Population health and health inequalities

The level of health inequalities experienced within and across different population groups in Lancashire and South Cumbria is unacceptable. Tackling health inequalities is a national priority but for LSCFT is simply the right thing to do. Health inequalities are defined by NHS England as “systematic, unfair and avoidable differences in health across the population, and between different groups within society.” These inequalities are deeply rooted in socioeconomic factors and addressing them is critical to improving both individual and population health outcomes.

This stark reality underscores the urgent need for targeted interventions, particularly for groups whose lives have become more challenging due to compounded health and social disadvantages.

The LSCFT health inequalities plan is designed to ensure that as a system partner we are addressing these pressing issues in line with national recommendations and strategic frameworks, including the refreshed Trust clinical strategy and Quadruple Aim. Our approach to quality improvement offers the opportunity for LSCFT to do something transformational and sustainable in tackling the health inequalities experienced by the communities we serve. We will work to fully align the health inequalities plan to our approach to continuous improvement and will ensure that a health inequalities lens is applied to all improvement and transformation work we do, hardwiring our approach to health inequalities.

This plan provides assurance to the Board of Directors, system partners and, importantly, the communities we serve, that the Trust is taking the right, intelligence led and evidence-based actions to reduce health inequalities, with clear mechanisms in place to measure the impact of our efforts and anticipate future demand. By focusing on prevention, earlier intervention, managing unwarranted variation in experience, access and outcome, resource equity, and population health management, this plan sets out a sustainable approach to meeting the immediate and long-term needs of our most vulnerable populations. It also demonstrates our alignment to the three strategic shifts set out by the government for the NHS in particular the shifts from hospital to primary care and community services and from treatment to prevention.

It should be noted that this plan will evolve as we deepen our understanding and develop our insights. Successful iteration will be informed by the voice of our communities, our staff and our partners at place. It will require delivery across all director portfolios and ownership across all networks. 

Six key deliverables

  1. Understanding our communities, neighbourhoods, households, families and individuals.
  2. Creating the conditions for tackling health inequalities by investing in our people and the supporting leadership behaviours.
  3. Getting alongside our communities; people and partners.
  4. Earlier intervention for those experiencing complex and/or multiple social disadvantage.
  5. Permit and nurture targeted health inequalities interventions.
  6. Research, measurement and return on investment.

The outcomes will result in:

  • More years of better health.
  • Services adapted to the population’s needs with greater equity across access, experience and outcome measures reflecting the needs of groups by geography, groups experiencing economic injustice, protected characteristics groups and socially vulnerable groups across all ages.
  • Improved health outcomes i.e. measurable improvements in patient reported outcome measures (e.g. DIALOG+).
  • Reduced delivery cost.
  • Positive socioeconomic wealth across Lancashire and South Cumbria.

Abigail Harrison
Chief Digital, Infrastructure and Improvement Officer and Chair of the population health and inequalities working group

Anchor institution

The Trust’s long-term sustainability is tied to the wellbeing of the populations we serve, we have significant assets and resources which could be used to influence the health and wellbeing of our communities, impacting on the local social, economic and environmental priorities to reduce health inequalities across Lancashire and South Cumbria. To be achieved through:

  • Employment and investment in workforce.
  • Procurement and spend.
  • Reducing environmental impact.
  • Use of buildings and spaces.
  • Working together with local partners.
  • Work together with local communities.

Community Roots

Community Roots has evolved, following a public renaming competition, from the Recovery College service. Now hosting three distinct teams, we offer a range of health and wellbeing courses through our Learning Team, we are developing our approach to lived experience expertise in our workforce through our Peer Workforce Team and implementing accessible and inclusive engagement practice through our Engagement and Outreach Team.

Our Learning Team offer courses that are co-designed, alongside people with lived experience and professionals by experience, to help anyone living or working across Lancashire and South Cumbria to access informed health and wellbeing opportunities important to them. We are passionate about providing preventative and recovery-based opportunities that promote wellbeing, access to support and connection across a range of local community partners that promote hope and personal control.

In 2024/25 we:

  • Supported 5701 enrolled learners
  • Delivered 357 courses in
  • Facilitated over 553 sessions

We deliver across two sites, one in Burnley and the other in Preston. We host over 90% of our sessions online, to ensure inclusive access across the whole of Lancashire and South Cumbria.

