NHS North West London Integrated Care Board’s Vibrant and Healthy Communities (VHC) programme fosters collaboration among the Voluntary and Community Sector (VCS), NHS, Local Authorities, Public Health, and other stakeholders to address health inequalities in Kensington & Chelsea and Westminster. The Community Solutions Fund, a key workstream of the VHC programme, leverages the transformative potential of community-driven healthcare interventions to address inequalities in healthcare utilisation.
The fund’s inaugural programme, Screen, Detect, Protect (SDP), aimed to encourage earlier detection of cancer among marginalised communities. Between January and June 2024, nine VCS organisations collaborated with NHS health professionals to design and deliver community-specific health campaigns and activities.
In addition to increasing uptake of cancer screening among the targeted populations, the SDP programme served as a pilot to test and evidence the effectiveness of the programme approach in working more effectively with local VCS organisations and communities. Envoy Partnership was commissioned to comprehensively evaluate the SDP programme’s achievements and generate actionable recommendations for future funding rounds.
Both the impact and process evaluations employed an overlapping mixed-methods approach. This methodology integrated primary qualitative and quantitative data collected by Envoy Partnership and VCS organisations from January to July 2024, alongside secondary clinical data on cancer screening attendance rates provided by the NWL ICB Business Intelligence Team for each target community group.
The main features of each approach are outlined below.
The process evaluation intended to capture the learnings and successes of the SDP programme to create actionable recommendations for future Community Solution Fund programme approaches.
The research took place from May to July 2024, using a mixed-method approach to capturing feedback from stakeholders involved in the conception, design, and delivery of the SDP programme. This included nine interviews with the VHC team, nine interviews service providers from the nine SDP projects, as well as an online survey distributed to the seven delivery partners working with one of the SDP projects.
Envoy Partnership conducted nine interviews with the service leads from funded VCS organisations at the beginning of the evaluation to define the goals and anticipated outcomes of their projects within the communities they serve, and the project activities and inputs that would lead to the intended results.
The identified clinical and community-defined target outcomes guided the selection of metrics to benchmark the impact of project activities. The participating VCS organisations were tasked with collecting their own primary data to showcase the impact of their projects, with Envoy Partnership supporting the development and refinement of data collection tools and methods as necessary. The research methodologies and data capture types differed across organisations based on the specific needs of their service users (e.g., language, learning levels) and projects (e.g., frequency of activity).
Envoy Partnership also conducted 11 one-to-one interviews and two focus groups with service users from eight of the funded VCS organisations, as well as ethnographic observations of two SDP projects, to contribute to case study material for the report. Envoy Partnership also distributed a survey to VCS organisations to assess the overall demand for transport services among their service users, and a survey to health professionals who supported SDP projects to explore their perspectives on how the interventions may influence cancer screening rates and behaviours in the community.
The SDP programme effectively harnessed collaborative efforts among community organisations, the NHS, Public Health, and Local Authority departments, which were crucial in advancing cancer screening initiatives. Health professionals played a vital role, with their expertise ensuring the accuracy of cancer-related information and enhancing workshop delivery. Their involvement in reviewing materials and leading sessions bolstered the confidence and effectiveness of the VCS organisations.
The SDP projects were largely consistent with the VCS organisations’ previous interventions, as many leveraged established activities that had proven successful in the past. Most organisations brought prior experience in clinical topics and collaborations with health professionals, and many had conducted other cancer-related initiatives either shortly before or alongside their SDP projects. However, the programme’s workshops and learning sessions were considered a particular benefit and distinguished it from other grants. These sessions offered significant networking and resource-sharing opportunities, enhancing collaboration among VCS organisations and contributing to the programme’s overall success.
Several challenges were identified by stakeholders, including the six-month timeframe, which was deemed insufficient. Issues also arose with the programme’s structure, goals, evaluation requirements, and the availability of health professionals. Many organisations encountered unexpected staffing and resource limitations but managed to adapt by utilizing internal expertise and external networks.
“When somebody has the resource, somebody has the expertise, and somebody has knowledge and trust with the community, this is where you can make impact and this is where you can deliver and sustain as well.”
The findings from the SDP projects reveal a complex landscape of cancer screening engagement across diverse communities. Collectively, these initiatives reached over 5,200 individuals through 709 events and activities, with an additional 421,000 residents engaged indirectly via digital campaigns and community outreach. The organizations involved adopted a wide array of approaches, from health workshops focused on cancer awareness to large-scale digital campaigns, each tailored to the unique needs and characteristics of the populations they served.
The evaluation demonstrated that the SDP programme successfully addressed current barriers to uptake of cancer screening services by:
Overall, projects made a notable impact on increasing knowledge and awareness about cancer screenings, with many service users reporting higher likelihoods of attending screenings in the future. However, immediate, observed changes in screening rates were mixed, reflecting the complexity of these issues and current data limitations in attributing outcomes directly to interventions. These findings underscore the importance of continued, culturally sensitive engagement and tailored support to address the multifaceted barriers that hinder cancer screening participation in diverse communities.
The findings underscored the importance of continued, culturally sensitive engagement and tailored support to address the multifaceted barriers that hinder cancer screening participation in diverse communities. By bridging communication gaps, providing tailored information, and involving health professionals, the programme significantly raised awareness of earlier detection of cancer within the targeted communities.
However, the absence of individual or cohort-level tracking on systems such as SystmOne, EMIS, or WSIC has made it challenging to directly measure the programme’s impact on cancer screening rates over the medium to long term. To better assess and enhance future Community Solutions Fund programmes, the VHC team should explore ways to integrate system data with service user data. This combined approach could offer a clearer picture of the impact of these initiatives. Additionally, feedback from stakeholders highlights the need for clearer communication, extended project timelines, and well-defined roles to optimise future efforts. Collaborations between VCS organisations and NHS clinicians present valuable opportunities for mutual learning and continuous improvement, and it is essential for the VHC team to incorporate structured mechanisms that facilitate practical adaptations and responsiveness to community feedback.
The evaluation revealed several key opportunities to further address barriers to cancer screening and enhance early detection efforts within target communities and other marginalised populations:
By implementing these recommendations, the NHS and community organisations can enhance the effectiveness of cancer screening programmes, reduce health inequalities, and foster a more inclusive and supportive approach to early cancer detection.
