Q Exchange

‘Powering Up’: Co-producing solutions to health inequality with young people

Empowering young people and clinicians to co-develop a digital platform and other teaching tools to improve efficiency and equity of access to chronic condition care using improvement and coaching science

Read comments 63 Project updates 1

Winning idea
2023

Meet the team

Also:

Professor Doug Simkiss (Chief Medical Officer & Deputy Chief Executive, BCHC)
Dr. Lisa Van Geyzel , (Consultant Paediatrician, Birmingham)
Amy McLean, (West Birmingham Development Lead)

What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Clinicians rarely talk about health inequality with patients missing opportunities to help in meaningful and materially significant ways.

Young people (YP) with chronic conditions are especially vulnerable: adolescent health is often overlooked and clinicians cite this group as daunting to connect with (Patton 2010). Adolescent DNA (did not attend) rates are as high as 15% (Campbell 2015) and strongly correlated with deprivation (Bouraoui 2022). Health inequality and disengagement compound to delay access to adolescent care, negatively affecting health outcomes now and into adulthood.

Focusing on two deprived urban areas, what can YP in London and Birmingham teach us about their chronic conditions to increase the effectiveness and equity of clinical contacts and reduce delays in accessing care?

“Powering Up” is a pilot that aims to:

Talk meaningfully to YP about health inequalities
Empower YP to take charge of their own health
Equip clinicians to coach YP in navigating health problems under social constraint

What does your project aim to achieve?

Building on the established success of the Wellbeing and Health Action Movement (WHAM) – a digital platform that uses improvement science to empower clinicians with the knowledge, tools, and community to address social determinants in practice – ‘Powering Up’ is an improvement project that combines QI, coaching, and the power of digital to empower YP and clinicians to put health equity and behavioural change at the heart of medical consultations.

Working in mixed teams, YP from deprived areas with chronic conditions such as asthma, juvenile arthritis, and diabetes, will explore with their clinicians how to address health inequality sensitively and engagingly.

We believe that empowering youth and clinicians to address the social determinants will:

Increase engagement, confidence, and self-efficacy in YP with chronic conditions
Improve clinician capability for coaching and consultation in relation to social determinants

Together this will mean YP’s health or social needs will be met more quickly.

How will the project be delivered?

‘Powering up’ is a highly collaborative team of clinicians, YP, educators, and digital specialists with considerable expertise in paediatrics, improvement, digital innovation, and leading national initiatives. Drawing on the strengths and networks of London and Birmingham’s teams we will:

‘Listen Up’ – ENGAGEMENT EVENTS: A series of ‘big room’ conversations to learn from ‘young advisors’ how to talk about health inequalities
‘Back it Up’ – DIGITAL CREATIVITY: A select group of ‘young programmers’ will be mentored and supported to use the above to creatively tailor WHAM’s Health Inequalities HeatMap for YP
‘Power Up’ – ‘Developing the WHAM METHOD’: WHAM will work with YP in an agile, iterative approach to ‘adopt and adapt’ ideas to develop a new model of consultation aimed at coaching YP through their social determinants.

The project will be managed by WHAM and overseen by a multi-disciplinary steering group including YP across London and Birmingham.

WHAM DELIVERY PLAN – Q Exchange

How is your project going to share learning?

‘Powering Up’ will produce an evaluated, accessible, co-produced educational intervention that can be replicated nationally.

WHAM: Collectivism is core to WHAM’s philosophy; our website is an open-access, free-to-join repository of crowdsourced learning on addressing health inequality in practice, and it will include the products of this project.
EVALUATION: We will perform an Impact Assessment; Measurement of outcomes; Reflection on partnership working
DISSEMINATION:

Community building WHAMinars and podcasts in association with the RCP
Delivery of workshops & training packs for teams through the RCPCH
Blogs and formal articles, including for Q Community
Conference presentations e.g. International Forum on Quality and Safety in Healthcare; RCPCH; RCP
‘Speak Up’ – Young advisor-led social media (Instagram/Twitter/TikTok) connecting young people with chronic conditions beyond our catchments area to the project.
Local Academic Health Science Networks are on board with a view to embedding into systems

How you can contribute

BEFRIEND: WHAM believes in collaboration, not competition. We would LOVE to have your help - ALL welcome!
SUPPORT: We recognise that working with young people and measuring outcomes is complex; can you help us to calculate a return on investment and how best to design evaluation questions? Or can you advise on managing and developing digital tools with limited resources?
STRETCH: Be our critical friends: help us to be better by offering challenge and critique.
JOIN: WHAM's community of practice and the Child Health and Wellbeing Group SIG to discuss how to make health equity a reality.
SHOUT: If you like what you see, spread the word! Tweet, Insta, email, Tik Tok - however you like to communicate, add your voice to a growing movement for health equity.

Plan timeline

1 Jun 2023	SET IT UP: Recruit Project Manager; Connect partners; Scope stakeholders
1 Sep 2023	LISTEN UP: YP Engagement events ; identify 'Community Lightning Bolts'
1 Nov 2023	BACK IT UP: Develop Digital outputs
1 Feb 2024	POWER UP: PDSA cycles with CLBs and "adopt & adapt" teams
1 Apr 2024	BIG IT UP: dissemination, embed with AHSNs, secure long-term funding

Project updates

9 Feb 2024

Powering Up has been underway for 5 months and our learning is coming thick and fast. For now, we will hold back on saying too much about the findings from the project’s research questions and instead focus on the ‘process’ learning that is as much – if not more – the reward of all our hard work.