Throughout 2024/25 we implemented a new enrolment form, enabling us to record protected characteristics in line with inclusion guidelines. We have recorded the following data in relation to our learners:

Age

  • 7% are aged 16 to 24
  • 18% are aged 25 to 34
  • 33% are aged 35 to 49
  • 30% are aged 50 to 64
  • 4% are aged 65 to 74
  • 1% are aged 75 or over
  • 7% did not wish to disclose

Religion

  • Buddist 1%
  • Christian 33%
  • Hindu 1%
  • Muslim 15%
  • Do not wish to answer/no faith 46%
  • Pagan 1%
  • Other 3%

Gender

  • Male 21%
  • Female 73%
  • None 4%
  • Do not wish to answer 2%

Sexual orientation

  • Heterosexual 65%
  • Bisexual 8%
  • Gay male 1%
  • Gay Female 2%
  • None 16%
  • Prefer not to say 8%

Marital status

  • Married 40%
  • Single 32%
  • Divorced 7%
  • Civil partnership 2%
  • None 15%
  • Other/prefer not to say 4%

Ethnicity

  • English/Welsh/Scottish/Northern Irish/British 72%
  • Pakistani British 8%
  • Indian British 3%
  • Any other Asian British 2%
  • Any other ethnic group 5%
  • None/prefer not to say 10%

Disabilities

  • Yes 50%
  • No 32%
  • Prefer not to say 14%
  • None 4%

Our database also shows us that our learners identify as:

  • 31% LSCFT colleagues
  • 21% community members
  • 29% service users
  • 11% students
  • 5% carers
  • 2% partner organisations
  • 5% identified as veterans

Outreach and engagement

Our Outreach and Engagement Team have continued to deliver the HARRI mobile engagement service, completing 66 site visits and engaged with 2,298 community contacts across the Lancashire and South Cumbria. A range of health information, recovery, resilience services are offered on board HARRI. This year we carried out 668 blood pressure checks and referred 375 of those on to services.

Strategy and improvement away day

Community Roots @Chai hosted a staff away day with Ursula Martin, Chief Strategy and Improvement Officer, welcoming 78 staff. A visit to the local mosque included a presentation from Dr Yas Burnley Primary Care Network Director and Afrasiab Burney Council Lead. In the afternoon the team took part in a range of Community Roots sessions including stress, mindfulness, sewing, nature and arts sessions.

Feedback from staff included:

“Really enjoyed the session - very informative and felt great to be out in nature which is not something everyone has the privilege of or finds time to do! The session leaders were great, very friendly and made everyone feel welcome”

“Felt daunting at first discussing stressors in front of strangers, however the facilitator was excellent at delivering the session and making everyone feel comfortable. We learned lots of great tips for coping with stress and that it's normal to feel overwhelmed sometimes. Would highly recommend to others.”

Dying well matters

In partnership with Dr. Yas, from Burnley East Primary Care Network, and East Lancashire Hospital Chaplin, a workshop was delivered at Community Roots @Chai to raise awareness and understanding of death and dying. Feedback concluded the session was informative personally helpful for attendees.

Transformation Team

The Engagement Team in partnership with the Community Physical Health Transformation Team have been working with teams from Lancashire Teaching Hospitals and LSCFT, travelling around Central and West Lancashire.

The aim of the programme was to collaboratively de-escalate our system and improve the management of long-term conditions through enhancing community care and collaborate between partners to optimise alternatives to hospital provision, improve intermediate care provision and support those with long-term conditions to remain well within a community setting, supported by integrated provision. 

As part of this work, HAARI was utilised to engage with our community and better understand their needs and promote new ways to access physical health services in their area. 

The Engagement Team has proactively reached out to all our partners who are actively involved in engaging with local communities and providing health and wellbeing checks. This year, we have established our first health promotion group. This initiative will support the team in better managing our campaigns and, most importantly, reduce costs by avoiding duplication of efforts.

Our partners

  • Research Team (LSCFT): Providing valuable insights and data to inform our health initiatives.
  • Public Health Improvement Lead: Leading efforts in public health improvement and community engagement.
  • Fylde Coast Medical Centre: Offering health check services and support to families and communities.
  • Mary O'Gara Foundation: Supporting families who have been bereaved by suicide.
  • Together, we are committed to making a positive difference in the health and wellbeing of our communities.
People stood in front of community engagement bus, HARRI.

The Library of Lived Experience for Mental Health

Following the publication of the guidebook in 2022, Community Roots has worked in partnership with Lancaster University to develop colleagues in the art of book, librarian and reader trainings. Project managed within the Peer Team, we have been raising awareness of the intention to commence book training from May 2024, with keen staff interest.

The LSCFT Library of Lived Experience will be developed to empower people with lived experience of mental health and wellbeing difficulties to share their experiences and recovery journeys. Human books will develop their stories and produce a synopsis for readers to select and read. Librarian roles will be developed to coordinate libraries and provide support to all attendees.

It is hoped the Library of Lived Experience will empower LSCFT staff to confidently share their experiences, contributing to better understanding and the validity of lived experience contributing to the improvement of our approach to person centred care and the development of services. Readers will experience the opportunity to listen, question and reflect on the impact of experiences of people who access our services, developing their ‘whole-person’ approach to delivering care.

