  • A toolkit for practices to use to (registration, environment, flexibility with appointments, access to free training, pathways to external support, etc)
  • An ‘I Need Extra Help Card’ scheme for a person to record individual needs and potential adjustments
  • An ‘Access to Healthcare’ video featuring people with lived experience and colleagues in primary care
  • A wider SMD resource pack for all colleagues working in primary care
  • A set of ten lived experience recommendations (to be made available as a poster) to help embed ‘SMD friendly’ approaches, with suggestions including:
    • A flexible appointment system
    • Allowing for reasonable adjustments
    • Providing an SMD ‘drop in’
    • Ensuring services and patient care is trauma-informed

These approaches have been co-produced with the dual aims of:

  • Improving patient experience / overall health for people experiencing SMD
  • Providing support to colleagues and manage pressures in primary care (e.g. by reducing missed appointments, supporting quicker access to external support to help with wider needs, etc)

These resources have initially been outlined in dedicated PLT sessions on SMD for colleagues in primary care in July, and are now being endorsed and adopted within a new Inclusion Health and SMD Primary Care toolkit being developed locally through a Phoenix Fellowship.

ICS Award for Nottingham City and South Notts Place-Based Partnership teams!

We were delighted to see the Opportunistic Flu Vaccinations initiative win the Prevention Award at the Nottingham and Nottinghamshire Integrated Care System Awards on 6th November 2024.

In 2022, clinicians from Nottingham city and South Notts PBP Secondary and Primary Care Interface Group discussed how NUH could offer flu vaccines at their city and QMC campuses to reach underserved communities with low vaccination rates. The project team was made up of PBP partners from NUH, ICB, NHSE, working closely with primary care.

The initiative intends to act as a ‘mop up’ to primary care clinics which have generally finished by December. Between December and March, after most flu clinics have finished, the teams used primary care data to identify patients who were unvaccinated and ‘matched’ this with NUH outpatient data. Patients then receive a text message the day before their outpatient appointment, giving them the opportunity to drop in to get their flu jab at one of the NUH vaccination hubs.

The project has run for two years. Last flu season, nearly 1,000 patients/carers received a vaccination at NUH after receiving a targeted text message. 83% of those vaccinated were in the under 65 ‘at risk’ category making them high risk of serious illness from flu due to pre-existing health conditions. Nearly 400 of those vaccinated last year, attended in March, indicating the ‘mop up’ approach is successfully engaging with people who would otherwise not seek a vaccination.

The project will enter its third year this year and we are hoping to see another increase in the numbered vaccinated. It’s a fantastic example of how working in partnership across primary and secondary care can improve health outcomes in Nottingham and Nottinghamshire.

We look forward to seeing how this project continues to evolve and help more people this flu season. Congratulations to everyone involved!

Watch this video to find out more:

Heart of our Community

Thank you to everyone that came and contributed to our first Heart of our Community event on 26 September, bringing together key voices from the Nottingham healthcare network to discuss how to improve heart health through collaboration.

Heart conditions are one of the leading causes of ill health and premature death in Nottingham, with multiple complex factors contributing to these high levels. Statistics presented on the day by Dr David Johns (Deputy Director of Public Health at Nottingham City Council) showed how poor heart health disproportionately affects people from Black and Asian backgrounds, with smoking and poverty also substantial contributing factors.

To combat the multiple causes of poor heart health and effectively target the communities who are most at risk, we need to share knowledge, experience, and insight across networks. The Heart of our Community event aimed to kickstart such relationships and help us all look at the wider picture of heart health in our communities.

We were privileged to be joined by contributors from across the network who reflected on their experiences of working with patients encountering heart problems, and their thoughts on how we can improve outcomes. After PBP Clinical Director Dr Husein Mawji opened up the event, Dr Andy Foster and Ciara Stuart from the PBP spoke about how Integrated Neighbourhood Working can be utilised to help target specific communities more at-risk of heart conditions.

There were also valuable insights from Dr Emma Sawyer (GP at Sherrington Park Medical Practice), Jules Sebelin (Chief Executive of Nottingham Community and Voluntary Service), and members of the Nottingham CityCare cardiac team. New PBP Chair Tim Guyler closed out the day speaking passionately about why improving heart health is of personal importance to him, and praising the work being done to help connect the dots between services in the city.

We would like to thank everyone who attended the event and shared their thoughts and ideas on how we can work collaboratively to tackling this vital issue in our community. We hope the discussions held and the connections made will help us create a joined-up approach to improving heart health in Nottingham.

You can read more about the purpose of the event here: https://healthandcarenotts.co.uk/wp-content/uploads/2021/05/Heart-of-our-community-Event-Summary.pdf

Community Health and Wellbeing Hub wins PMA Award!

Congratulations to the PCN5 (Bestwood & Sherwood) ARRS workforce for their success at 2024 PMA Awards! Their Community Health and Wellbeing Hub took home the top prize in the ‘Innovation in General Practice 2024’ category at last week’s award ceremony.

Their health and wellbeing hub takes an innovative approach to connecting people who often feel shut-out of traditional health services. It creates a space for building communities, while providing attendees health advice and signposting to additional services in the area.

This initiative takes a holistic approach to improving health outcomes for people experiencing isolation and do not have a strong social circle around them. This could because they are recent migrants, are experiencing grief, or have mental/physical health conditions.

The PMA’s are prestigious awards in healthcare, and nomination is national recognition of the high-quality work in reducing healthcare barriers being done by the team in Bestwood & Sherwood.

This nomination follows on from their success at the i2i Awards in September, where the hub picked up the ‘Addressing Health Inequalities Award’. You can read more about that on the NCGPA website here: www.ncgpa.org.uk/news#BlogPost18275

Congratulations to the whole team on their incredible achievement!