WHAT HAVE YOU LEARNED SO FAR?

Powering Up has reached an inflexion point where we are re-evaluating our configuration and approach. Though sometimes painful, far from a negative, we see this as sign of growth.

WHAT COULD OTHERS LEARN FROM YOUR EXPERIENCE?

In any collaboration (whether it’s between lovers or business partners) the importance of aligned values and goals cannot be overstated; they undergird everything else. We realise now that we ought to have spent much more time thinking rather than doing in the early stages of this project. We ran before agreeing on the direction we all wanted to run in. Had we stepped into this with greater clarity then we might have been able to uncover some important differences in approach earlier.

WHAT ARE THE NEXT STEPS?

This has not been a setback so much as a prompt for closer reflection and reorientation. With the overall goals of the project intact we are moving forward with a stronger emphasis on:

·       community vs hospital settings

·       arts and creative methods as tools for co-production

·       developing digital outputs more generally rather than fixating on specific entities such as our envisioned ‘heatmap’

·       streamlined processes: for simplicity, clarity and speed.

· data capture: how to show impact and to whom and for what purpose?

In summary, while some changes are afoot, we have already made good progress and we are learning quickly from our mistakes.

HOW CAN YOU HELP?

We are looking for those who can help us to think big and think into the future. We know that Powering Up is just the beginning: our work in generating interest and energy but we want help with harnessing that. If you have thoughts on where we could take this or would like to talk about collaboration, please get in touch.

More specifically, we are interested in building connections with those working in the area served by King’s College NHS Trust and Guy’s and St Thomas’ NHS Trust. If you represent third-sector organisations or patient and community groups in that area, we’d love to hear from you!

Comments

Gill Phillips 9 Feb 2024

I ’ve been following this project with interest, and enjoyed the latest update – 9 February, thank you.
The points made about ensuring aligned values and goals really resonated, and are central to any successful project.

I think when people are passionate and keen to get going, it can be easy to make assumptions, so well done for teasing this out and ensuring greater clarification as your project evolves. “We ran before agreeing on the direction we all wanted to run in” is such a great quote and I’m sure lots of people in the Q community could identify with this!

It is music to my ears (excuse pun) to see your closer focus on arts and creative methods as tools for coproduction, and in looking more towards community settings.

There is deep synergy with the ‘Whose Shoes’ work we are doing with @Lyse Edwards and her fabulous colleagues at Midlands Partnership. FT. Check out #MPFTWhoseShoes. Yesterday, we launched our new coproduced resources around children and young people’s mental health, bringing together a wonderful mix of people to explore this vital issue. We will have some important learning to share from this, so I look forward to our ongoing catch ups! Well done and keep going with this fabulous work.
1. Guddi Singh 12 Feb 2024
  
  Gill, it's so lovely of you to post a comment to our update! I would love to learn more about the resources you mentioned, as there is no doubt that Powering Up and Whose Shoes are closely aligned in ethos and ambition. Let's stay in touch about ways we can work together and hope that we can repay your kindness ourselves one day :)
Nikki Davey 20 Jun 2023

Hey Hannah and team - congratulations! SO glad this one got funded. :)
Clare Smith 5 Jun 2023

There are so many aspects of this project that I love; that it s focussed on young people, that it empowers the patient/service user, that it starts with wellness and prevention, and that it considers the social determinants of health.

You get my vote! All the very best and I look forward to hearing how things progress.
Susan Hannah 2 Jun 2023

A brilliant project proposal and fully support the team to address this important and wicked problem. I am curious about how you will know that the changes you make are making a difference - what measures could you adopt to track progress and measure impact, I am sure you have thought of this but happy to connect if I can be helpful. Susan
Dougal Hargreaves 24 May 2023

Fantastic project, and great to see all the rich discussion too!

And maybe an opportunity to complement/link up with some brilliant work that Rachel McKeown and the Association for Young People's Health team published last year. This work had a more population health/advocacy perspective but tackled a lot of the same challenges.

Language matters: how should we talk about young people’s health inequalities? - ayph

Good luck and look forward to hearing how the project goes!
1. Guddi Singh 24 May 2023
  
  Dougal,
  
  What a great point. "Powering Up" is premised on the idea that the health service so often speaks at cross-purposes to those it serves, which is all the worse when it comes to neglected populations and young people. We want that to change, hence the project...
  
  We are super keen to reach out to AYPH, so if you are able to connect us to Rachel McKeown then we would be most grateful!
  
  Thank you and hope you we can continue to benefit from your wisdom as thins progress...
  
  Best,
  
  Guddi
Amy Maclean 20 May 2023

Excellent project! Excited to tap into the dozens of secondary schools in some of the most deprived areas of Birmingham for their insight into what health means and what digital tools can help. They are so eager for connection to our NHS and at the ready to help and be involved--this project is the perfect vehicle and Birmingham's diverse landscape can generate the results that can be relevant everywhere in the UK. The secret is to frame the offer to young people as something they can get their head around and contribute to in a way THEY can understand and articulate. What excites me most about this project is the SHOWING of how this engagement with youth can be a regular part of 'business as usual' for young people in B'ham and beyond. Good luck!
1. Mary Salama 23 May 2023
  
  Thanks so much Amy! Being part of my first community school event last week with you has given me new ideas and insight. The Young People you are working with have a perspective that will hopefully help to shape both this project and more to come. So grateful for your support and energy!
  
