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29 September 2023

First ELFT Annual Population Health Report

Programmes from tackling racism to financial advice and support for service users are included in a first population health report produced by East London NHS Foundation Trust. 
The cover of the Trust's first annual public health report

It is the first report of its kind produced by a mental health, community health and primary care trust and in co-production with service users to show the work taking place across communities supported by the Trust. 

The ELFT strategy commits the Trust to taking action to improving population health along with improving quality of care, staff experience and value. 

The Trust believes it has a responsibility to make the communities it serves a fairer place to live and work, and to see those communities thrive. 

Work on population health across services and geographies, including being an Anchor institution and a Marmot Trust, is ELFT’s way of turning this aspiration into reality. 

Service users have helped produce the new report to identify case studies of good practice and areas where we have the opportunity to do more. 

“Improving population health can only be achieved through true collaboration,” said Laura Austin Croft, Director of Population Health.

“This report really demonstrates a commitment to innovation and change led in equal partnership by service users, colleagues and partners across the health, social care and voluntary and community sectors in North East London (NEL) and Bedfordshire, Luton and Milton Keynes (BLMK).” 

She added: “We also recognise we can’t do everything all at once. For the coming year we have chosen to focus on three key priorities: employment, income maximisation and physical health.”

Our health
We know that while access to good healthcare is important, our health is built on many factors. Having a safe place to live, enough money to be able to afford healthy food and pay bills, a good job and social networks are key elements of this.
Addressing these wider determinants of health helps build healthy communities, and at ELFT we are committed to playing our part in creating these.
This is new ground for NHS organisations, and we are only beginning our journey. The annual population health report highlights examples of our work under our six objectives. Below are the objectives and case studies for each.

Discovery College
Our DISCO (Discovery College) offers free workshops to young people between 13 and 18 years old across Luton and Bedfordshire. All our workshops are done in groups either face to face or online. The Discovery College cultivates a non-judgemental environment and allows everyone to share their voice, creating healthy resilient neighbourhoods. Workshops cover themes such as personal growth, healthy relationships, life skills and creativity. We welcome parents and carers, professionals and supporters to come along too. In six months in 2022 106 young people attended 401 sessions.

Better Days
Better Days is a series of co-produced creative projects across Luton, Bedfordshire and Milton Keynes. It aims to increase engagement, break down stigma and reach young people who might not otherwise access services. Involvement in creative projects can help to begin a dialogue about health and wellbeing. Examples so far have included poetry nights and a queer craftivism collective.

Healthier Wealthier Families
ELFT is testing a new programme with partners in Newham and Tower Hamlets called Healthier Wealthier Families. It aims to improve the financial wellbeing of children and their families. This programme is based on an approach originally developed in Glasgow, and which is now being piloted in other countries including Australia. The idea is to intervene as early as possible in a child’s life to reduce financial hardship. For ELFT, the Healthier Wealthier Families programme will see financial wellbeing advisers from an organisation called Our Money Newham sit in specialist children’s and young people’s services. These advisers will help families experiencing financial hardship make the most of their incomes and help them find other sources of support. We have commissioned an external evaluation to assess the difference this project makes.

Individual Placement and Support (IPS)
Individual Placement and Support (IPS) is a programme that helps people with severe mental health conditions into employment. We recognise that it can feel daunting to start the process of finding employment, especially when people have been out of work for a long time, or have not had the opportunity to build a career in the first place. We provide one-to-one support that is unlike any other jobseeker programmes. This includes personalised support, a rapid job search followed by placement in paid employment, and ongoing in-work support for both the employee and the employer. The team helps each individual find work which suits them in terms of location, hours and use of their skills. We can also help people access other support they are entitled to, such as reasonable adjustments at work.

Inclusive recruitment in Newham
In Newham we have been running a Quality Improvement project on inclusive recruitment
in partnership with Newham council’s 'Our Newham' programme. We have focused on recruiting Newham residents into nursing support worker and admin roles at ELFT.
To do this we have given support to local candidates including promoting these roles, offering a walkaround a hospital, offering mock interviews and helping with applications. We have recruited 72 people so far.

