There’s no such thing as ‘hard to reach’

People and communities who are seldom heard by decision-makers used to be labelled ‘hard to reach’. Thankfully, practice has moved on from labelling our communities as the problem to thinking how we can work with the many communities we serve in an ongoing and meaningful way.

In the work I led in NHS North West London, we started by asking people a simple question: ‘What matters to you?”. Using population data to target communities in each of our eight boroughs through an inequalities lens, we developed an in-reach programme that took in a range of communities we had rarely talked to before: travelling communities, refugees and asylum seekers, faith groups, people with learning and physical disabilities, homeless people, users of mental health services, young people and wide range of others.

Insights from these groups were rich and varied. There were consistent themes that might be expected, around the difficulty of getting GP appointments, the complexity of the healthcare system, communication with patients, waiting times and mental health support. But there were also very specific things about the way in which individuals experienced health services.

Deaf people missing their turn at the GP surgery because their name was called out. Disabled people unable to access NHS premises. People with learning disabilities receiving letters and explanations that they found unintelligible.

The range of experiences led to the creation of our Co-Design Advisory Body, where representatives of our diverse communities and those working with them presented to NHS leaders on their experiences. They were the most informative and enlightening  meetings I attended in over 20 years in the NHS. We heard from many of the groups listed above and also specific north west London minority communities. In the second half of the meeting, we would discuss specific challenges we were facing with the communities.

What stops people living healthy lifestyles or going for screening and vaccination appointments? How would we consult your community on changes to end of life care, mental health services or general practice? How should health services communicate with you?

We learnt such a lot and the insights were shared with system leaders in what I hope will be the beginning of a sea change in how the NHS – and indeed the wider public sector - relates to its residents.

Nobody was hard to reach. They wanted to talk to us – they just didn’t feel anyone had ever listened to them.