  Mary 😊
2. Hannah Zhu 22 May 2023
  
  Thank you Amy - it would be great to partner with you and share ideas and learning on how this can be done in Birmingham too with similarly diverse populations, let's keep in touch :)
Hesham Abdalla 20 May 2023
A great project.

I've been promoting it with Q colleagues in Oxford. Do you have a presence or could you raise the profile at the RCPCH conference next week?

Key to getting the vote will be distilling the idea into an easily digestible format for Q members and your three main components are a great way of communicating that:
1. Listen Up engagement events to learn from young advisors how to talk about health inequalities
2. Back it Up digital creativity to tailor Wellbeing and Health Action Movement (WHAM) Health Inequalities HeatMap for Young People
3. Power Up developing the WHAM method to develop a new model of consultation aimed at coaching YP through their social determinants. The project will produce an evaluated, accessible, co-produced educational intervention that can be replicated nationally.
As most Q members do not look after Young People, I would emphasise how the new consultation model that you develop will have application to all age groups.

Finally, I would encourage you to think about how to disseminate and institutionalise it. The Comprehensive Geriatric Assessment is one of the most effective holistic evaluations, and there's lot to learn from this, including how it is promoted by the RCGP, British Geriatrics Society and NICE, for example.
1. Mary Salama 23 May 2023
  
  Thanks Hesham.
  
  Brilliant insights as ever. Dissemination and forward planning is key. Will look forward to further discussions and pointers!
  
  Mary 😊
2. Hannah Zhu 22 May 2023
  
  Dear Hesham,
  
  Thanks so much for your comment - I will be joining the RCPCH conference online this week and would love to chat or catch up with any Q members about WHAM or this project idea.
  
  Really helpful insights and I agree the comprehensive geriatric assessment is a great example of how this is done well in adult care and will certainly explore the learning we can take from this for our project. I also think we should be working with geriatricians to improve transition for our complex adolescent patients to adult care.
Alan Cribb 20 May 2023

I am very supportive of this proposal. It stands a realistic chance of closing the gap between services and the young people they are meant to serve. The elements it brings together are recognised as crucial by many but, at the same time, ‘slow to happen’ – tackling health inequalities, engagement with young people, aspirations towards meaningful co-production, rethinking clinical professionalism to better incorporate work on social determinants, and responding to the disillusionment produced by intensified, ‘worn out’ and alienating working conditions. In this case I think the combination of these elements is compelling – not least because this is very much a ‘bottom up’ initiative from a team who are already being the change that they want to see. If health systems (and the systems they must join up with) are going to be renewed this is only like to happen if the change is ‘owned’. Likewise more expansive, adaptable and imaginative forms of professionalism, inter-professionalism and collaborative working will best arise from the energy of existing professionals rethinking and reworking healthcare professionalism from the inside. In this case this includes exploring and practically developing forms of expansive professionalism in which engagement, empowerment and co-production are taken seriously. This funding for the next step in this trajectory would be a much deserved boost. Other commenters are, of course, right to ask questions about how the team’s ideals might be most effectively translated into practice and how they can ensure their work aligns with that of others. But I note that team members – unsurprisingly given their ideals – are very happy to take feedback on board to strengthen their approach.
1. Guddi Singh 22 May 2023
  
  Dear Alan,
  
  Thank you for taking the time to review our project and for your thoughtful response. Given your considerable experience and your current work exploring healthcare ethics in the world of QI, I am glad that you feel that the project reflects the values of empowerment, collaborative interprofessionalism, and co-creation. We have been grateful for responses that help us to think concretely about how we will translate our aspirations into hard reality, but it is good to know that at least the 'philosophy' of the project feels sound to you!
  
  All my best,
  
  Guddi
Kate Pryde 18 May 2023

Great work on getting shortlisted.

Health inequalities and social determininets of health so important right now especially for young people - they are our future!

A few thoughts. I'm not entirely clear from your aim if you want to - improve health outcomes & attendance (through identifying barriers to this ) in those under social constraint (for me this should be the outcome measure) or if you want to increase conversations/capability around social determinents (for me this is a process measure).

The way to uncover the challegnes and solutions is clealry as you suggest through curious questions, listening and coaching. As someone else commented using appreciative inquiry approach woudl be perfect here.

I wonder if you are making an assumption that digital is the way to go - barriers to engaging might not be solved by digital platforms.

Bob Klaber and team at imperial are doign some great work with their council director of communities project #2035 - you maywell be aware but certainly worth tapping into and thinking how you might reach out via services other than health - faith and education as well as sport all spring to mind.

To quote Kedar Mate at this week's IHI/BMJ Quality and Safety conference "think big, start small". I wodner if you want to pick just one disease? Diabetes or chronic renal failure always spring to mind as have some easily trackable biomarkers in HbA1c and GFR. What about using PROMS too as an outcome? Edinburgh-Warwick scale is good as a pre-post intervention or PedsQL which is validated and free to use for 'unfunded' reserach (hopefully this would count!)

