Health literacy is a critical success factor for neighbourhood health
Neighbourhood health was high on the agenda at the Labour and Liberal Democrat party conference panels organised on behalf of the Community Pharmacy UK. However, implementation remains nebulous, with more unanswered questions than a clear direction of travel. But it is clear health literacy will be a critical success factor both to boost self care and allow people to navigate care closer to home with confidence.
Variation baked-in
With greater devolution and localisation there are questions to be answered about national framework standards to underpin local delivery. There are very real concerns about how patients and the public navigate a system with variation baked in.
Variation has been a barrier to the uptake of the NHS app. ICB level promotion of the APP was beset with complexity because GP practices could choose which functions to turn on or off. Apply this variation to the delivery of care and it can present challenges to those already struggling to identify the right care setting to visit. These are often the people with the lowest health literacy.
Health literacy and access to care
The living self care survey found nearly a third of adults with no formal educational qualifications lacked the confidence to treat the symptoms of cough. 1 in 4 of this group would use A&E as their first healthcare choice. The OECD adult skills survey tells us 1 in 5 adults have skills levels at or below level 1 in numeracy, literacy and adaptive problem solving. These are below the levels expected at the end of primary school. The health skills gap is real.
ICBs are charged with improving population health, tackling inequalities, improving outcomes and securing best value for the NHS resource. Removing health literacy barriers for this group will be a critical success factor.
The role of health information
Information and support is vital across the self care continuum for prevention, access to screening, self care of minor ailments, supported self management of long term conditions and cancer, frailty and social care. Local delivery can only succeed if it is underpinned by standards set in Modern Service Frameworks for long term conditions. People with diabetes, for example, should have equity of access to treatment, technology and annual diabetes checks wherever they live. How this is delivered can be decided locally.
Similarly, the evidence-based self management programmes and support developed by organisations like Diabetes UK should be embedded in local services. Diagnosis Connect, one of the few funded commitments from the NHS plan, will facilitate this and pilots start soon. But in the meantime, there is a danger that local services will develop their own information which will not meet the PIF TICK nationally-recognised standard for health information.
Information quality standards
A particular challenge for NHS teams is keeping information up-to-date with rapidly changing clinical evidence. Too often good NHS information projects are funded for a cycle, investment is made in co-production but the funding ceases and the projects are never updated. A recent study of more than 25,000 NHS patient information leaflets found 1 in 5 are past their review date and 1 in 3 had no review date.
There is huge duplication of effort and waste of resources in local information development. The best performing organisations now signpost to trusted sources in the charity sector and produce their own content only when there is genuine local need. With more than 160 PIF TICK certified organisations there is plenty of choice. Providing health literacy friendly information can help people navigate care with confidence, this is a genuine local need that local teams should focus on.
Building on trusted community assets
Access to general practice remains a challenge. Total triage is a useful system for many but presents barriers to others. At a recent Parliamentary event one GP listed all the requests for appointments received one morning and asked people to group them into GP appointment, nurse appointment, pharmacy first or self care with OTCs. Most of the professional audience had to do some head-scratching, the task was more complex than it first appeared. The public needs support to navigate this.
Pharmacy First has been a huge success. More than 38 million GP appointments have been avoided by using pharmacist prescribers. This system builds on a trusted service people are already familiar with and is located in the heart of communities. Pharmacists are keen to do more and expand the range of services offered, working closely with GPs via a shared record. But how do we ensure awareness of this service is broader, particularly to those with lower health literacy?
One option discussed at the round tables was to embed information and support and the neighbourhood service around registered populations. In most communities registered populations sit at GP practice level and in schools. This is something health charities in the PIF membership are keen to explore. A pilot involving community pharmacy and dementia care has had a positive impact.
Building skills in schools
Building up from existing assets offers real opportunity to build health literacy from the foundations. A good example is a project in West Wales where a specialist community pharmacist, working in partnership with Asthma and Lung UK, runs sessions in school on asthma management for children and parents. Schools present an opportunity to embed skills for health literacy and media information literacy.
This week a school in Glasgow has appointed a teacher for AI literacy. As people struggle to access primary care, more are turning to the confident authority of AI for answers. Public behaviour change has been rapid. 1 in 7 say they turn to chatbots first for health advice and 1 in 5 do not seek professional advice.
We need to build the health and media and information literacy skills of the public and we are working with the tech companies to facilitate this.
Improving the quality of AI-generated health information
We also need to improve the quality of AI generated health advice. Analysis by the Eve Appeal found ChatGPT missed common signs of gynaecological cancers in test scenarios and provided overly reassuring advice, prompting its campaign Chat to your GP not CHatGPT.
Eve Appeal along with more than 100 other organisations is backing our call for a cross-governmental taskforce to work with the tech industry to improve the quality of health information answers provided in response to UK searches. This needs political leadership, genuine partnership and public debate.
The future of neighbourhood health
Neighbourhoods exist in a national and global context. Standards are needed to ensure equity in access to services and information. We need to build skills in community assets at the intersection of health and media literacy to realise the promise of care closer to home.