Good quality work in Luton
Good quality work includes employers ensuring there is a good working environment, and that people can stay in their jobs. We developed training in partnership with Luton Council and Total Wellbeing Luton on the importance of good quality work and how to create a workplace that is supportive for people who may have mental ill health. In addition, working in partnership with Luton Adult Learning, we highlighted their Mental Health First Aid courses to grow capacity within Luton organisations to spot and respond to signs of mental health issues amongst staff. The continuing effects of isolation following the Covid-19 lockdowns and the current cost of living crisis have led to a growing recognition of the importance of supporting those suffering from anxiety, stress and depression.

Specialist GP practices
We run three specialist GP practices in East London for people living in hostels or supported accommodation, rough sleepers, and people who spend a significant amount of time on the street or in other public places. We are working in partnership with a charity called Groundswell to help service users to get access to stable accommodation and other forms of support.
For people who are homeless, lack of access to a bank account can make it very difficult to move into employment. Our homelessness teams have partnered with HSBC’s no fixed address service to enable homeless people to access bank accounts.

Real Living Wage
We are working with our suppliers to ensure as many of them as possible pay their employees the Real Living Wage – a wage that helps people meet their everyday needs. Since we began this work we have increased the proportion of the Trust’s suppliers paying the Real Living Wage from 22 per cent to 68 per cent, and we are aiming to reach 100 per cent by 2026.
One of our key successes has been in our new contract with OCS, a company providing services like cleaning, catering and electrical services on ELFT sites, which began in 2022.
The contract secured an increase in monthly take-home pay of nearly £185 for domestic cleaners and porters at the Trust. Policies on paid sickness and maternity leave have also been brought into line with NHS Terms and Conditions.
Our programme has been independently evaluated and we are continuing to expand its scope and impact.

Integrating sustainability
Integrating sustainability across the Trust has been identified as a key aim for the Green Plan and will help the Trust meet its targets of net zero carbon emissions by 2040. To be successful in this work we need teams across the Trust to understand their impact and commit to change.
We have worked with departments across ELFT to integrate sustainability into their annual planning cycles. Before this engagement only a handful of departments, such as Estates and Facilities, included sustainability actions in their plans.
Now more than half have sustainability actions in place and our aim is for this to be at 100 per cent by the end of our two-year Green Plan.

Energy monitoring and audit
A significant part of the Trust carbon footprint involves the energy we use across our estate. Ongoing energy monitoring and energy audits across our large and varied estate have helped us to identify areas for improvement and energy reduction. Thanks to a targeted approach to our building management systems, lighting upgrades and process change involving our contractors, we have reduced our energy use by 18 per cent across all utilities in one year.

Reducing print volumes
Printing and paper use across corporate services is a significant cost for the Trust, as well as having a large carbon impact. Since 2019, we have reduced our overall print volumes by six million pages per year. We have seen significant reductions in our back office, with print volume reductions saving more than one tree per month.
We have also made a real impact on the proportion of our printing that is in colour, which has a higher carbon footprint than mono. Colour printing now accounts for only around 7 per cent of our overall printing.
The changes in our print behaviours over the last few years have reduced our annual spend by £500,000.

Re-using and repairing walking aids
Staff in the musculoskeletal service identified a significant area of waste as all walking aids, such as crutches, were disposed of once a service user had finished using them, even though many were still in good working order.
Following QI methodology, they set up a process to check, sanitise and, when necessary, repair, walking aids so they were ready to be used again.
Since August 2022, 161 walking aids have been recycled, reducing waste and saving the Trust over £1,000.

