Prevention is a crucial part of the NHS's approach to improving population health and tackling health inequalities. The NHS Long Term Plan commits to close the gap in health inequalities within communities, while the Health and Care Act 2022 establishes a legislative framework that supports collaboration and partnership working to integrate services for patients. System working therefore offers an opportunity for trusts to contribute to a shared goal of bettering outcomes for communities.
Although health outcomes are shaped by a broad range of determinants, including education and deprivation, we know that as anchor institutions trusts have an important role to play in tackling health inequalities. Holistic and community-centred initiatives that provide preventative measures ensure that all system partners can positively contribute to a person’s health journey.
One community-centred prevention initiative to address health inequalities is the creation of health hubs. This long read explores what health hubs are, how they can improve access for groups facing health inequalities, their broader social and economic benefits, and the role of trust leaders in their development.
What are health hubs?
Health hubs are delivered in collaboration with system partners, the voluntary, community, faith, and social enterprise sector (VCFSE), and the community to transform everyday spaces into healthcare services. Various forms of health hubs have been established by trusts across the country to improve access to healthcare and provide wellbeing support, lifestyle advice, and education. Through this approach, these hubs present an opportunity to prevent ill-health and the worsening of existing health conditions, reducing demand on primary and secondary healthcare services, and addressing health inequalities.
Health hubs can offer multiple services in one convenient location. This could include outpatient and vaccination clinics, routine check-ups such as blood pressure tests, and mental health and wellbeing support. Hubs can offer physical health screenings for conditions such as hypertension and cancer, and services to support specific groups such as those with severe mental illness (SMI). These are all clinical areas that have been identified in NHS England’s Core20PLUS5 framework as requiring accelerated improvement to reduce health inequalities.
The impact of health hubs is wide ranging, including increased visits and decreased 'Did Not Attend' rates compared to traditional healthcare services (particularly for deprived communities, ethnic minorities, and young people) and reports of increased confidence in healthcare services. For example, the 'MSK hub' in Sutton, supported by rehab services from Epsom and St Heiler University Hospitals NHS Trust, provides rehabilitation and physiotherapy services within leisure centres. A high proportion of patients attending their service are from the most deprived communities and the service has led to high levels of patients reported improvements in their conditions (over 60%) and reductions in re-admission rates to services.
Trusts have embedded health hubs in a range of community-centred settings, including:
- Shopping centres (such as University Hospitals Dorset NHS Foundation Trust's 'outpatient assessment clinic' located in the Dolphin Centre in Poole).
- Places of worship (such as South Central Ambulance Service NHS Foundation Trust's 'Safe Space' located in St Mary's Church in Reading, and the 'Health Hub' located in Cambridge Central Mosque, supported by numerous system partners including Cambridgeshire & Peterborough integrated care system).
- Leisure centres (such as West Suffolk NHS Foundation Trust's 'Leisure and Health Hub' located in Brandon leisure centre).
- Libraries and children's centres (such as Mersey Care NHS Foundation Trust's 'The Life Rooms' located across Liverpool).
- Café's (such as West London NHS Trust's 'crisis support café' located in Circle café in Ealing).
- Markets (such as Somerset NHS Foundation Trust's 'Rural Health Hub' located in the farmer’s market in Frome).
- Sports stadiums (such as York and Scarborough Teaching Hospitals NHS Foundation Trust's 'outpatient services' located in the Community Stadium in York).
Mobile health hubs have also been created to provide greater healthcare access for transient communities, such as homeless and Gypsy, Roma, Traveller communities, who may be less likely to reach out to primary and secondary healthcare services. Cambridgeshire and Peterborough integrated care system (ICS) has developed a 'Health bus for homeless' and Central and North West NHS Foundation Trust have a 'mobile health eco-cycle', both of which provide targeted services for those experiencing homelessness.
How health hubs can improve access for groups facing health inequalities
The Kings Fund finds the following features are important in terms of access to healthcare services:
- Physically accessible (e.g., have appointment availability, are close in proximity, have disability-friendly premises, and are reachable via online or telephone).
- Timely (e.g., ability to see a healthcare professional quickly and receive care out-of-hours).
- Sensitive to the patient’s choice (e.g., individuals can receive face to face or online support).
Some groups are more likely to face barriers to accessing healthcare services, which can lead to and exacerbate health inequalities. Alongside physical, timely and patient-sensitive access barriers, additional challenges can include the cost of healthcare, communication barriers, and a lack of trust towards healthcare services. One of the main aims of health hubs is to address these barriers for groups who struggle to access traditional NHS services.
Health hubs can also offer social prescribing and connect individuals with community organisations that hold activities such as exercise classes, art programmes, and support groups - providing a gateway for people to receive support from other services. These activities enhance social connections and mental wellbeing, promoting overall health and reducing feelings of isolation. For example, 'The Bromley by Bow Centre', supported and part funded by East London NHS Foundation Trust, is a healthcare and community hub in London that provides social prescribing services such as advice for housing, employment and finances; classes for the arts, gardening and other creative activities; and mental health support including befriending and counselling.
Saving costs for patients and services
Deprived communities (particularly low-income, unemployed, or homeless individuals), rural communities and specific social-demographic groups (e.g., carers, disabled people, young people, and older people) face greater cost-related barriers to accessing healthcare.
Transport poverty relates to the difficulty or inability to make necessary journeys due to an individual's income, the price of travel, and service availability. Being unable to travel to healthcare appointments in an affordable and timely manner means that individuals cannot receive the healthcare they need.