Good luck and do reach out if I can support.
1. Hannah Zhu 22 May 2023
  
  Thanks Kate for your really helpful insights and comments!
  
  Re first question - part of our problem analysis is to improve our understanding by having more conversations (using appreciative enquiry - would love to hear your top tips on this when we start planning) and build capability around social determinants so that we can aim to improve health outcomes & attendance (through identifying barriers to this). I agree with your thoughts on process and outcome measures - thank you for helping us clarify this.
  
  Thanks for the reminder - agree that overly relying on digital solutions may worsen health inequalities when considering digital poverty so we will need to carefully consider other strategies too.
  
  Will definitely check out Bob Klaber and team's work with their council director of communities project #2035. I've partnered with faith and charity organisations like CAP previously, which are brilliant!
Laura-Jane Smith 18 May 2023
I am so excited to see this reframing of what healthcare could be! I am also tearing my hair out trying to support patients to improve their health and watching them return to the very situations that are making them sick. The only way that we can transform medicine is to think creatively and expansively and really challenge the status quo. Young people are exactly the right people to do this, and I really think this project could be part of a true revolution, which will benefit us all. I want patients to have the power to change their illness trajectories, and for clinicians to feel purpose and satisfaction in their jobs.

Questions:
- Do you have a clear plan for documenting every stage of the planning so that you can capture all the learning from the process?
- What will happen after the life of the project funding?
- How will this system interact with NHS records? How will it be integrated into other workstreams so that it's not yet another silo-ed system that needs additional logins? Otherwise I fear clinician uptake will be affected
- How will you support and compensate the young people co-creating the platform?
Thanks

LJ x
1. Guddi Singh 22 May 2023
  Dear LJ,
  
  Thank you so much for your kind response and probing questions. This is high praise coming from someone with TWO of the strongest projects in this year's exchange (and yes, I absolutely will be voting for them ;))
  
  To answer your questions:
  1. Do you have a clear plan for documenting every stage of the planning so that you can capture all the learning from the process? - Our documentation process will involve our young people partner at every stage of the planning and delivery of our project. We will use wide range of tools: thematic analysis, interviews and surveys codesigned with young people to extract learning
  2. What will happen after the life of the project funding? - WHAM started with no funding, but we aim to sustain our mission by finding a way to sustainably put young people at the heart of healthcare. We will use the pilot to learn how to become bigger and better and as the basis for building a business case. We are also keen to explore partnerships with both academic and 3rd sector organizations as we see WHAM feeding into both research and user-facing outputs.
  3. How will this system interact with NHS records? How will it be integrated into other workstreams so that it's not yet another silo-ed system that needs additional logins? - Very good questions! 1) One of our pilot sites has a system that enables patients to access and document their medical records. Powering Up is about shaping care around what matters to young people. It is this kind of ethos that we want to see everywhere. WHAM seeks to empower young people to interact with their own medical records in a meaningful way, and importantly, to co-lead the conversation with their clinical providers. Currently, one of the young UCLH interns is running a QI project: "What matters to you?" She is testing multiple ways for young people to interface directly with medical records and systems, including, a text message sent to young people a few days prior to their appointments asking them about three main issues they want to discuss with their clinical team. 2) Our aim is to use health coaching to shift care provision from transactional to predominantly non-directive consultations, including enabling young people to add their input into their own medical records. We believe this could reduce burnout from the over-processing of data experienced by the clinical team. This pilot will showcase that enabling patients to access their electronic health records, along with coaching to tap into young people's intrinsic motivation, can enable them to add their input in a significant part of their own health records and support a leaner documentation process to enable the best use of limited consultation time. We think clinicians will buy into this!
  4. How will you support and compensate the young people co-creating the platform? - We believe that young people can derive huge value from this project. Of course, we will remunerate people's time financially, we think WHA's legacy can last longer. Our programme explicitly seeks to build capabilities and confidence - as well as specific skills in digital production - in young people who can then go on to use them in high education or work.
  LJ, I couldn't agree more that it is time for "patients to have the power to change their illness trajectories, and for clinicians to feel purpose and satisfaction in their jobs" ¡Viva la revoluión! ;)
  
  Thanks,
  
  Guddi
Khadija Begum 18 May 2023

"A kid can't be healthy, if the context they are in is sick" - was such a memorable line from the video you have put together - just brilliant. Off The Record is a Bristol based mental health charity for youth aged 11-25: https://www.otrbristol.org.uk/about-otr/ The team is skilled in youth engagement, and as you have mentioned on your project page, working with young people and measuring outcomes is complex; it could be worth reaching out to them if you think any of their digital work overlaps with some of the project aims for WHAM? Would love to see this shortlisted idea be put through for funding as it's an area of health equity that is in dire need of change.

Very best wishes with this project!
1. Guddi Singh 18 May 2023
  
  Khadija you are so generous with your praise - and I'm glad you liked the video!
  
  What a great shout-out to "Off the Record": I love their rights-based approach and emphasis on being inclusive of all cultures and identities. There is no question that we could learn from their methods and experience, so we will definitely be in touch.
  
  I am also wishing you well in your own project bid. As I said before, I think we have a lot of shared aims and aspirations - let me know if you think we could help or collaborate on addressing health inequalities together any time! :)
Megan Morys-Carter 17 May 2023

Guddi, this sounds like a fantastic mission, and I think you're right that young people are one of the groups most in need of engagement. I really like your listening approach and starting from user-led needs.

