Una Nicholson explains how changing the questions we ask people about the service, is making MSK more equitable

Why we do this work 

According to the World Health Organisation, ‘Health equity is achieved when everyone can attain their full potential for health and well-being.’ And no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.’

We know that our society is not fair and equitable. Systemic and institutionalised bias affects every aspect of life, including the work. The more we get to know our communities – who is using our services and the barriers they face – the more we can do to redress the balance and strive to be part of a great change that will improve life for everyone.

Where we were

About a year ago we changed the way we gather, map and track data within Sussex MSK Partnership, our Sussex wide musculoskeletal service serving a population of 600,000.

We asked people how they describe themselves in terms of ethnicity, gender, ability, sexuality, religion and caring responsibilities

What we did

We asked people how they describe themselves in terms of ethnicity, gender, ability, sexuality, religion and caring responsibilities. Using these insights, we created an Equity Dashboard which maps who is using the service against population data. It also tells us how our patient population reflects the general population in terms of indices of deprivation.

At the same time, we started to invest and build our community networks through relationships with local authorities and voluntary organisations. We created our quarterly community network event, The BIG Conversation, as a forum for learning, networking, and idea generation directly with service users and their support networks.  Our staff led group, Bright Ideas, also acts as a vehicle for colleagues to suggest improvements for their patients.

What we’re learning

Our data tells us we are meeting the full diversity of our communities and that the systemically disadvantaged are coming through the door. But our conversations also revealed that while people from poorer areas are making it into the service, they may have to navigate obstacles to get to our sites, such as multiple bus journeys. And with some areas having only 70% broadband coverage, people couldn’t always access our web resources which support people to live well with their condition. Further to this, our clinicians told us that we needed to improve interpreter services as people were arriving for appointments but faced language barriers to getting what they needed.

What this means for patients

Now we’ve revamped and upskilled our patient care advisors on interpreting provision, we direct people to digital drop-in support, and we plan to take mobile services into less affluent areas – small changes that can make a big difference to individuals.

We continue to monitor the data and work with our communities and our staff. We’re even looking forward to getting stuck in to the 2021 census data this Autumn, comparing our reach with the general population so we can spot any gaps.

Health equity won’t happen overnight, but we will keep iterating, learning and improving, to realise our goal of creating exceptional care for everyone.

Una is the Head of People, Teams and Culture at Here and MSK Patient Partner Lead.