20 July 2022

Applying QI along the journey to becoming a Marmot NHS trust – Tackling social determinants of health in Newham and Luton

Over the past 50 years, the recognition of the role that the wider social determinants of health play have been increasingly highlighted. These building blocks of health include things like work, education, housing, demographic factors and access to food to name a few. However, what is clear is that those who are more socio-economically disadvantaged have poorer outcomes and reduced opportunities in life. In essence we don’t all experience the same access or experience to the things that help us thrive.

In 2010 Sir Michael Marmot emphasised that to help improve outcomes for all and improve equity, further work was needed on the complex interactions between the social determinants of health. To help focus the work of those tackling inequity he set out 6 (now 8) “Marmot Principles”

Figure 1 – Marmot Principles

ELFT has responded to this challenge by committing to reducing inequities for those we serve as part of our strategic objective to Improve Population Health. In support of this, the organisation is working to become one of the first “Marmot NHS Trusts” in the country, adopting the marmot principles and framework.

Currently, ELFT is using its expertise in Public Health, Quality Improvement (QI) and People Participation to focus its efforts in working with system partners around two key areas: Employment in Luton and Children and Young People in Newham.

Lead by the Public Health Team, partners in both Luton and Newham have been brought together through a series of workshops. As part of these, they have been working to:

  1. Understand the issue at hand and where ELFT can best support
  2. Develop a vision statement for the work
  3. Agree a handful of key priorities
  4. Develop a portfolio of work (existing and new) to help meet the aim

Throughout, teams have used a range of QI tools such as divergent and convergent thinking to help them develop and narrow down ideas to take forward.

Below is a short summary of the progress of the work so far and what we will be focusing on over the coming months.

Employment in Luton

 ELFT is working alongside partners in Luton to support the ambition of becoming a Marmot Town so ‘that by 2040, Luton will be a healthy, fair and sustainable town, where everyone can thrive, and no-one has to live in poverty.’ Having fair and good employment is a significant contributor to enabling people to gain and maintain the resources that can contribute to them staying healthy and helping reach this aim.

In Luton the focus of the work is around supporting service users to gain and retain employment and skills. The work has been codesigned through several partner workshops to help develop the purpose statement, an aim and a set of key priorities to take forward.

Partners involved include Luton Council, Voluntary Sector Organisations, OCS soft facilities management and members of the population. Below you can see the portfolio of work presented as a driver diagram.

Figure 2: Driver Diagram for the Luton Employment Work

From these, two key pieces of work are currently being taken forward using QI methods to develop an aim, theory of change, some simple measures, and tests of change:

  • One project team is looking at accessible and inclusive recruitment to increase the number of ELFT service users in employment. Here a range of stakeholders including service users and colleagues from HR are involved and are currently working to begin to understand the problem and develop a driver diagram for the work.
  • The other project team is focussing on access to banking for homeless people, which is a prohibitive factor in this group gaining employment. Currently the team are working with partners to identify some specific barriers here with the intention of developing a driver diagram with change ideas they can test

Children and Young people in Newham

In Newham the focus of the work has been on children and young people. With around 37% of the borough population aged between 0-25, Newham has one of the youngest populations in the country.

Following partner workshops, three key areas have been identified by stakeholders as important to take forward.

Figure 3 – Menti Results from Newham Workshop identifying key areas

The next steps for this work will be for those involved to consider what they hope to achieve and develop a portfolio of interventions.

Important work is already underway, including a project to tackle the level of child poverty in the borough, which is one of the highest in the country. For the next phase of this project, the team are looking at testing the Healthy Wealthier Families intervention, first piloted in Scotland, which is designed to provide access to financial advice and benefits support in the community. Currently the project team are working with members of the population to understand how to tailor the intervention locally. They are also looking at what measures would be best to support them know if the change has resulted in an improvement.

Over the coming months we hope to be able to share further progress from the teams particularly around how they are getting on with testing their change ideas and sharing what they are learning as part of the work.


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