Bola Owolabi: A mission to close the health gap
What does it take to bridge health inequalities that have been widening across the UK? The woman tasked with this formidable task, Prof Bola Owolabi, addressed Stronger Things.
She discusses the motivation behind working with people forgotten by society and by the data; working with the new ICSs to take a joined-up approach to health, and where she has seen powerful examples of healthcare made better through community power.
Interviewed by Claire Kennedy, vice chair of New Local’s Board and co-founder and managing partner of PPL.
Prof Bola Owolabi: I’m a GP in the northeast of Derbyshire, in one of our ex-mining villages that I think represents the essence of the work that we do in trying to reduce health inequalities. In addition to that, I also work in NHS England, as Director for the National Health Care Inequalities Improvement Programme.
I think for me, it’s the people that I see at my surgery, week in week out, that inspire the work that we do.
Whilst I appreciate the importance and the power of data, policy and strategy, ultimately, I do think the work we’re trying to do is really about people and their lives. And what it means to find yourself at the margins of society, what it looks like to live at the peripheries. That’s what I care about. That’s what drives me.
And I’m blessed with an incredibly committed team that genuinely also care about these things.
Claire Kennedy (PPL, New Local): I think we all know that the world around us at the moment can feel challenging. The theme of Stronger Things this year is ‘Making it Happen’. One of the things that has always really struck me about your work and coming across you is your positivity and your optimism and your hope. And I think that’s incredibly powerful for an audience like ourselves and for wider society. I wonder if you’d be able to talk us through some of the things that drive that hope, for example, your work with Core20PLUS5 and really shaping a way that we can respond to health inequalities?
Bola: Thank you, Claire. You’re right, that often the conversation around health inequalities ends up being a very deficit conversation about everything that is wrong. But that’s not what energises people. People are energised by a sense of hope, and possibilities.
And so we try and talk about the work we all need to do in reducing health inequalities from that strength-based position. And I’ve said many times before, and I’ll say it again, that we should embrace our agency to act. Every individual has a agency to act, whether in our own personal lives, or in our professional lives.
When I’m talking to my GP colleagues, I talk about the fact that we can do something in that individual patient-to-patient interaction, we can do something in the Primary Care Network, we can do something in our own local system around influencing policy.
Every one of us has agency and the Core20PLUS5 is not the ultimate solution to health inequalities, it’s a place to start. Because one of the things people said to me when I started in this role, was the fact that health inequalities are not new. And this is not the first time that anyone has tried to make inroads in it. And so the point of CorePLUS5 is about agency. It’s about giving us focus on a handful of things, so that we can gain some traction, and in that way be able to demonstrate impact within a reasonable timeframe.
For those who may not be familiar with Core20PLUS5, it’s a mechanism for our 42 integrated care systems (ICS) to know where to start: which population group can we focus on first, and which clinical conditions contribute the most to the life expectancy gap? And so the Core 20 are the 20% most social economically deprived communities by the index of Multiple Deprivation, the ‘plus’ are the people who will still be lost from the data, but who we know from our own local knowledge and insight: people experiencing homelessness, some of our coastal communities, asylum seekers and refugees, those in the criminal justice system, traveller communities, gypsy Roma communities: they are the plus.
The idea is each of our 42 ICS know who their core 20 plus are, and then drive relentlessly after those five clinical areas of cardiovascular disease of chronic respiratory disease of cancer, maternity, mental health, and across all that smoking cessation. It’s a healthcare inequalities improvement mechanism.
And actually, it’s the contribution of the NHS – it’s not the sum total of what we need to do. I describe it as the NHS contribution to our wider effort with local authority and voluntary sector partners.
Claire: I know you’ve started to talk there about the role of wider communities in working in partnership with the NHS, I wonder if you would be able to elaborate around, for example, the community connectors programme as a way that you’ve taken forward some of that thinking really explicitly to reach some of those communities.
Bola: I’ve often described the role of the NHS in tackling health inequalities across four domains. And one of them is being an active partner with other colleagues and partners within the integrated care system, particularly our local authority partners, the voluntary sector, our communities themselves.
One of my reflections from the pandemic is the power of the voice of community. I remember conversations with Pastor Agu of Jesus House here in London, when we were really struggling to get the vaccines to the edges; conversations with Imams, and some of the leaders of our gurdwaras. And they were the ones who said people may be petrified of the virus, they may be petrified of leaving their homes, but they will go to their places of worship. If you can put the vaccines in places of worship, they will come.
