Health and social care case studies

Increasing awareness of bowel cancer symptoms among the Asian Community –NHS Hillingdon Clinical Commissioning Group (Formerly NHS Hillingdon)

This case study illustrates the benefits of collecting and using equality information to identify the needs of people with particular protected characteristics and to measure progress in responding to those needs over time.

Background

NHS Hillingdon Public Health Team looked at the information available on cancer types and rates in the Borough in 2010. They found that:

• Among cancers, bowel cancer accounted for a large proportion of cancer deaths;
• More people under 75 were dying of cancer in the South of the Borough which has a high Asian population compared to in the North;
• Cancer was a substantial contributor to inequality in death rates, particularly among women living in the most deprived 20 percent of the borough.

Cancer can often be successfully treated if detected early. For example, eight out of 10 cases of bowel cancer can be treated successfully if detected early .

Action taken

Based on the baseline data outlined above, the Public Health Team decided to launch an awareness campaign in the South of the Borough (Hayes and Harlington) which has a high Asian population.

The Public Health Team found that members of the Asian community had more limited awareness of the symptoms of bowel cancer, which was reducing the chances of early diagnosis with implications for survival rates. One of the reasons for this appeared to be that Asian people felt that cancer did not affect their family or their community (or was less likely to affect them).

In light of these findings, NHS Hillingdon focused their campaign on various actions to raise awareness of the symptoms of bowel cancer among the Asian community, particularly women. Those actions included:

• Designing and distributing leaflets about bowel cancer in English and in relevant Asian languages;
• Holding workshops, facilitated both in English and in other predominant languages. These were organised through existing local organisations e.g. women's groups or charities particularly targeting Asian communities or religious centres;
• Displaying campaign posters on buses and in tube stations in the Borough;
• Promoting messages by advertising on the Sunrise Radio Network - the UK's largest Asian radio network.

Outcomes

Surveys undertaken before and after the campaign revealed that awareness of the main symptoms of bowel cancer increased among people who had received information from the Public Health Team. Almost 80 percent of those who had seen or heard at least one element of the campaign could spontaneously recall at least one symptom, compared to less than 60 percent of those who had not been exposed to promotional material.

Advertising on the Sunrise Radio Network was found to be particularly successful in reaching Asian women.

Using equality information to reduce non-attendance at the Diabetic Eye Screening Programme - Royal Marsden NHS Foundation Trust

This case study illustrates the benefits of collecting and using equality information to identify the needs of people with particular protected characteristics and to measure progress in responding to those needs over time.

Background

All people with diabetes are at risk of developing diabetic retinopathy. This is the most common cause of blindness in people of working age in the UK. There are usually no obvious symptoms until it is well advanced. Evidence shows that early detection and treatment can prevent sight loss. It is therefore very important that it is identified and treated as early as possible.

The Diabetic Eye Screening Programme (DESP) offers annual eye screening to people with diabetes. Data collected in 2011/2012[1] about patients who did not attend showed that the service had the highest non-attendance rate (21.2 percent) of all services delivered by Sutton and Merton community services.

Actions taken

A health equity audit was commissioned to look at equity of service provision, uptake and outcomes among patients referred to the DESP. The audit looked at whether there were differences between the non-attendance rates of people with particular protected characteristics, i.e. age, gender and ethnicity.

The audit concluded in late 2012. It showed that patients of working age were more likely to miss appointments compared with older age groups, and the highest non-attendance rate (40 percent) was found in the 22-31 age group.

To improve accessibility for patients of working age, the service has expanded its out-of-hours provision to include weekend clinics. It also offers patients the option to make and change their appointments by email so that busy patients no longer have to call during working hours to do this.

Outcomes

These initiatives have contributed to reducing the overall non-attendance rate for the DESP.  It has gone from 21.2 percent in 2011/12 to 15 percent in 2012/13.

Such a reduction in the non-attendance rate represents a financial saving for the Royal Marsden[2]. In addition, given the important role of screening in the early detection of diabetic retinopathy, such initiatives should have a positive impact over time in preventing sight loss among patients of working age.

Additional work currently under way

The audit commissioned in 2012 also suggested that White and Asian females and African males had higher non-attendance rates when compared with other ethnicities. However, it cautioned against drawing conclusions due to the quality of the data available.

As a result, the service has amended the data collection process for primary care providers. This will provide a more complete ethnicity profile for the population in future and will be used to re-audit service uptake in 2014/15.

[1] For the Royal Marsden Patient and Membership Equality Profile report 2011/2012

[2] According to the Dr Foster Hospital Guide 2012, 5.8 million outpatient appointments were missed by patients in 2011/2012, representing a loss of potential revenue to the NHS of £585 million. Reducing non-attendance rates not only represents a financial saving for the NHS, it is also a way to reduce waiting times and to improve efficiency.

Supporting job applications from disabled people: improving confidence and work experience for disabled people - Frimley Park Hospital

Background

In its employment equality compliance report for 2010/2011, the Frimley Park Hospital NHS Foundation Trust (the Trust) noted that it had received fewer job applications from disabled people than might be expected, given that eight percent of the population in its catchment area is estimated to have a disability.

Although disability is generally underreported among applicants in the job market, the Trust felt that a specific commitment was needed in order to encourage more disabled people to apply for jobs at the Trust. Mindful of the specific duties (under the Public Sector Equality Duty), the hospital defined the following objective to fulfil this aim:

• Work with organisations such as the Shaw Trust to place disabled people with the aim of developing skills and confidence to support long-term employment prospects. This includes provision of support for applying for permanent posts within the organisation.

Action

In 2012/2013, the hospital contacted the Shaw Trust to ask for curriculum vitae of disabled people who were looking for work placements. The Shaw Trust put forward three curriculum vitae and the hospital identified placements that would best suit the skills of these individuals. Assistance with job applications/interviews was given at the end of the placements so that the three individuals could apply for temporary and permanent positions within the Trust.

Outcomes

In 2012/13, the Trust reported the following progress: out of the three disabled people appointed through Shaw Trust on work placements, two have now been appointed as temporary staff, and one to a permanent post.

The work placements at the hospital made a significant difference to the lives of those involved. In particular, it has enabled participants to gain skills and confidence to apply for jobs afterwards. One participant stated that it has enabled him to demonstrate his skills in a real workplace which gave him the confidence to apply for a permanent post in the Trust. 'At the interview, I could talk about real work skills I had developed in my placement, something I had previously been unable to do'.

The hospital is still working with the Shaw Trust to continue providing more disabled people with potential job opportunities in the coming years.