Surrey Innovation for Healthcare Inequalities Programme (InHIP)

Introduction

The Surrey Heartlands InHIP project’s primary aim was to increase access to high cholesterol and familial hypercholesterolaemia (FH) screening and associated treatments in the community, focusing on populations from deprived areas, Black and Asian minority ethnic groups, and those ineligible for NHS health checks, largely due to age.

The aim of this evaluation was to support local quality improvement efforts, contribute to the national evaluation workstream, and inform future projects addressing inequalities by sharing valuable insights and learnings. Findings from this evaluation will aim to support in improving access, experience and outcomes to health care innovations for people in the most deprived areas of the UK and those people considered to be in ‘inclusion’ groups (Core20PLUS5).

The following questions were identified for the purposes of the evaluation

1. How effective has the project been at reaching hard-to-reach groups (Core20PLUS5)?
2. What effect has the project had on outputs or outcomes across the target groups?
3. What has been the monetary impact of the InHIP programme?
4. Is the approach a feasible option for future initiatives?

Methodology

Quantitative:

Datasets were shared by the ABC and YMCA to Unity Insights, containing demographic and metric data. There were 74 individuals who were included in the initial startup phase, and 475 in the established programme phase. Health outcomes included: cholesterol, hypertension, diabetes, QRISK, BMI, family history, heart age, and referral status.

Qualitative:

There were five interviews in total, lasting up to 45 minutes. Interviews were held over Microsoft Teams during February 2024. Participants were prompted on eight interview questions. Thematic analysis was conducted on the interview transcripts to organise the analysis by each theme.

Benefit forecast modelling:

The number of patients engaged was multiplied by treatment escalation rates, associated risk reductions in adverse events and their associated costs to estimate total five-year savings to health and social care.

Results

• The programme reached more individuals under 40 and more individuals from ethnic minority groups in the established programme phase compared to the initial startup.
• Analysis suggests that the patients within the pathway came from Core20 postcodes and that the programme reached individuals with higher levels of deprivation compared to the broader Surrey population, even though the Surrey region is largely not deprived.
• Across both clinics, 267 individuals with health indicators of clinical conditions were provided health education and 183 were escalated to a GP for further care.
• Interviews revealed that staff praised the programme for the positive work it had achieved in reaching these target groups, and participants emphasised the difference they had been able to make in people’s lives, but acknowledged some challenges. They noted managers in other services playing gate keeping roles to some communities, and mismatched priorities between some health care providers.
• Despite the teething troubles, participants felt strongly that their work should continue. Building on existing relationships were suggested as the most effective way forwards.

Summary of findings

How effective has the project been at reaching hard-to-reach groups (Core20PLUS5)?

• Results suggest the project was effective in increasing engagement with ethnic minorities, under 40s and Core20 group (although this rise was marginal).

What effect has the project had on outputs or outcomes across the target groups?

• The project improved identification of individuals at risk for CVD within some of the target groups (ethnic minority groups) as the project matured, this could enable early management of their conditions and potentially prevent adverse outcomes.

What has been the monetary impact of the InHIP programme?

• The Benefit forecast results show that there is a potential benefit to health and social care within the Surrey Heartlands ICB geography of £101k over 5 years. The size of the monetisable benefit, plus the likely scale of the unmonetisable benefits, presents a business case for continued investment and scale-up of the project. Costs were not incorporated into this analysis.

Is the approach a feasible option for future initiatives?

• Interviews revealed staff recognise the significance and importance of the programme, felt it had a positive impact on upstream pressures and felt strongly that their work should continue. They did acknowledge some limitations of the current design but suggested some ideas to address these challenges.

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