Update on Inequalities in Health Fund Projects
My statement on the inequalities in health fund covers three parts: a reminder of the fund and its purpose, examples of what the fund is doing to help people to improve their health in communities across Wales, and future development of the fund as a considerable asset in our work to improve health in Wales.
I set up the inequalities in health fund in 2001 to stimulate and support local action to address inequalities in health and the factors that contribute to them, including inequity in access to health services. Coronary heart disease has been the fund’s first priority, and it has been extremely successful in providing disadvantaged communities and groups with help at grass-roots level to tackle the risk factors associated with chronic disease. Ninety-six per cent of projects involve local health boards and, with partnership high on the agenda, NHS trusts are partners in 82 per cent of projects. Local authorities are partners in 52 per cent of projects, and voluntary organisations are partners in 37 per cent.
In Wrexham, the travellers project has provided 200 gypsy travellers with risk screening and advice in a form that is accessible and acceptable—over 95 per cent of travellers are now registered with a general practitioner. Also in Wrexham, the hearts and minds project that helps people with mental illness and learning disabilities, has signed up 73 per cent of general practitioner practices and has helped around 700 people. On the Plas Madoc estate, an outreach clinic run by a nurse practitioner has seen 1,800 people—21 per cent of the practice list. Of the target group, 40 per cent reported a reduction in smoking, 31 per cent have improved blood pressure control, and 64 per cent have better cholesterol monitoring.
In Flintshire, Prestatyn Town Council’s healthy communities project and the heart of Flintshire project have, between them, seen over 3,000 people participating in walking the way to health. Results show a reduction in body mass and an increase in fitness levels. In Gwynedd and Ynys Môn, the calon lân projects have gone from strength to strength.
In Gwynedd, screening has identified 37 per cent of people needing referral, and 4,000 people in Ynys Môn have had the opportunity of help to improve their lifestyle. In mid and west Wales, the Wales cardiac network chose Ceredigion to roll out the autonomous administration of thrombolysis by paramedics as a direct result of the inequalities in health fund project. In Swansea, 12 practices involved in the pilot screening register project have processed a third of their target, having seen over 31,000 patients. In Pembrokeshire, a project has increased accessibility to GP screening clinics by holding them during evenings or at weekends. Local pharmacists will be tackling the issue of hard-to-reach patients using a specially developed package. Powys County Council is running cardiac rehabilitation services in five leisure centres, and the 36-week programme has seen a 94 per cent adherence rate. In Carmarthenshire, a toolkit has been developed to help local GP practices implement the coronary heart disease national service framework. All 26 practices in Carmarthenshire are involved, and the toolkit is now being rolled out to other local health boards. A cardiac rehabilitation project has increased the uptake rates from 11 to 78 per cent in Llandovery and from 15 to 89 per cent in the Amman valley, which compare favourably with the national average of 30 per cent.
In south Wales, the Cardiff local diabetes services advisory group has adopted the approach developed by a GP-led project as the gold standard for the provision of diabetes services. The barefoot project in Cardiff bay has supported more than 600 people, and in Newport, the dharkan project has developed a blood-pressure monitoring and advice clinic. A clinic was held in a Bangladeshi mosque on worship day, and the service may now be offered to other local mosques.
Rhondda Cynon Taf’s heart attack project covers 17 of its most deprived wards and targets a population of 11,000. Blaenau Gwent has six projects. Some 462 people have contacted the smoking cessation service and, four weeks after their personal quit date, 67 of those that attended classed themselves as non-smokers. Participants in an obesity class lost an average of 2.7 kg, with 53 per cent of attendees extending the lifestyle changes to the rest of their families. Also, a cardiac project run by the Royal Glamorgan Hospital resulted in a reduction of 10 per cent in re-admission rates, with average length of stay reduced by three days and a fall in bed occupancy from 7.5 to 5.6 per cent. In Merthyr Tydfil, 12 small firms are improving the health of their employees in a groundbreaking project that utilises the experience of a large private sector employer as a mentor. The project links better health and business improvement. Barry heart health offers lifestyle change advice and a food co-operative, which allows local residents access to fresh and affordable fruit and vegetables. Caerphilly’s healthy-eating project has established milk bars in local comprehensive schools, salad bars in local primary schools, and training for 25 school cooks to encourage healthier catering practices.
The inequalities in health fund and its projects demonstrate how our agenda is working. They strengthen the prevention role of the NHS with other organisations and partners and generate evidence of effectiveness, both of which were emphasised as important by Derek Wanless. The action is happening at grass-roots level, with real help being developed in communities by, and with, people to improve their health, and this should be celebrated. This is exactly the type of action that we want to see delivered as part of ‘Health Challenge Wales’, as the nation’s challenge to work together for better health.
I have given examples today to illustrate the difference that the inequalities in health fund is making in communities. For this reason, I announced in November a two-year extension to projects. Much has already been achieved, but there is still more to do, and the additional time will allow projects to further demonstrate their effectiveness and for local health boards to consider their longer-term funding. As stated in ‘Wales: A Better Country’, we are committed to extending the fund, and I will be considering how we can build on the fund’s success to date.