Insights Bulletin: Tackling health inequalities in care

An insights bulletin from Acacium Group

Acacium Group is one of the NHS’s largest partners offering staffing, managed services and innovative delivery models to local health and social care systems.

As a trusted partner of the NHS, public health and local authorities for more than 35 years, we are focused on improving access to healthcare in underserved communities and reducing health inequalities through the breadth of our offering.

Our market-leading specialist businesses are at the forefront of our efforts to tackle health inequalities in service provision, with Xyla Health & Wellbeing and Xyla Digital Therapies delivering quality care in diabetes prevention, healthy lifestyle education, and mental health services. In 2021 alone, we provided mental health support to almost 38,000 people, and helped more than 210,000 people change their lifestyle to lose weight, reverse or reduce the risk of type 2 diabetes.

This briefing, which is intended for all those with an interest in tackling health inequalities, sets out:

• Facts and figures on health inequalities
• Tackling health inequalities: lessons from our service provision
• Contact information

Facts and figures on health inequalities

Health inequalities continue to be a significant challenge, with (for example) a 19-year gap in healthy life expectancy between the richest and poorest areas of England.¹ Each year, health inequalities cost the NHS £4.8 billion in greater hospitalisations alone,² and greater disease morbidity impacts livelihoods and burdens healthcare services.

The pandemic has starkly exposed many existing health inequalities, with COVID-19 disproportionally impacting those from certain communities³ – especially those from deprived
and Black and Asian groups.⁴ At the same time, restrictions in access to healthcare, education, and on day-to-day living has led to worsening health outcomes, with growing childhood obesity⁵ and high-risk drinking prevalence⁶ highlighting weaknesses in current approaches to public health.⁷

In the UK, 13.6 million people are at risk of developing type 2 diabetes,⁸ with growing evidence that most cases can either be prevented or delayed in those who are at high risk.⁹ However, the burden of diabetes is unequally shared. Ethnicity and socioeconomic status are major determinants of diabetes-related inequality, and access to screening and treatment services is generally lower among these groups.¹⁰

Despite the increased policy prioritisation on mental health in recent years, the deep inequalities which lead to mental health difficulties and the stark differences in access to quality services, remain.¹¹ Although people living in more deprived areas are more likely to be
referred to IAPT services, they are substantially less likely to make a successful recovery and their condition is more likely to deteriorate.¹²

Health inequalities also have immediate consequences for the NHS. Waiting lists have increased by 55% in the most deprived areas since April 2020, compared to a 36% increase in the least deprived areas, with this trend continuing in those waiting more than a year for treatment.¹³ Variation within the spread of the care backlog has real effects on lives and livelihoods, with long waiting times impacting financial and economic security¹⁴ – which could entrench inequalities further still

Lessons from our services

NHS Diabetes Prevention Programme

Xyla Health & Wellbeing specialises in innovative health solutions to support local communities to live healthier lives for longer.

Our approach is embedded in clinical best practice and underpinned by behaviour change to support sustained lifestyle improvements. Being the largest provider of the NHS Diabetes Prevention Programme (NDPP), we hold a wealth of knowledge that we have channelled into our diabetes remission, weight management, and healthy lifestyle education services.

Overview of our programme

1. Initial one-to-one assessment to evaluate health and wellbeing, understand individual needs, solutions to barriers, motivations and programme goals
2. Group or individual sessions on type 2 diabetes prevention and strategies to empower sustainable lifestyle change
3. End of programme review to examine progress and support with post-programme goals

The role the NDPP plays in reducing health inequalities

The NHS Diabetes Prevention Programme plays an important part in reducing health inequalities. In the national programme, there is a consistently higher attendance rate of individuals from ethnic minority backgrounds, and individuals who are deprived.¹⁵ This is also true across the range of services Xyla Health & Wellbeing provides, including the NDPP.

The benefits of Xyla’s approach

The importance of broader lifestyle prevention moving forwards

Smoking, high blood pressure and high body mass index (BMI) together account for 25% of the burden of disease in England, and some of the main risk factors behind higher incidence of disease can be attributed to behavioural risks¹⁶ – which are more common in deprived communities.^{17 18}

During the pandemic, Xyla Health & Wellbeing expanded its range of services into an enabler of broader lifestyle change, covering smoking cessation, weight management, and mental health support, as well as diabetes prevention and remission to help reduce the burden of obesity.

