Nottingham’s Health Partnerships in Action

Over the last three years the Nottingham City PBP has been overseeing the delivery of Nottingham’s Joint Local Health and Wellbeing Strategy (2022–2025), a statutory function of the Health and Wellbeing Board. We have brought partners together with a shared mission: to reduce health inequalities and support people across the city to live longer, healthier lives.

Following publication of our final delivery report, presented to the Health and Wellbeing Board on 28 May 2025, we want to take a moment to reflect, not only on what we’ve achieved, but on how we’ve worked together, what we’ve learned and where we go next.

Through this Strategy, we’ve taken on some of the city’s most challenging and deep-rooted health issues, including smoking, obesity, mental health, financial insecurity and severe and multiple disadvantage. Nottingham is one of the most deprived districts in the county where wider determinants of health, such as access to good quality housing, low incomes and poor training or employment opportunities, often exacerbate health challenges people face.

We were never going to transform health outcomes in three years, but I am proud to say that we have made real progress and set the foundations for this transformation to take place as we move into the delivery of the refreshed Strategy for 2025–2028.

Together, we’ve supported thousands of people across the city, from people quitting smoking or better managing their weight, to those facing homelessness, addiction issues, trauma or financial hardship. In 2024 we saw the launch of ‘Thriving Nottingham’, the city’s new Integrated Wellbeing Provider, significantly expanded smoking cessation capacity in the city as well as increasing resources to support people to manage their weight, stay physically active and maintain a healthy diet.

This Strategy has not just been about launching new services, it’s been about doing things differently. It’s been about working across boundaries, breaking down silos, and building trust between teams and communities. And through that, we’ve made real progress. Through the partnerships we have established, we have worked together to join up services around people’s needs, rather than the other way around.

From multi-agency working groups to cross-sector delivery teams, we’ve shown that when we share our resources, insights and energy, we can create more joined-up support for local people. We’ve developed shared goals and co-designed delivery plans, underpinned by the voices of people with lived experience to shape what we do. Partnerships like, the Smoking & Tobacco Alliance, the Eating & Moving for Good Health Alliance and the SMD partnership have demonstrated what true collaboration looks like in practice and the impact it can have.

Of course, it hasn’t all been easy. The past three years have brought financial pressures, increasing demand and reduction in resources. We’ve learned that maintaining momentum takes consistent leadership, time, and space to build relationships. We’ve seen how critical it is to have the right people around the table, and to keep them there. We’ve also seen the value of flexible delivery and shared ownership, especially when working in complex or uncertain environments.

Looking ahead to the next phase – our 2025–2028 Strategy – we know that deep collaboration must continue to be the foundation of our approach. Our new focus areas, including alcohol-related harm and ensuring every child has the best start in life, will benefit from the strong infrastructure and learning built through this work. We’ll also need to strengthen engagement with citizens and communities and keep challenging ourselves to tackle inequalities with determination and care.

None of this would have been possible without the people who’ve worked so hard to make it happen – across organisations, sectors and neighbourhoods. Thank you to everyone who has played a part. You’ve shown what’s possible when we act with shared purpose and put people at the centre.

Together, we’re creating a fairer, healthier Nottingham, and the journey continues.

To bring these achievements to life, we’ve created a short video that highlights just some of what’s been delivered through the strategy over the last three years. It celebrates the power of partnership, the difference we’ve made together, and the impact on people’s lives across Nottingham. We invite you to take a moment to watch and to feel proud of what we’ve achieved, together.

Suzey Joseph dedicates her BEM to Changing Futures

Suzey Joseph BEM, Clinical Lead for the Homeless Health Team, has chosen to dedicate her award of the British Empire Medal to wider efforts to improve the lives of people experiencing Severe and Multiple Disadvantage (SMD) in Nottingham.

Suzey has been a driving force behind increasing recognition of the extreme health inequalities faced by people experiencing multiple disadvantage and the opportunities for local services to make a difference by working together to meet their needs.

Reflecting on her award, Suzey said:

“Attending Morning Service to celebrate our Communities and The King’s Official Birthday at Southwell Minster is reminiscent of when I addressed the congregation with the High Sheriff of Nottinghamshire for Framework’s Christmas challenge 2018 and raised awareness of the terrible suffering I witnessed whilst caring for people at their rough sleeping locations. I had at the forefront of my mind that I would endeavour to improve access to GP Practice for all, ensuring that no matter what, everyone can be registered with a GP, enabling me to facilitate continuity of care and improve hospital discharge and outcomes for the most vulnerable members of our communities.

“So much has been achieved since then. I have networked and worked side by side with fantastic people who are genuinely dedicated to making a difference. What’s improved over the last 7 years to help us help those we care for is the wonderful way we now work collaboratively and share our knowledge and skills. Working collaboratively brings challenges, competing priorities and resources, but our SMD Partnership network has overcome this enormously, with Changing Futures leading the way.

“Ultimately, I believe the biggest impact has been the creation of the Practice Development Unit. It’s interactive and easy access for all; gives learning, skills and confidence; and networks across the entire sector and beyond, with readily available up to date information and training continually improving lives.” 

Bobby Lowen, Programme Director for Changing Futures Nottingham, was full of praise for Suzey and the work she has done in the city: “People experiencing multiple disadvantage are too simply dismissed as having made poor choices or being too hard to engage without realisation of the trauma they may have experienced in their lives. Suzey has shown first-hand the difference that partnerships and compassion can make and has been an inspiration to colleagues and services across our system who are working to bring together their support around the needs of individuals. We are indebted to her for her groundbreaking work in outreach and for using her honour to highlight the continuing efforts of our partnership in Nottingham.”

We would like to congratulate Suzey on receiving the British Empire Medal. It’s deserved recognition for her incredible work improving lives of some of the most vulnerable and disadvantaged people in Nottingham. The work of her and the Changing Futures team has never been more important. They are invaluable assets to our city.

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.