Tackling racism in Bedfordshire
In the wake of global events in 2020 highlighting racial disparities, Bedford’s Working Together Group wanted to take action. We started by creating anti-racism steering group which included staff and service users across Bedfordshire and Luton.
Tackling this topic was challenging, emotive and personally charged for many, however it was heart-warming to see the membership of the meeting grow and that staff and service users alike were committed to taking action.
The local police hate crime coordinator also attends our group and is helping provide print resources for staff and service users.
We have collected the views of staff and service users and identified key areas for improvement. We want to focus especially on implementing a genuinely zero tolerance approach to racism.
We found that in just two months 86 pieces of service user feedback in our area contained racist or discriminatory language.
The Quality and Performance team was part of the conversations we had in the steering group, and they have supported the zero-tolerance approach by no longer including such feedback in their reports. However there is still more to be done to ensure that staff and service users know what to do when they experience racism, and to be confident that the whole organisation will support them.

Compass Community Interest Company
The NHS is not always best placed to deliver projects to improve the wellbeing of marginalised groups.
There is greater benefit in communities themselves being given resources and opportunity to improve their own health and wellbeing.
This also builds capacity, skills and employment in these communities. Through our linked Community Interest Company Compass, we gave out £130,000 to a wide range of grassroots projects, including those which provide culturally informed therapies, psychosocial support for asylum seekers and undocumented migrants, and wellbeing
activities for BAME women.

Creating a more inclusive service
Young people who access Luton & Beds CAMHS wanted to create a more inclusive service and help staff feel more confident working with trans and gender questioning service users. They developed and delivered training to staff which has both improved individual practice and stimulated system change.
For example, ELFT’s clinical records system now has the capacity to record gender identity and pronouns. The training has been so successful that external organisations now invite us in, including local acute Trusts, schools and colleges, social care and police. We have also advised sports coaches on trans inclusion.
This work complements the work of Rainbow Bedfordshire, who have been working to promote LGBTQ+ inclusion in adult services, including establishing an LGBTQ+ trans inclusive swimming club. Initiatives such as this improve access to sport for trans people, which can support their mental and physical health. CAMHS Participation staff with lived experience have also established a trans safe space for young people accessing CAMHS.
This is the only such group locally and has been welcomed by young people and their parents.

Our tobacco dependency service
Our tobacco dependency service aims to increase the proportion of people in inpatient settings who quit smoking. Since 2019, the service covers all directorates including people with severe mental illness and forensic services.
Since relaunching in 2022, the service has seen over 900 patients: 307 patients have quit smoking, including 169 using standard nicotine replacement therapy and 138 switching to
vapes to stay smoke-free for more than 28 days. A unique feature of the new model is ongoing support in the community from the same advisor for six weeks after discharge. The new service has not only supported many patients to quit smoking but has also helped reduce violence and aggression on inpatient wards by 57 per cent, which was often related to lack of access to nicotine alternatives or a consistent tobacco dependence treatment careplan.
Staff who smoke are also supported confidentially by advisors within their individual directorates. To further reduce inequalities, we have increased the availability
of vapes for service users and staff to help support them to stay smokefree for longer.

Reducing inequalities in cervical screening
We run Cauldwell Medical Centre, a GP practice based in Bedfordshire. We sought to increase cervical screening for women under our care. We identified that 62% of women aged 50–64 received screening, compared to only 54% of those aged 24–49. Using a QI approach, we tested a range of change ideas to both increase screening overall and reduce this gap including:

  • Outreach events
  • Text messages that allowed people to self-book appointments
  • Changing appointment letters to stop blaming women for their cancer
  • Translating resources into core population languages

As a result of the work the difference in the percentage of women being screened in the two groups decreased from 8 per cent to 3 per cent alongside an increase in screening overall.

ELFT's population health approach is further reflected in our Anchor Plan 2023 which highlights progress and priorities from our work to invest in and work with the communities we support, while ELFT's Marmot Trust work is included as a case study in a new report by UCL Partners.
'Acting on the social determinants of health to reduce health inequalities: innovative approaches by provider trusts’ by UCL Partners was published on October 12.

ELFT Annual Population Health Report 2023