Dame Elizabeth Anionwu Award for Inclusivity in Nursing and Midwifery

Patient care should be equal regardless of people’s individual differences but, sadly, progress still needs to be made across the board on diversity, equity and inclusion in health and social care. There are, however, already many nurses and midwives making a difference. This category was launched in 2023, in partnership with Institute of Health and Social Care, London South Bank University, to champion inclusive patient care. Returning for a second year, this prestigious award is open to individuals or teams working in the NHS or independent sector. It aims to shine a light on the work of those who have had a significant impact on improving diversity, equity and inclusion in patient care. Named in honour of Dame Elizabeth Nneka Anionwu the UK’s first sickle-cell and thalassemia nurse specialist, this award will recognise those who work with and care for diverse populations, communities and groups. Inclusive care can improve outcomes for groups with protected characteristics such as age, race, gender, sexual orientation, religion and disability. Likewise, care improvements result from more inclusive access to maternity care and to treatment for people affected by conditions from HIV to cancer to mental health. We are interested in entries based on projects and innovations that focus on inclusive health care. Projects and innovations must be nurse- or midwife-led and demonstrate inclusivity in nursing and midwifery.

Birmingham and Solihull Mental Health NHS Foundation Trust
Addressing inequalities through effective co-production

A wealth of research indicates the various health inequalities across the health care spectrum especially in the areas of access, experience and outcomes. In forensic mental health population, the inequalities are very high due to nature/ degree of mental illness, offending history and associated restrictions, lack of placements and supplementary integration in the community. In our trust, we started the Reach Out Inequalities Service Evaluation (ROSIE) (Jan’22–Dec’23) to establish the experienced inequalities, develop better understanding and generate insights to address the identified inequalities. The evaluation was led by a service user expert by experience supported by two clinical inequalities leads (RMNs). The methodology used were traditional research approach with co-production by service users, staff and other stakeholders. We formed a steering group, composed of service users, carers, engagement leads and other multi-disciplinary leads. This steering group was led by the Associate Director (RMN) which met fortnightly to oversee the progress and provide solutions to barriers experienced. We engaged with patients (300) across the forensic division and collected the data, which was analysed using thematic approach. Experienced challenges were around COIVD restrictions, cultural resistance, the limitations of the professionals. However, such challenges were discussed in the steering committee and in various governance meetings with clear accountable supportive actions. The main findings were restrictive practices, discrimination, being judged/ under-valued, lack of recovery focus, poor physical health, poor access to employment/ education/ training and cultural/ spiritual care. We devised clinical inequality strategy. We established a sustainable community initiative project (£250K) to address some of the above inequalities. Following that, we had culturally appropriate advocacy service, increased access to spiritual care, collaboratively working with various professionals for inclusive care with co-production at centre. Planning to embed this co-produced model across the whole division as part of business as usual within next five years.

Bolton NHS Foundation Trust
Supporting diabetes management in the homeless population of Bolton

Homeless adults with, or at risk of, diabetes in Bolton are now receiving personalised care and support, thanks to the integration of a diabetes specialist nurse (DSN) into the homeless and vulnerable adults team (HVAT). Insulin management in the homeless is very complex and difficult to manage, due to chaotic lifestyles and eating patterns, and access to suitable storage – all leading to an increased risk of diabetic emergencies. Our DSN now spends a day a week with the HVAT and working closely with homeless hostels within the town to develop links. She has facilitated the delivery of a rolling programme of basic diabetes training and education to increase the confidence and ability of hostel staff to better support their service users and colleagues.Of the 200 people on the HVAT caseload, over 39 patients have been identified as having diabetes [T1/2/3c] since we started recording in this way. These patients will now receive the nine diabetes specific checks, which historically this patient cohort would likely not achieved. Due to the complexities and often chaotic lifestyles of this group, engagement with healthcare services can be limited or sporadic. The programme includes retinal and foot screening, working closely with specialist screeners from other parts of the organisation to offer town centre appointments to increase likelihood of attendance, and appropriate onward referral to specialists for cardiovascular issues, other signs of complications and chronic disease. Once on the programme we assess the frequency of review based on complexity, identifying if a patient needs more advanced treatment and provision of technology or other specialised support. We also work closely with people who are at risk of diabetes but don’t yet meet the threshold, liaising with health improvement practitioners to ensure that they get basic support and a further review in 12 months.

