‘Mass Screening’: Wandsworth Community-led Health Clinics

January 22, 2021

Thomas Herweijer is a Project Manager at the South West London Health and Care Partnership (SWL HCP). He shares his experiences as a project lead co-producing long-term health condition screening clinics with local community empowerment networks, reaching out to BAME and other hard to reach groups through work supported by our Innovation Grants in 2019.

In the UK, according to data from the Office of National Statistics (ONS), approximately 7.4 million people live with cardiovascular disease (CVD), almost five million with Type 2 diabetes, and respiratory disease is the third biggest cause of death. Prevention, early detection and intervention of these long-term conditions (LTCs) represents a huge opportunity to make a difference in reducing incidence and human burden as well as improving wider outcomes and reducing health and care costs for the NHS.

We know that people from marginalised communities (including Black, Asian and Minority Ethnic ‘BAME’ communities) are at a higher risk of  developing these conditions . This has been further highlighted by a Public Health England report on Disparities in the risk and outcomes of COVID-19. We had also heard personal testimonies from people in our communities that they were least likely to engage with early interventions. They are often underrepresented in preventative services such as the NHS Health Check programme due to a lack of trust and confidence in mainstream services with services provided not adapted or tailored to their needs. This results in these communities having to make more use of emergency services, increasing health inequalities.

In 2019, South West London Health and Care Partnership (SWL HCP) and Wandsworth Community Empowerment Network (WCEN)  applied to the Health Innovation Network (HIN) for an Innovation Grant of £10,000 to co-produce and co-lead a ‘Mass Screening’ pilot project, initially focusing on stroke prevention. It received senior management sponsorship from former Managing Director at Merton and Wandsworth CCG, James Blythe, and clinical sponsorship from Dr Nicola Jones, a Wandsworth GP and clinical chair of Wandsworth CCG, and Dr Karen Kee, a stroke consultant at Croydon University Hospital. The application process was short and easy with a helpful template provided. The bid was successful and the partnership received the exciting news that the project had received funding within eight weeks from submission.

“ … we managed to complete health checks in 441 people across six health clinics at local Black Caribbean and Black African Churches, a Tamil temple and two mosques. ”

The ‘Mass Screening’ project initially was aimed at targeting underrepresented communities at high risk of CVD and specifically stroke, aligning with the HIN’s stroke prevention programme priorities. Our plan was to reach out to communities at their local place of worship or community network through co-produced and community-led ‘Stroke Busting Health Checks’ offering a range of health checks to a minimum of 1,000 people to address the unacceptable healthcare inequalities in Wandsworth. Enabled by the senior management and clinical sponsorship, we received additional funding from the CCG allowing us to broaden the scope and impact of the project to also include offering health checks for Type 2 diabetes and chronic obstructive pulmonary disease (COPD). The project was renamed to ‘Community-led Health Clinics’ in acknowledgement of its broader approach.

The main purpose of the pilot was to identify people with previously undetected LTCs, enabling timely diagnosis and treatment to reduce their risk of ill health and hospitalisation. In addition, we aimed to reduce the healthcare inequalities in BAME and underrepresented groups across the most deprived areas of Wandsworth. Despite having to prematurely end our project in March 2020 because of the Covid-19 pandemic, we managed to complete health checks in 441 people across six health clinics at local Black Caribbean and Black African Churches, a Tamil temple and two mosques. We observed the following findings:

  • 61 per cent of participants were detected with a high or moderate risk of Type 2 diabetes using the Diabetes UK ‘Know Your Risk’ tool;
  • 27 per cent had a blood pressure of >140/90 indicating possible hypertension;
  • Four participants had a blood pressure of >180/110 indicating severe hypertension (n-4);
  • 18 participants had Atrial Fibrillation; and
  • Nine participants out of 35 participants had suspected COPD .

We raised awareness of these conditions and trained 25 locally trusted community members to become ‘community health coaches’ with the aim to support their communities in empowering them to receive a health check, act and change their lifestyles and behaviour where indicated. Where a new risk factor was discovered, the community health coaches were able to support people to visit their GP.

The HIN was flexible in understanding that it was not possible to deliver face to face health checks once the pandemic was upon us. Our pre- and post-health clinic confidence surveys were produced in partnership with the HIN. These provided us with extremely valuable insights regarding participant awareness of risk factors, satisfaction levels, motivations and intent to act on their behaviour and lifestyle. The location and the faith leaders played an important role for people attending the clinics and 36 per cent of the respondents said they were motivated by their faith leader. There was also an increase of between 15-25 per cent of participants across the clinics who post-clinic said they would prefer to have a health clinic at their place of worship or community centre compared to pre-clinic.

“The project has delivered a proof of concept and identified further opportunities for early detection and interventions across both physical and mental health conditions.”

The true feeling of community cohesion and social capital created through this project with trained health coaches and volunteers working across each other’s churches, temple and mosques adds unexpected value to the project as illustrated in the picture above.

The success of the project was further evidenced by a video that was co-produced with the local places of worship and community networks.

The project has delivered a proof of concept and identified further opportunities for early detection and interventions across both physical and mental health conditions. We are now working to spread this approach across south west London and seeking further investment for building on reciprocal trust between these communities (the social capital) and institutions such as the NHS. It has justified investment to increase sustainable community capacity, capability and leadership to reduce inequalities, but also in (digital solutions) to integrate the community and the wider health and care system.

The unique approach and success of this project has been recognised by being shortlisted for an HSJ Partnership award. In addition, the project has now partnered with the Decathlon Prevention Programme, another 2019 HIN Innovation Grant winner, which will see this innovative prevention approach be culturally adapted and delivered virtually to BAME communities in Merton and Wandsworth funded by a grant from NHS Charities Together. Never underestimate what a sum of money and a co-produced project can achieve for our communities.

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By Rita Mogaiji