It is hoped we will work closely with diversity and inclusion colleagues to identify, through our staff networks, the experiences of our staff in relation to issues they may have faced regarding their protected characteristics, and strengthen our approach to supporting staff who experience bullying, harassment and racism in the workplace.

The implementation of the library will be evaluated and contribute to a research project developed in partnership with Lancaster University.

Key priorities for the implementation of the Library of Lived Experience

  • Range of staff from experience and engagement involved in developing and supporting this research.
  • Recruitment of experts by experience and experts by profession to develop their books.
  • Launch of Library in Q3 2024.
  • Story Development: To curate a diverse and representative collection of narratives contributed by the communities we serve, drawing on the learning and engagement achieved through this research and practice.
  • Book training delivery: To deliver book training sessions consistently throughout 2025. These sessions will be coordinated by the Peer Team at Community Roots and will feature regularly on the Community Roots timetable. Sessions will be offered across both sites to maximise accessibility.
  • Library review and future launch: To undertake a comprehensive review of the Library of Lived Experience in Q3 2025, with a view to launching the next phase, the Living Library.

Peer workforce

Since 2021, peer facilitators have been an integral part of the workforce at LSCFT. These roles are designed to ensure that the voices and perspectives of those with lived experience are embedded across all service settings, promoting a culture in which service users feel heard, valued, and empowered in decision-making and self-advocacy.

Peer facilitators are currently employed across a range of services within the Trust, including inpatient units, early intervention services, perinatal mental health, learning disability services and, community mental health teams. At present, there are no peer facilitators directly employed within secure services.

Senior peer facilitators, who also bring their own lived experience, are employed to provide enhanced peer support and mentorship. They also play a critical role in the recruitment process and the ongoing education and development of the role across the organisation.

Key priorities for the implementation of the peer workforce

  • Inclusive recruitment: To develop a peer workforce that reflects the diversity of the service user population.
  • Recruitment framework: To implement a streamlined and tailored recruitment approach, ensuring the involvement of senior peer facilitators and individuals with lived experience at all stages of the process.
  • Career development pathway: To establish clear training and career progression routes for people with lived experience working across LSCFT, including access to accredited programmes such as the Level 3 Peer Support Worker Apprenticeship.
  • Equity of access: To address geographical disparities in the availability of peer facilitators across services, ensuring that all service users, regardless of location, can access support from a peer worker.

Carers Engagement and Triangle of Care

Recognising that carers are integral to our communities, we acknowledge their marginalisation and the emotional, practical, and financial impacts of their roles, including on their mental and physical health.

At Lancashire and South Cumbria NHS Foundation Trust, we are proud to have achieved Star 2 accreditation in the Triangle of Care programme in June 2025, demonstrating our ongoing commitment to involving and supporting carers as partners in care.

Initiatives to support carers

  • Training: An online module on the Triangle of Care and carer awareness was launched during Carers Week 2024. Following its launch, the training was made mandatory for all staff from February 2025, and to date, over 7,000 staff members have completed it, significantly enhancing awareness and understanding across the Trust.
  • Carer Charter: We are working with organisations across Lancashire and South Cumbria to develop a jointly agreed Carers Charter. Although there have been delays due to ongoing pressures within the Integrated Care Board (ICB), the charter remains firmly on our agenda, and we are committed to progressing it as soon as possible.
  • Carer referrals: Staff are actively encouraged to signpost carers to local organisations for assessments and support, including peer support, counselling, respite services, and benefits advice. We have seen a positive increase in staff logging conversations with carers about referrals, including noting whether carers wish to be referred or choose to decline which is a key step in ensuring carers’ preferences are respected and documented.
  • Cultural inclusivity: We are pleased to have been accepted onto the Triangle of Care working group, supported by a carer representative. This collaboration will help us strengthen our approach to cultural inclusivity in how we engage with and support carers from diverse backgrounds.
  • Carer champions: We now have over 100 carer champions in place across the Trust. These champions play a vital role in promoting carer awareness and best practice within teams. We’ve also established an active MS Teams chat to support peer connection and knowledge sharing, and we successfully launched a Carer Champions Network session during Carers Week, further strengthening our community of practice.
  • Our goal remains clear, to ensure carers receive the right support at the right time, helping to prevent burnout and enabling them to continue in their vital roles effectively.

Service feedback

Updates to the process of collecting feedback include the refresh of Friends and Family Test feedback cards to expand the demographics collected. The updated survey includes questions such as ‘is your gender identity the same as the sex that you were registered at birth?’, this question was included following discussion with Lancashire LGBT to ensure correct wording, ‘do you have a diagnosis of autism?’ and, ‘are you neurodivergent (for example, ADHD and/or dyslexia)?’ The inclusion of these (optional) questions means that we are better able to cross reference protected characteristics with patient experience data including free text comment narrative. The inclusion of autism diagnosis and learning disability status has supported the collection of data as part of the greenlight toolkit, by the learning disability and autism matron.