What is your plan for the digital part of the project? Are you planning to create digital interventions? There are a lot of start-ups, social enterprises and hospital teams that have created digital therapeutics and apps for management of conditions - it might be worth tapping into the networks of TheHill and other groups to look for existing solutions as well as creating your own from scratch.
1. Guddi Singh 18 May 2023
  
  Hi Megan and thank you so much for your questions - really thought-provoking...! Our 'intervention' is aimed more at connecting clinicians and young people to useful resources and each other, but you are totally correct that we need not reinvent the wheel. We will definitely check out The Hill and see what else is out there. So glad to have your expert input - thank you!! :)
Christina Pagel 17 May 2023

The project looks fantastic! Young people with chronic conditions are often overlooked and their needs and wants for their treatment cannot be assumed to be the same as older adults. Engaging YP as this project will do is essential!

I wish this project every success!
1. Guddi Singh 17 May 2023
  
  Love your enthusiasm Christina, and we share your desire to platform the voices of young people!
  
  I know that you are keen on rigor, and on the evaluation side being strong. We haven´t had space here to elaborate on this, but have some creative ideas for thinking about how to evaluate this project. Would be great to chat with you further if you´re up for it - it might be mutually beneficial to develop these methodologies.
  
  Thank you :)
David Crabtree 17 May 2023

Really powerful project and I love the way you have presented it.

Paediatric pain is deeply underfunded and understaffed sector in the NHS. Persistent pain is also indelibly linked to social determinants of health. Were you planning on including any patients with persistent pain conditions within the engagement events?

They may be an invaluable group crying out to be listened to. In my experience people with pain have a lot to say (good and bad) about interfacing with healthcare.
1. Guddi Singh 17 May 2023
  
  Wow, David, thank you for such thoughtful feedback - you make an excellent point! You are so right about persistent pain, and though we have not explicitly focussed on this group, it is a great idea to hear these voices. If you have thoughts on how best to find voices of this sort, we´d love to hear more.
  
  Thank you for engaging with Q Exchange and for your time in considering our project - hope you will be voting for us next week :)
Karelle 17 May 2023

So great to see a piece of work that is focusing on giving a platform to the voices of young people from communities that so often get neglected! As a nurse, I would want to see this project being run with an interdisciplinary ethos and for there to be a creative element to the co-production - I know this is something you can do Guddi ;) Good luck!
1. Guddi Singh 17 May 2023
  
  Thanks so much, Karelle - really appreciate your feedback! You are right - we want this to be about ALL clinicians, and certainly not just doctors. And given the previous network feedback we have received, we are seriously taking forward the idea of incorporating creative approaches in this work - fab idea!! ;)
Alison Jones 28 Mar 2023

Hey Mary,
Looks and sounds amazing.
Appreciative Inquiry is perfect for the Listen Up element. AI is always a 2-way thing 1)collect data 2)impact audience to feel heard and empowered to generated change ideas.
I don’t see this in the proposal but I do know that the key thing is to come across as a safe pair of connected hands - so HF have supported us in LfE and AI previously. Acknowledging those things and the LfE team being within your organisation would, I believe, be considered positive in the ‘is this an environment where success is likely’ question.
Also, what about implementation? All the focus is on the kids - quite right, but the change needs to happen in the existing system, what are you doing to open the door to that change. Again, AI (of course!) Note #2 above - feeling heard, so people in the organisation at least feel consulted. True co-production will have the kids views and ideas moderated thro consultation with the staff who have to make them work in practice (WAD and all that)
Anyway, I think AI, safe pair of hands, implementation x
1. Mary Salama 28 Mar 2023
  
  Dear Alison
  
  Thank you so much for your comments above. You know I am a huge AI fan and embedding the principles in this project will I am sure reap rewards. Great points especially involving staff in the evaluation of how we can achieve outcomes in the current systems with the 'work as done'. Really hoping the LFE team in Birmingham can be part of our stakeholder input and help to shape how we progress.
  
  Mary 😊
Jane Runnacles 27 Mar 2023

Really supportive of this excellent proposal- I would like to comment further and offer some thoughts when I am not attending- apologies for this brief comment to meet the deadline for now…will keep in touch!
1. Guddi Singh 28 Mar 2023
  
  Hi Jane, Thank you for supporting our work! We would love to hear more about your thoughts when you have time ;)
DEEPTHI JYOTHISH 27 Mar 2023

Great to see Birmingham and London come together once again after BLACHIR, to embark on a transformation journey to address health care inequalities. BLACHIR project implementation in Birmingham has engagement from key community partners including youth groups, with co-production work underway on themes such as health promotion and healthcare access by young people. The strategy of coaching and empowering embeds autonomous health behaviours for a lifetime, and the subsequent cascading is a cost-effective, efficient scaling up model. Happy to link you in with our existing networks. Good luck.
1. Guddi Singh 28 Mar 2023
  
  Wow! Deepthi, the work of BLACHIR has been truly inspirational and phenomenal. It is incredibly kind of you to offer access to your network. It is a no-brainer for us: we would be honoured to connect and learn from your hard work! Let's get in touch properly to discuss further - in the meantime, thank you for supporting our project! ;)
Hesham Abdalla 27 Mar 2023

What a great initative! Some of my greatest learning experiences as a paediatrician has been on how to take a coaching approach in my consultations to empower young people and then step back in admiration as their confidence (and health) improves!