East and North Hertfordshire NHS Trust
Carers experience programme

The Carer Experience Service was initiated to address the significant lack of support for carers within our organization. Upon assuming a leadership role in November 2022, I was struck by the absence of dedicated assistance for carers, despite their critical role in patient care and within our local community. This realization compelled me to create a platform that prioritizes carers' needs.Our approach involved conducting comprehensive Carers Forums in collaboration with Carers in Herts, both online and in-person. By closely engaging with carers, we co-created the service to align with their experiences, perspectives, and challenges, which deeply inspired and motivated our efforts. Throughout our journey, we faced challenges such as early identification of carers and improving communication between clinical teams and carers. However, each obstacle strengthened our resolve. We developed a Carer Awareness Training program to equip staff with the skills needed to provide compassionate support. Our efforts have yielded positive outcomes, including enhanced visibility and support for carers and increased awareness among staff. Looking ahead, we aim to expand carer support services, integrate carer identification into standard protocols, and further raise awareness among colleagues. The initiative has received widespread recognition from other organizations, signalling the potential to positively impact carer support and patient care beyond our organization. With unwavering dedication and compassion, we are committed to advancing the well-being of carers and patients, one step at a time.

Homeless Health Service
Homelessness cervical cytology

Homeless women often experience severe and multiple disadvantages, this severely impacts on their ability to access timely and appropriate health care and as a result of this are at increased risk or mortality and morbidity. Homeless women have the average life expectancy of 43 with almost a 3rd dying of preventable illnesses including cervical cancer. Homeless women face multiple barriers to accessing cervical cytology including not receiving or reading their invitation letters or follow up letters, high prevalence of sexual trauma, lack of washing facilities and complex intersecting substance misuse and mental health problems. With the Support of a volunteer GP the HHS nursing team were able to identify over .157 women who were either overdue a smear test or lost to follow up for existing smear tests, SWAG funding was procured and the HHS team hosted a treating event on trauma informed care for homeless women and the importance of cancer screening for homeless women. This training event was aimed at support workers working across housing and homelessness sector who would be supporting women to attend healthcare appointments. Availability of smear testing was widely publicised and an outreach clinic at a homelessness women's shelter has been set up with plans to attend women's hostels across the city. One of the biggest challenges was accessing up to date records for our patients, many patients at HHS only hold a temporary registration although they may access all their healthcare from us and so each record had to be individually looked up, cross checked and have alerts added to our notes. This was incredibly time consuming and could not have been achieved without a significant time investment from the volunteer GP. There were also concerns about opportunistic screenings being rejected by the laboratory as they were not 'due'.

Leeds Community Healthcare NHS Trust
Collaboration safety improvements between AnE and police custody detainees

There were major issues and concerns getting highlighted with repeated incidents that involved Patient safety with regards to discharges from A&E into police custody NHS services and the police also bringing in patients who had been arrested and requiring urgent care. These were picked up by repeated incident reports, feedback from staff and patients and through formal investigations conducted by myself. Firstly, the A&E staff had very little training on detainee patients who in their own right present as often being very complex, there were difficulties in communication between A&E, Humberside Police and Custody NHS services which had been ongoing for years. Patients were often discharged without a proper thorough assessment, no care plans, no records or handovers the policies, protocols, pathways and records were not fit for purpose. This caused major risks to patients' safety and care and we had a number of patients who were discharged requiring urgent care and being returned to A&E this put a strain on all services, increased costs, and damaged the patient journey. We also had issues identified that the police officers were risk-taking with patient safety and not doing a holistic thorough assessment of the patient when arresting them and often bringing them to police custody NHS services which is not designed to conduct urgent care instead of taking to A&E for appropriate treatment so delaying their care which was often life-threatening. From this, we organised a new panel of people from Hull Trust, Lincolnshire and Goole Trust, Leeds Community Healthcare and Humberside Police and looked at creating new pathways, paperwork, improved standards and training to support all areas. The difficulties faced were staff pushbacks, the buy in from 3 trusts and the police, and agreeing paperwork and pathways. We hope to roll this out to West Yorkshire and South Yorkshire.

Serco Group, Mental Health Innovations UK and Unify Business Solutions
SHOUT for prisoners

The National Audit Office report on mental health (2017), calls for an urgent ‘step change’ in efforts and resources to support mental health in the community and in prison. In the community, patients are increasingly able to access family and other support in ways that are unavailable to prisoners, e.g. online applications. Now more than ever, being in prison has a major impact on prisoner wellbeing. It is therefore incumbent upon us to support the most vulnerable prisoners with innovative methods and tools. Historically, a text service to support mental health in prison has been impossible as phones/technology are not readily available or have limitations in a custodial environment. However, Serco, alongside Mental Health Innovations and Unify have collaborated to scope, build and develop a technology to enable such access to SHOUT.SHOUT is a confidential mental health text service that supports people in crisis with issues such as suicidal thoughts, abuse or assault, self-harm, bullying and/or relationship challenges. On reaching out to the service, individuals receive help to move from a moment of crisis or distress to a place of calm, and then further support to create a joint safety plan to mitigate future crises. Serco, MHI and Unify developed the service to ensure viability within a prison. Prisoners are able to access the service 24/7 from their in-cell devices. To ensure prisoner safety and access to emergency services when using SHOUT, we developed an Active Rescue Standard Operating Procedure (building on the established MET police process). Through this process, for anybody displaying signs of crisis, an emergency call is placed to the prison to initiate an in-person welfare check on the individual. Due to the success of SHOUT, the pilot has been extended to additional prisons and is now offered to our staff for additional mental health support.