The cost of accessing healthcare is also a barrier for these communities. This can include making telephone calls for appointments, transportation costs, additional fees at the dentist, and the price of prescriptions. Other hidden costs may include having to take an unpaid day off work to attend an appointment or arranging care for those with caring responsibilities. These factors paired with other financial challenges during the cost of living crisis, can create greater barriers to accessing healthcare services, widening health inequalities.
Health hubs offer services closer in proximity, in more familiar and convenient locations, making appointments easier and cheaper to attend. By offering walk-in and out of hours services, health hubs can also provide timely access to care, without the need for telephone or internet appointments – such as the Black Country Healthcare NHS Foundation Trust’s 'Walsall sanctuary hub', which provides out-of-hours mental health support. There are also opportunities to provide financial advice and support within community-based health hubs, including prescription pre-payment options and healthcare travel cost schemes.
Health hubs offer a dual benefit by creating savings for both patients and healthcare services. As a preventive initiative, health hubs contribute to the early detection and management of health issues, reducing the need for costly treatments associated with more advanced conditions. Health hubs can relieve pressure on A&E, beds and discharges, with research showing 15% lower non-elective admission rates and 10% lower ambulance conveyance rates for systems that have invested in community care.
The reduction in acute demand with higher community spend is estimated to save £26m for an average-sized ICS. NHS Hampshire, Isle of Wight ICS and system partners developed the 'Andover Health Hub' in the Chantry shopping centre – within the first five months of opening they enabled an additional 2000 health checks to be delivered, reducing long waits and pressure on the town's primary care services, local hospitals and ambulance service. On top of the financial case, receiving care in the community is also better for patients and their outcomes, especially those who are frail or elderly. The cumulative effect of potential savings for both patients and healthcare services from investment in these initiatives is significant.
Improving communication
Health information can be hard to access and understand, with 42% of working-age adults in England being unable to use everyday health information. Groups experiencing poor health and digital literacy may experience this more acutely, such as those with low education, living in deprived communities or older people. Similarly, people with multiple conditions to manage, including people with long-term health conditions, disabled people, and people with mental health issues, may find themselves navigating overwhelming or contradictory information. There can also be barriers for those that do not receive health information in their preferred communication style, such as those who do not speak English as their first language or those that require brail or sign language. From booking appointments to understanding medical instructions from healthcare professionals, engaging and communicating with healthcare services can be a challenge, which could potentially deter people from seeking support, exacerbating health inequalities.
Health hubs can play an important role in bridging health communication gaps. Some hubs provide an educational and supportive environment to ensure health information is communicated in an accessible way to meet their needs. For example, the national Health and Digital Literacy Partnership pilots provided eight health literacy and digital inclusion projects in collaboration with NHS trusts and system partners – such as Derby and Burton NHS Foundation Trust and Midlands Partnership NHS Foundation Trust's 'Be Your Health'. These hubs deliver a range of services including demonstrations of medical instructions, reviewing health materials to ensure they are clear and written in plain English, and digital education workshops to ensure that health information is disseminated, and that people's digital skills and confidence improves.
Health hubs can therefore act as a powerful prevention tool by improving knowledge, engagement, self-esteem, and confidence. This can enable communities to make informed decisions about their health and adopt positive health-seeking behaviours.
Creating a safe space
Certain groups may experience a lack of confidence or fear when accessing healthcare services, including ethnic minority communities, migrants, those with SMI, LGBTQ+ communities, individuals on low-income, survivors of abuse and those with substance disorders. There are numerous reasons as to why these groups feel less safe in healthcare settings, some may include language barriers, cultural misunderstanding, stigmatisation, discrimination, financial barriers, and reliving negative and traumatic experiences. For example, people living with SMI experience some of the worst health inequalities, with a life expectancy 20 years less than the general population.
Through working with system partners and the VCFSE sector, health hubs can offer an informed service that is sensitive to the community's concerns around healthcare, listening to what they need to create a safer space. Establishing health hubs within trusted community settings, including places of worship (such as South London and Maudsley NHS Foundation Trust's 'Be Well Hubs') or known LGBTQ+ spaces (such as 'Birmingham's LGBT Centre' supported by University Hospitals Birmingham NHS Foundation Trust), can also break down barriers to accessing more traditional healthcare services. Services can also be tailored to the community's needs. For example, South West London ICS's 'Croydon Health & Wellbeing Space' in collaboration with Croydon BME Forum and Mind delivers specialised mental health support for ethnic minority communities.
Building trust and understanding the unique concerns of different groups is crucial in ensuring people feel comfortable in accessing healthcare services and addressing health inequalities.
Broad social and economic benefit
Alongside health and social benefits derived from better connections and support, health hubs also positively contribute to the local economy by increasing footfall for local businesses – for example, Warrington and Halton Teaching Hospitals NHS Foundation Trust's 'Halton Health hub' has attracted 150 extra visitors to the shopping centre each week. This reflects the broader role of trusts as anchor institutions serving their communities.
The role of trusts
As the case studies throughout this long-read demonstrate, joint working with system partners, the VCFSE sector, and the community is key to addressing health inequalities.
Health outcomes are shaped by a wide range of determining factors, but trusts have a key role to play in prevention and could consider the development of health hubs as part of their offer to patients. Trust leaders could:
- Spend time listening to and understanding their local community to help tailor health hub services to specifically meet the needs of those experiencing health inequalities.
- Ensure that health hubs meet statutory guidance to work with partners to put people at the centre of everything they do.
- Work with system partners, including local government and VCFSE colleagues, to ensure there are appropriate resources for health hubs to work effectively and that they can be based in optimal locations.
- Analyse data from their trust to improve intelligence on community health, and to further improve healthcare access, safety, experience, and performance.