My only other recommendation is to consider how to support scaling in your strategy, so that you can grow exponentially, rather then linearly. For example connecting with charities such as Asthma UK or Diabetes UK would give you access to a ready network of "pre-activated" families.

Moreover, partnership with BAME networks in your own trusts could also help you reach the "hard to reach". I'd be happy to put in touch with mine in Oxford.
1. Guddi Singh 27 Mar 2023
  
  Hello Hesham and thank you for such interesting ideas. Seeing how much conversation this bid has raised tells me that there is a huge amount of interest in this intersection between inequality and empowerment and so I hope we can use this project to collaborate widely and grow our network through Q more... This includes connecting with the 3rd sector, as you say, but I also wonder if there might be a way for our project to feed into/ benefit from Hexitime, which I know you are involved with? Anyway, lots to ponder - thank you for your support!!
Debajit Sen 27 Mar 2023

I am delighted to read the encouraging feedback. We are hoping to undertake this exciting collaborative work which we think will facilitate engaging with our harder to reach communities.
Debajit
1. Guddi Singh 27 Mar 2023
  
  Debajit - we are indebted to you for being willing to collaborate on something so ambitious an innovative. Fingers crossed we can pull something off... Thank you!
Mary Salama 26 Mar 2023

The canal team in Birmingham are delighted to be collaborating with Guddi and team WHAM to look at how we can improve access to care for CYP (Children and Young People) across some of the most deprived areas.

One of the strengths of the Q community is to connect people and in this case ideas and aligned goals.

We look forward to supporting this programme of work and collaborating to refine it in addition to testing some of the proposals. We are excited about bringing some of our established connections (@whoseshoes) and training methodologies such as role reversal simulation #teentalk as options for how we engage with our CYP.

https://q.health.org.uk/idea/2023/canal-children-in-charge/#comments
1. Guddi Singh 27 Mar 2023
  
  WHAM are the delighted ones!
  There's not doubt about it #BetterTogether ;)
Hannah Zhu 26 Mar 2023

I'm excited to be part of WHAM and this movement! Health inequalities are the biggest problem facing the NHS and along the lines of the CORE20PLUS5 approach, we need to be targeting our co-production efforts to making healthcare more accessible for the most deprived 20% of the population who have the worst health outcomes! This proposal really is at the heart of all the key messages from all population health documents, NHS long term plan and State of Child Health - keeping young people at the centre and equipping clinicians and integrated care partners to reach those who are most vulnerable.

We really need support to continue to develop, maintain and improve our digital tools and make our WHAM QI map of projects and resources as meaningful, accessible and useful as possible for all healthcare professionals doing these QI projects.
1. Guddi Singh 27 Mar 2023
  
  Great point Hannah about the new NHS priorities and how WHAM's work and Powering Up align so well with them... Priorities are one thing, but changing practice is another. I hope that with this project we can demonstrate tangible change on the ground that lasts. Thank you for being on board ;)
Helen Chatterjee 26 Mar 2023

This is an important and timely proposal. The only way to bring about health systems change that gets to the heart of tackling inequity is by co-producing solutions with those individuals facing inequalities.

I really like the digital creativity element - I am sure you have thought about this but worth considering digital exclusion factors that may face certain users but not others (e.g. visual, hearing or other impairments; special educational needs etc). To this end I wonder about having some specialist digital expertise on the team or securing these skills through your young programmers.

Best of luck - looks like you have a very strong team.

Helen Chatterjee, Professor of Human & Ecological Health at UCL and AHRC Research Programme Director for Health Inequalities.
1. Guddi Singh 26 Mar 2023
  
  Helen thank you so much for your enthusiasm for the project. It certainly chimes in with the work you are doing on creativity and health inequalities - though much smaller in scale obviously! Your point about bringing on specialist digital expertise to the team is an excellent one and something that we absolutely should factor in. If we are successful, given your base at UCL, I hope we will be able to stay in touch and tap into your academic networks with our results from the project as it unfolds...;)
  
  Till then, huge thanks!
Gill Phillips 25 Mar 2023

Exciting to see the London and Birmingham teams coming together on this important project. A lot of expertise is coming together here and the will to get CYP voices and holistic needs at the centre of health care, rather than just grown ups making assumptions.

I attended a Colab Partnership webinar hosted by Mary Salama last week and was blown away by the lateral thinking approach to finding solutions to helping children with complex needs go home sooner when the reasons keeping them in hospital were logistical rather than medical. Bringing this HUMAN approach (families want to be together at home) is the way forward for all QI initiatives.

This team will deliver great outcomes and will definitely get one of my votes!
1. Mary Salama 26 Mar 2023
  
  Thank you Gill for your lovely comment and your support! I agree exciting times looking at bringing a wide range of expertise together on this bid. Looking at application across 2 geographic areas will strengthen both the work and the wider application. We are really excited about how much we can learn when we put these key questions to our young people.
2. Guddi Singh 25 Mar 2023
  
  Gill, I am thrilled that you are excited about our project; coming from a Q Community expert like you, that means a lot!
  