Suffolk GP Federation
The Very Important Invitation Project

This project was initially set up with the aim to increase the uptake of cervical screening across Suffolk. General practice data suggested that most practices across the county were achieving between 74%-77% coverage of cervical screening uptake. We developed a training package for primary care whereby we produced two training sessions. One aimed at reception/admin/care navigator staff and one session for practice nurses or clinical members of staff who undertake cervical screening as part of their job role. Alongside this, we created a working tool kit for practice staff to be able to refer back to if and when needed. We recognised the importance for practices to achieve their 80% coverage targets but this made us want to look further into the 20% of the non attenders to see whether there was any outreach work which could be done in the community. This allowed us to hone our primary care education package to have a particular focus on health inequalities and to raise awareness of underserved communities by reducing barriers. Further to our support for primary care, we started networking and building relationships within the VCFSE sector. In particular, organisations supporting the LGBT+ community, local churches covering different faith communities, people with learning disabilities, physical disabilities and/or serious mental health issues, the travelling community, people from black, asian and mixed ethnic backgrounds, those living through deprivation and/or homelessness and people who have a history of abuse or trauma. This allowed us to be able to provide health promotion and education sessions as well as tailored support in accessing cervical screening to individuals most at risk of health inequality. Further to this the project also provides education sessions to secondary schools about HPV and cervical screening awareness as the research points to early education being paramount.

University College London Hospitals NHS Foundation Trust
Inclusive conversations

Personally, and as a team we embarked on our Equity, Diversity, and Inclusivity (EDI) journey and as I/we learned to listen, see, and understand our colleagues, more staff started to share their personal stories and challenges; e.g., lived experiences of race, religion, culture, neurodiversity, gender, and sexuality. I became more confident in being curious and asking questions to learn about, and help my team, but I became very aware that many of my colleagues were anxious about saying the wrong thing. This was often due to lack of confidence, education and thinking about empathy for others, and I wanted to help.Our department was diverse, but the data told us we were not inclusive – far from it. The appraisal questions in the NHS staff survey around relationships with line managers and the experience of appraisal were extremely poor. I thought about how I; my direct reports, sisters and charge nurses should prioritise and value creating opportunities to have meaningful discussions in safe spaces which enabled them/me to connect, learn, understand, and meet the needs of our diverse team, and for team members to feel connected, listened to, valued and respected with the ambition of enabling an inclusive culture, which will ultimately positively impact on patients too. I am a Dame Elizabeth Anionwu fellow, and the fellowship enabled me with an opportunity to really explore creating an appraisal document and process which was more inclusive and person-centered, by including a section on the lived experience for staff with any of the nine protected characteristics in relation to equity, diversity, and inclusivity, in a safe space, and line managers would support all staff with their unique needs. This was tested on critical care, and my ambition was on track to roll out trust wide.

West Road Medical Centre
Primary care partnerships

The aim of the project was to build relationships with local services, to support those who may have issues accessing primary care in an attempt to reduce inequalities in health. The barriers included those who do not have English as their first language, mental health issues, learning disabilities, homelessness, asylum seekers and those living in poverty. I linked in with local services to reach target groups, offering opportunity for empowerment through health education. I signposting to other services including social prescribing, weight management, smoking cessation, mental health services, physio, diagnostic hubs, primary care, secondary care. I helped people navigate the NHS and learned more about difficulties accessing primary care services. It was challenging to find time to link with other groups. I arranged to do a family fun day with a local charity called Riverside but it got cancelled due to poor weather. I made links with Connected Voice but I never got the chance to offer education sessions as my project day was a Friday, when many religious groups visit the mosque. The local foodbank became the focus of the project recognising the benefit of a nurse offering 'a one stop health drop in for all.' I supported clients with respiratory disease, diabetes, raynauds, new cancer diagnosis, MSK issues, women’s health, children’s health and immunisation, smoking cessation, mental health, acute conditions, missed hospital appointments, previous hospital admissions, prescription issues and education on primary care services work. Signposting to other services meant patients could access services without waiting weeks to see a GP first. My futures plans include weekend clinics at the surgery for foodbank users, targeted education sessions as I have plans to role out other health education sessions in the community. I would like to start with asthma education sessions in school for teachers, parents and pupils.