The lesson I learned from that is that there are insights about what will work in our communities that I will never know as a GP, I will only ever get to that insight by respectfully talking to the people on the ground. I’ve often said and I’ll say it again that the other thing I learned is that the messenger is just as important as the message. For as long as it was health care professionals and professionals of other descriptions, people had their reticence. But when people who looked like them sounded like them, began to say these messages, it cut through in a way that I could never have done.
That’s why we’ve recruited and our recruiting a cadre of CORE20Plus connectors. They are people from the community, the trusted people who can explain the ‘why’ in a way that makes sense to their communities and cuts through the jargon that sometimes we still end up using despite our best efforts not to.
Claire: I wonder whether you’ve also had some reflections on the role of local authorities in that that broader kind of place-based approach to health inequalities?
Bola: Absolutely. I make it my business to go around the country. Everyone who joins my team, we tell ourselves we don’t have coat hangers, because health inequalities don’t happen within our plush offices. They happen out in the community and that’s where we try to locate ourselves.
In Newcastle you have HealthWORKS who worked with the local authority, with the local NHS Trusts. They are a charitable organisation. I was with them looking at the work they’re doing in terms of cardiac rehab for people who’ve had a heart attack, the work that they’re doing to support people with diabetes to be ready for their elective procedure, the work that we’re doing with the elderly to try and reduce the incidence of falls. It’s a joint local authority, NHS and VCSE partnership.
In Bradford, I saw doulas, they are volunteers from the community, and they support women, typically women from very vulnerable backgrounds. They will support them for up to six weeks before delivery. If their culture means their partners can’t be there, the doulas will be there in labour, and they will be there for six weeks after as volunteers. They’re not healthcare professionals, but they’re making a powerful difference.
I saw the NHS working with local authorities in Clacton-on-sea, where they’re supporting people from the Sixth Form College to gain apprenticeship and work placements. And that’s where I met the wonderful Elliot, who said to me: “Doctor Bola, I have global delay.” I said, “Elliot, I can’t see it. You’re running this dispensary amazingly well.”
These are the examples I see all over the country where local authority colleagues with the NHS understand that not one of these organisations can on their own genuinely reduce the health inequalities that challenge our communities. The answer is between us.
Claire: I wonder if we could have your thoughts on how you think we collectively as a community can start to work together to scale some of these innovations to support those who are already innovating to take that even further?
Bola: If we start from an individual level, we often see that conversation, purposeful conversation, is the most powerful tool for change. Maybe there is a conversation you could have, after this conference, maybe there is an email you could send, maybe there is a feeling that things haven’t quite worked out between local authority and the NHS. Let’s try again. And just understand that actually, we are all trying to achieve the same thing. Sometimes it’s our language that holds us back, sometimes our drivers, sometimes our constraints. But maybe we can go and have those conversations on the basis of we’re all trying to do the right thing.
The second thing we can do, is let’s get out there. There is enormous, wonderful work that people are doing with very little, I am amazed by how much people do with very little money. It’s extraordinary. Let’s not assume that until we have the millions, we can’t make transformational change. I think if we commit to get out there, we’ll see lots of wonderful things. And once we see them, let’s not reinvent the wheel. I think there’s a danger of ‘it wasn’t made here syndrome’, where we try and start all over again. Let’s celebrate that which is working. And let’s build from strength, but do so with our communities.
I’ll just leave a note of warning about not trying to ‘lift and shift’. It’s really important to work with our communities to contextualise things, to make sure that it’s relevant, and that it would work for them. I think those three things, we can all start there. So I think that’s our action list from today is to take those things forward.
Claire: One of things I think it’d be lovely to end on is just to give you the space to talk a bit about your vision for the next five years.
Bola: The vision I think has its power in the fact that it was crafted through the voices of many people. When I started in my role, I spent the first six months – 7am till 7pm – literally every day, just talking to individuals, organisations, teams right across the country. What should we do? And what people said to me was, Don’t boil the ocean. If you try and do it all, you’ll end up doing nothing.
The vision that we came up with is: ‘exceptional quality healthcare for all’ – underscoring ‘for all’. And be mindful of three dimensions, that people have equitable access. It’s not about equality, because equality assumes the same starting point – that’s not true equitable access. Once people cross the threshold, that they have an excellent experience, and that the combination of equitable access and excellent experience is what gets us to the optimal outcomes that I believe unites us.
That is the vision and how will we know in five years: two things, what the community says. I have often said that stories, people’s stories are data with soul. And whilst we do need to count the numbers, I think the stories that our communities tell in five years, is probably the most powerful measure of success. Alongside that, we have data that measurably demonstrably shows the narrowing of the gap.
It’s people’s stories, combined with our data that will tell us whether we’ve been true to the vision of leaving a powerful legacy beyond the pandemic of narrowing the gap.
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