  I am also delighted that Mary Salama and the rest of the talented team at Birmingham have seen promise in our work and wanted to join forces.
  
  One thing is already clear: the two sides have a united sense of purpose and commitment to addressing inequality and to making space for the voices of young people to be heard and acted on.
  
  We also share the same wicked sense of humour, so here's hoping for a fun and productive collaboration!
  
  Thank you to Q Exchange for being the match-maker ;)
Debbie Teale (nee Taylor) 25 Mar 2023

I do love the idea as you are absolutely giving the voice and choice to the children and also supporting them to start taking control of their own health and care (which always gets the best results) by collaborating to get what their needs are and how best to meet them. I don't know if you are aware but I did start doing my children's nursing degree and we were fully supportive of the children telling us what they wanted and how it should be done (they were seen as the experts in their condition as many were diverse with rare genetic conditions that many professionals only read in textbooks, so it is great that this is still being done and children's voices valued.

I think it is really important to get everyone's voice heard, and this looks a great example of that, but I can see some loopholes that might disadvantage some even further. I do have some reservations about child who are unable to use digital technology (for whatever reason) that this might push the marginalised even further into the gap. Will there be someone to assist children/young people to support them to use and understand the process? Or their parent/carer should they be unable to use it?
1. Guddi Singh 25 Mar 2023
  
  Deb these are really valuable insights coming from someone with lived experience and as the Lead Peer Support Development Coordinator at the South West Yorkshire Partnership NHS Foundation Trust.
  
  Our bid includes a Health Navigator that will increase disability access.
  
  I want to reassure you that this is not going to exclude young people because the digital tools are actually for clinicians to use in order to help point young people to resources that would be useful to them in their social circumstances.
  
  I will make this clearer in the proposal - thank you for helping to make it better!
Helen Leveret 24 Mar 2023

The way we deliver paediatric healthcare has got to be re imagined in the 21st century because our current model is not working. This project is an innovate way of trying to do this, improving health outcomes and addressing inequalities. I love that young people are at the heart of the project. In an NHS that feels like it's floundering it's innovative projects like this that give me hope.
1. Guddi Singh 25 Mar 2023
  
  Thank you - if WHAM is about anything, it is hope ;)
David Clayton-Smith 24 Mar 2023

This is very exciting work and I am a great fan of co-created services. The WHAM methodology, which I haven't come across in depth, looks valuable

My focus is really on anticipating and planning for delivery. The NHS can somtimes be diffcult to access however effective the service. I wonder if there's an opportunity within the WHAM methodolog, to enage and co-create some entry strategies either with one of the Academic Health Science Networks or even directly with commissioners?
1. Guddi Singh 25 Mar 2023
  
  Brilliant long-term thinking, David. We will explore the idea of linking with the local Academic Health Science Network now. Do let us know if there is someone, in particular, we should contact...
  
  Thank you!
Alan Howarth 24 Mar 2023

This is exciting and crucial work. Unless clinicians can obtain leverage on the social determinants of health, and unless young people can be supported to understand the risk factors for their health and take more responsibility for addressing them, our present model of health care will quite soon be unsustainable.

What happens when young people in clinical care return to the chronic sociogenic circumstances that caused their ill health? Doubtless you have to start small, within the medical world, to demonstrate the effectiveness of your approach (crucially including co-production and enlisting young people's creativity). But can you as clinicians envisage working, in selected and concentrated areas, with other partners who should have influence on the social determinants: education, youth services, social services, police, probation? Can you proactively seek out vulnerable young people, such as those turned away by CAMHS? Could this realistically be a widening of the upstream strategy which you mention?

I love the idea of WHAMinars.
1. Guddi Singh 25 Mar 2023
  
  We are honoured to have a member of the House of Lords excited about our project!
  
  And your questions about looking upstream to actively work with education, youth services, social services, police, and probation etc is 100% the goal. WHAM believes that change starts small and that embedding a mindset to improve inequalities will help to shift the medical profession from the siloed way of working that has gone on far too long.
  
  Ultimately, clinicians need to be empowered to be able to stand alongside politicians like yourself to call for a better world for our children to grow up in. We hope our project sows the seeds for that transformation.
  
  Thank you ;)
Damian Roland 24 Mar 2023

This is an important project with a team with the skills to deliver it. This clearly builds on existing infrastructure but starts to give it bite and is uniquely almost completely patient focused.

A few questions

1) - how will you ensure the delivery of coaching is equitable itself. There is a danger this project will reach those who are already on the cusp of this being able to POWER up? How will you ensure the most difficult to reach are reached?

2) Are there other partners that could be involved at this early stage. Barnados, RCPCH etc. They might not play an active role but my experience from other Q exchange projects is that early involvement gets buy in and then leads to better dissemination.

3) "promotion of an improved mindset" - what would be a practical outcome of this?

Finally I've mulled a bit on this sentence "empower young people in UCL’s integrated care system to work with clinicians to address health inequality for themselves." I know you don't mean it like this but should young people have to address health inequality themselves? If this project is successful should we be thinking about a wider more national debate whose role is to do what in improving health inequality?
1. Nikki Davey 27 Mar 2023
  
  This is a great initiative that has at its roots a small QI project led by Hannah Zhu looking at signposting children and young people to resources to help those living in poverty. Its really great to see how this has given rise to WHAM!
  