Ensuring equitable access to NHS mental health services

Xyla Digital Therapies is a pioneering new service improving the accessibility, affordability and effectiveness of psychological therapies within the Improving Access to Psychological Therapies (IAPT) programme. The service delivers seamless digitally enabled therapies throughout the patient pathway, in partnership with NHS services across the UK.

Reducing health inequalities through digital IAPT services

The IAPT programme is recognised for its ambitious approach to delivering psychological therapies at scale, with recovery rates in 2018/19 reaching 52% and the service having
been expanded under the NHS Long Term Plan.¹⁹

However, there are recognisable inequalities within access to face-to-face services. In 2020/21, 36.7% of the most deprived patients had completed treatment, compared to 53% treatment completion for the least deprived.20 This is despite the number of referrals being highest in more deprived communities21 – suggesting that although patients in deprived communities are
seeking help, they are less likely to find services accessible.

Our digital IAPT services have the potential to reduce health inequalities by making therapy more accessible to those patients who find it difficult to engage with services, and offering greater personalised solutions.

The future of digital IAPT services

The national IAPT programme was designed to reduce waiting times for talking therapy services for depression and anxiety.²³ Despite improvements in waiting times for most patients, the number of patients waiting longer is increasing²⁴, partly due to growing demand.

Digital IAPT services provided by Xyla Digital Therapies can deliver additional capacity to NHS services by expanding therapy hours, 7-days a week, and offering new platforms to provide innovative and seamless delivery. Digital IAPT offerings have an important role to play in helping the NHS manage the growing care backlog, and can be a part of the solution to inequalities in access to mental health services for hard-to-reach communities.

Recognising the challenges that children and young people face in accessing mental health care and support, Xyla Digital Therapies has been working closely with young people over the past 18 months to get their thoughts and ideas on how to best design a service that works for them – with a new integrated digital therapies service coming on stream shortly.

Contact information

We hope this short briefing is helpful. If you are interested in knowing more, please get in touch via info@acaciumgroup.com

Thanks

References

1. Office for National Statistics, Health state life expectancies by national deprivation deciles, England: 2017 to 2019, March 2021
2. NHS England, NHS Long Term Plan: More NHS action on prevention and health inequalities, January 2019
3. Local Government Association, A perfect storm – health inequalities and the impact of COVID-19, April 2021
4. Public Health England, Disparities in the risk and outcomes of COVID-19, August 2020
5. NHS Digital, Significant increase in obesity rates among primaryaged children, latest statistics show, November 2021
6. Jackson, E. et al., Association of the COVID-19 lockdown with smoking, drinking and attempts to quit in England: an analysis of 2019-20 data, May 2021
7. Deloitte, Tackling the elective backlog – exploring the relationship between deprivation and waiting times, November 2021
8. Diabetes UK, Diabetes diagnoses double in the last 15 years, May 2021
9. NHS England, Record high two million people at risk of Type 2 Diabetes, February 2020
10. NWCCN, Opportunities to access Diabetes Health Inequalities Improvement Programme funding in the North West Coast Clinical Network, December 2020
11. Centre for Mental Health, Commission for Equality in Mental Health, November 2020
12. NHS Digital, Psychological Therapies, Annual report on the use of IAPT services, 2020-21, September 2021
13. The King’s Fund, Tackling the elective backlog – exploring the relationship between deprivation and waiting times, accessed December 2021
14. Healthwatch, People living in the poorest areas waiting longer for hospital treatment, September 2021
15. Barron, E et al., Short Report: Epidemiology Progress of the Healthier You: NHS Diabetes Prevention Programme: referrals, uptake and participant characteristics, December 2017
16. Public Health England, The Burden of Disease in England compared with 22 peer countries: A report for NHS England, January 2020
17. Office for National Statistics, Likelihood of smoking four times higher in England’s most deprived areas than least deprived, March 2018
18. NHS Digital, Health Survey for England 2018 [NS], December 2019
19. Health Foundation, In deprived areas, patients referred for psychological therapy are less likely to receive treatment, December 2019
20. NHS Digital, Psychological Therapies, Annual report on the use of IAPT services, 2020-21, November 2021
21. NHS Digital, Psychological Therapies, Annual report on the use of IAPT services, 2020-21, November 2021
22. NHS Digital, Psychological Therapies, Annual report on the use of IAPT services, 2020-21, November 2021
23. NHS England, The Improving Access to Psychological Therapies Manual, August 2021
24. BBC News, Hidden waits ‘leave mental health patients in limbo’, December 2019