Kent County Council: A three-pronged approach to improve health of underserved groups

Kent County Council has launched three new initiatives aimed at changing the trajectory of adult care needs and tackling inequalities in coastal communities and among Gypsy, Roma and Traveller communities, who have the worst health outcomes of any ethnic group in the UK. 

Director of Public Health Dr Anjan Ghosh said:

“These three areas are absolute priorities for us – making progress will have significant impact on health inequalities in the county and support the sustainability of adult social care."

Kent has 350 miles of coastline with nearly a quarter of the county’s population living along it. While many of the coastal areas are places of great natural beauty, some of the worst health outcomes can be found in their communities.

To help tackle the health inequalities, the area has become one of 50 Marmot Places in England – and the only coastal one. The public health team started working with Sir Michael Marmot’s Institute of Health Equity in October 2024.

The focus in on six areas of high deprivation – Swale, Canterbury, Thanet, Dover, Folkestone and Hythe and Ashford. The programme is being led by a steering group incorporating 40 partners from across the council, NHS and voluntary sector.

Dr Ghosh said: “It has given us a great opportunity to really spend time looking at the data and evidence to see where we can have the biggest impact.

“We were aware we did not want to spread ourselves too thinly. Kent is really big and there are eight Marmot priorities so in the end we decided to focus on two – skills for work and work and employment. 

“In many respects finding good employment is the biggest single social determinant – it addresses poverty and improves wellbeing at the same time. It also fits in with the government’s growth agenda.

“We were really keen to get something going to try to get some quick results to give the programme momentum so we are now pushing ahead with two pilots.”

These target three specific groups – children leaving care, young people not in education or employment and prison leavers.

“We are working with two employers – the local NHS 111 provider to develop a pathway to become a call handler and East Kent Colleges to create more courses for these groups to get into social care.

“In both areas there are shortages so it was a perfect convergence – addressing vacancies in the public sector and supporting local people. Once we start getting progress we can build from there,” added Dr Ghosh.

In the council the public health team and adult social care are part of one directorate. That has provided the impetus for a new project that has recently been launched to embed prevention work into adult social care.

Public Health Consultant Sarah Crouch said: “The population in Kent is growing and we want to keep people well and independent for as long as possible, ideally preventing or delaying their need for care and support. Not only will that improve our residents’ lives, but it will also reduce the strain on council budgets.

“But there is very little published research to help us decide what actions we should prioritise in Kent to quickly change the trajectory of demand for adult social care. So we are looking at joined up health and care data for patterns to help us find those answers and design new initiatives which might quickly make an impact alongside our core work to improve the conditions people grow, live, work and play in.” 

A steering group has been set up within the council to oversee this work and data analytics, evidence and co-production with partners and the public are key features. A prevention framework is being drawn up and is expected to be launched in the autumn.

The aim is that the framework is to set out a new prevention first approach to social care, outlining key priorities and new ways of working to weave prevention into everything that social care does. Alongside the existing strength-based approach with residents, this has the potential to enable residents to live what Kent are calling “glorious ordinary lives.”

Making every contact count-style training may also be provided to staff, Ms Crouch said. “It would be terrific if every social care practitioner was confident to have a conversation about health and wellbeing and signpost to all our many sources of local support that can improve physical, mental and social health for the future.”

Kent has relatively large Gypsy, Roma and Traveller communities, partly because of the significant agricultural industry in the county. At the last census there were nearly 5,500 people in these communities – a rate of 3 per 1,000 people in the county, which is three times the national average.

Research suggests people from the Gypsy, Roma and Traveller communities have poorer health outcomes linked to poverty, adverse living environments, lifestyle factors and poorer access to health and care.

Two years ago the public health team embarked on a health needs assessment to map out the challenges these communities were facing in more detail. It identified a range of issues, including high rates of childhood illness, obesity, long-term conditions, smoking and poorer maternal outcomes.

Ms Crouch said: “We want to listen to the very different communities in Kent, build trust and jointly develop solutions that will improve health and wellbeing.”

A community of practice forum, involving representatives from the Gypsy, Traveller and Roma communities, has already been established to act as a sounding board for services to test ideas out and share opportunities to collaborate. 

And in the future the council wants to help establish a health champions network so people from these communities can be supported to offer advice and signpost their peers to key services.

Ms Crouch added: “We want to draw together culturally competent teams to work with local communities to understand each other and what could work to improve health. Local jobs for local people, improved education, housing and living conditions and better access to health services are all vital. 

“Above all else, we want to see an end to the racism and discrimination that Gypsy, Traveller and Roma communities experience and an increase in trust, understanding and joint working.”