  The questions posed by others are brilliant that I am sure will help the team as they identify their next steps. Its great to be ambitious AND at the same time be clear about what is in your sphere of control. This latter point ties to the Q posed above about scope of this piece (in relation to the funding and other resources available).
  
  In the original project (and other QI projects with a preventative element) one of the challenges has been to get the professionals comfortable and confident to connect with the topic in a way that lands well with young people. If they do not practice and develop this skill they will unintentionally 'scupper' things. So this project needs to address both sides of the equation in order to maximise impact.
  
  I'm really excited to see it and will encourage others to support it too!
2. Guddi Singh 25 Mar 2023
  
  Damian these are brilliant, on-the-nose questions, thank you!
  
  1) WHAM believes that populations are not hard to reach, but that the health service is. You are right that we must avoid exacerbating inequalities with this project. Our Youth Advisors will champion the idea in their local areas with a view to bringing in their contacts who might otherwise not engage.
  
  2) Great suggestion to partner with Barnados, RCPCH etc. I am in touch!
  
  3) An improvement mindset in the health workforce would mean that QI is business as usual and not sporadic. We believe healthcare quality would increase more rapidly as a result
  
  4) "If this project is successful should we be thinking about a wider more national debate whose role is to do what in improving health inequality?" Short answer: YES. Let's hope we're successful so we can discuss just that ;)
  
  Thank you!
Victoria Hume 24 Mar 2023

The need to "empower clinicians with the knowledge, tools and community required to address social determinants in practice" is abundantly clear. Giving clinicians the capacity and confidence to legitimately address wider social determinants will have both short and long-term impacts on the way care is offered; as systems are forced to adapt.

The intention to put power in the hands of young people will give this study real legitimacy. If the process is owned by young people the results will likely have an extensive impact through young people's own networks. It's also important that "creativity" is central to the development of the study; not only because this will serve the research aims but because unlocking this creativity will itself create agency, and a healthier relationship patient–clinician dynamic.
1. Guddi Singh 25 Mar 2023
  
  Victoria - thank you for your kind comments! Super encouraging. But I also take our point about 'creativity'. As Director of the Culture, Health & Wellbeing Alliance, your take on this is very much appreciated. And you are right that we ought to make 'creativity' itself a core plank of this work. Thank you ;)
Dr Nadeem Moghal 23 Mar 2023

Hi Aicha

good to see you are keeping on the innivation focus. I remember the great work did as a Darzi fellow.

Immediate thoughts after the first read

1. Punchy and pacy
2. To the point
3. Clear objectives

On second read

4. You are building an ecosystem embedded in the patient-clinician relationship

5. Why will a 15 year want to play?

6. Are there per disease tangible outcomes eg transplant compliance where rejection as a result of social determinants we think is a thing

7. Is the budget ask right? Sounds like a startup at stage one/two - you need more. Can you get more or ask for more?

8. Are you aiming for a finished product at the end of this or are you realistic about iterations?

The challenge in the NHS is that is a beast of creature that is almost impossible to engage, change and scale innivation into. Think and act like a start up. That will give you a framework and sense of opportunity. Think big but act to prove the model and the value.

good luck.
1. Aicha Bouraoui 23 Mar 2023
  
  Thank you so much Nadeem, very thoughtful of you.
  
  I was very fortunate to work under your leadership during the Darzi programme, you have been a true inspiration!
  
  Attempt to answers your great questions:
  
  4. You are building an ecosystem embedded in the patient-clinician relationship
  
  That’s correct we are aiming to embed addressing the wider determinants of health and health related behaviour, both of which which impact on health outcomes by more than 50%, into routine clinical care
  
  5. Why will a 15 year want to play?
  
  Why wouldn't a 15 year old want to play?
  
  6. Are there per disease tangible outcomes eg transplant compliance where rejection as a result of social determinants we think is a thing
  
  Yes, definitely by improving health behaviour we can improve disease outcomes .
  
  We know for example over 30% of medications prescribed for long-term conditions are not taken as intended.
  
  1. The National Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes, NG5. March 2015. Accessed 09/03/16. https://www.nice.org.uk/guidance/NG5/chapter/1-recommendations
  
  Rather than traditionally educating/ telling patients what to do, through the lens of health coaching we aim to address adherence in a way that empower patients to 1-take ownership of their health, 2-set up their own health related goals and 3- identify and test their own options. The clinicians role will shift from educator to facilitator working in partnership with their patients ( in the pilot young people with long-term rheumatic diseases) to help them address what matters to them.
  
  Crucially the value that WHAM project will add at is to help clinicians identify and support patients/ sign post them to right strategy to address the interrelated primary drivers (SDoH) of their poor health outcomes.
  
  7. Is the budget ask right? Sounds like a startup at stage one/two - you need more. Can you get more or ask for more?
  
  You’re absolutely right, for tis reason we are starting small pilots focusing on young people with long-term rheumatic diseases at UCLH and population of young people in Birmingham, which will enable us to extract learning, and guidance our strategy to fund and scale up the project to other health systems
  
  8. Are you aiming for a finished product at the end of this or are you realistic about iterations?
  
  We are not aiming to produce a finished product at the end of this particular project but start a process of iteration towards a finished product.
  
  Thanks so much once again for your very helpful feedback Nadeem
  
  Aicha