Tackling poverty in Tower Hamlets: what an improvement approach can offer.


For a while now I’ve been wanting to share some of the work I do in Tower Hamlets as a Quality Improvement Coach. Quality Improvement is a methodology that originated in manufacturing, and has been used widely in healthcare settings as a way of engaging staff from all parts of the health system in making change happen to improve quality.

I’m drawn to quality improvement because it offers a method to engage staff in making change happen in a very immediate way. Teams often use quality improvement to enact ”tests of change” and gather data on how effective these tests are, before spreading the changes that have an impact more widely. This could be any chance, from introducing new technology, to reducing waiting times or improving the way reception works. Quality improvement appeals to my desire to see impact quickly and to unleash leadership from all parts of the NHS, regardless of hierarchy.

I work with a couple of GP practices in Tower Hamlets as a coach, and recently started a project with a network of health and care staff in that borough, which is the subject of this blog, and which I wanted to write about as it is a great example of how the NHS can tackle the social determinants of health – in this case, poverty.

The quality improvement project team brings together an impressive range of people in Tower Hamlets, including GPs, network managers from the GP Care Group, health visiting teams, children’s centre staff, midwives and the council’s Poverty and Public Health teams. It has been a complete joy to see so many committed staff from across the borough’s health and care system coming together to work on something they feel so passionately about. 

The impetus for this project came from some of the GP members last year, when data was presented to them on the high rates of child poverty in Tower Hamlets. There was also some very powerful data showing the very low take up of two income supplements that are available for low income families: Healthy Start vouchers and Early Learning 2 provision. The current take up of Healthy Start, for example, was 59% of eligible beneficiaries in December 2019, with 1,854 claiming out of 3,121 in the area that this QI team is focused on. Though they are a small contribution to a household’s budget (each eligible child can access food vouchers worth £6.20 per week), over a year this adds up to a huge £338 per child, and many families in Tower Hamlets have more than one eligible child.

Poverty is obviously a complex topic, with a lot of different factors affecting it. The data we had on healthy start vouchers helped us focus on something very specific that we could try and change which would increase the amount that low income families in Tower Hamlets can spend on their weekly food, and the access they have to free childcare and employment support. It’s also an intervention that can be directly influenced by the health sector as parent’s applications for Healthy Start vouchers have to be signed by a health professional before they can be submitted.

We’ve subsequently been doing some community engagement to test our early assumptions and hypothesis, and working on our first set of change ideas, ready to test in the new year, and have been inspired by this similar project in Scotland. Some of these early ideas include:

·         working with midwifery teams on the advice and support that is given to expectant parents 

·         connecting with the health visiting team to communicate the offer of healthy start and EL2 vouchers once parents engage with that service 

·         promoting the healthy start vouchers at the local food bank  

(Above: an image of our driver diagram for the Quality Improvement project, mapping out the different things that affect the take up of Healthy Start and EL2).

We are lucky to have access to some amazing data thanks to the council’s poverty team, and have engagement from an incredible mix of organisations. Child poverty is an issue that no organisation can solve on its own, and the biggest asset we have is the commitment from the team working on this.

We’ll be testing and implementing actions to try and increase the uptake of Healthy Start and EL2 throughout 2020, and I’ll try and write an update later on in the year sharing news of where we’re at.

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