Ensuring feedback collected is representative of our population remains a priority, with a specific workstream within the Patient and Carer Race Equality Framework (PCREF) established. Work to examine the quality of data collected has been undertaken, identifying challenges in unrecorded ethnicity data. Feedback data, such as Friends and Family Test has been triangulated with complaints and PALS data to identify any themes and has been presented at the PCREF group. 

To increase the volume and representativeness of feedback, proposals to implement widespread digital methods of feedback collection have been developed. The benefits of this are twofold, increased rates of feedback collection and an improved ability to collect feedback in a confidential way. A pilot has been introduced which has shown success in heart failure nursing services.

Belonging by involving

In 2024/2025, the Experience Team received 298 requests for service user, lived experience, and carer involvement. The number of individuals registered for participation has grown from 128 in April 2024 to 166 in March 2025, resulting in an increase of 38 new members. This growth demonstrates our commitment to the recruitment and retention of involvement members, ensuring a diverse and skilled group of individuals capable of supporting various activities. We continually promote involvement opportunities and encourage staff to register individuals they involve.

Feedback from involvement activities this year:

“I enjoy helping make a difference to patients and helping them feel comfortable and listened to.”

“Hearing how happy the four service users/patients were on this ward and how safe they felt in general went well for me.”

“I have to say that the lead on the accreditation process was truly excellent, extremely professional and compassionate, and he deserves credit for this! It was an absolute privilege to work alongside him, and his two colleagues, who were also very professional and compassionate people, and were also a privilege to work with.”

“To be actively involved, my voice, my opinion, ideas, to be listened to or heard, to be understood, reassured, and my wellbeing being asked. The event was brilliant, so nothing more to add. Then my viewpoints action planned to help shape frameworks, policies and strategies.”

Youth Voices

The Youth Voices forum involves young people from various backgrounds and provides a platform for them to have their voices heard throughout the Trust. These individuals share their experiences, suggest improvements, and develop resources to enhance services for children and young people.

In June 2024, Riley Ashton was successfully elected as the incoming Chairperson for 2024-25. Riley had a clear vision for how to ensure that Youth Voices remains a success and performs strongly in the future.

In July, a meeting was held to focus on mapping out the future of the group, and time was spent reviewing what was going well and what needed to be changed. As a result, existing young people’s involvement groups in LSCFT networks now fall under Youth Voices, as well as creating Youth Voices groups in all areas (e.g. Youth Voices Preston). Groups such as The Crew (from The Cove), and others like SEND and eating disorder groups would also integrate under Youth Voices. We have promoted Youth Voices, the individual youth participation groups, and the service user carer council at several events.

Observe and Act

We continue to utilise the Observe and Act tool from Shropshire Community Health NHS Trust to evaluate service experiences from the perspective of service users and carers. This tool helps us identify areas for improvement in patient care, safety, communication, food standards, signage, and inclusivity. Training is provided to facilitators to ensure they understand diverse experiences and promote inclusion, accessibility, and equality in our observations. In 2024/2025, five of the six visits that took place had a service user or carer facilitator.

Park run at Guild Lodge

Twelve months ago, LSCFT made history by setting up the first secure parkrun event at a mental health facility in the UK.

Based at our medium security hospital, Guild Lodge in Whittingham, the course was created with the aim of promoting physical and mental wellness, reducing stigma and bringing patients and colleagues together with a common goal – to improve.

The event encourages walkers, runners and volunteers to attend and complete the course in the way that works for them. Almost 100 colleagues and patients have taken part so far, achieving 49 personal bests (PBs) and clocking up an impressive 1,420,000 metres. For context, that’s the distance between London and Rome.

But physical improvements aside (and they have been plentiful), the real differences our colleagues have noted have been in the overall presentation of our patients, with parkrun improving their moods and allowing them the opportunity to challenge negative thoughts.

V (not her real name), a patient on one of our step down wards, earnt herself the 25-event milestone t-shirt, after attending almost every Saturday since the event began. In that time she has progressed from beginner runner to being the fastest female on the course and completing her first marathon, something she describes as a “bucket list moment”.

V said:

“I love keeping busy and being here I have the benefit of time. I don’t have family or employment commitments making it hard to train or make time for activities. People talk about the runner’s high but it’s more than that. Running has boosted my self-esteem, made me healthier, given me a sense of achievement and allowed me to make friends with people I wouldn’t have ordinarily met. At parkrun I still get asked what department I work in – people automatically think I’m staff and one of the best things about parkrun is that there’s no judgment or titles. I’ve even been invited out for breakfast with some of the staff members after the run.”