Organisation

NHS West Yorkshire ICB

Project title: Developing a framework for Co-production to prevent Antimicrobial Resistance (AMR) in the Roma Population in West Yorkshire.

Project Overview

The mission of Integrated Care Systems is to reduce inequalities and tackle unwarranted variations in care. Antimicrobial Resistance (AMR) further complicates this, especially in West Yorkshire (WY), where socioeconomic factors heighten infection risks and AMR vulnerability. AMR is a particularly pertinent issue for Roma communities who, due to health inequalities, are at an increased risk of infection, often buy and share unprescribed antimicrobial drugs, have poor knowledge of infection prevention, and due to experience extensive barriers to healthcare. We also recognized that health care workers had poor cultural awareness of Roma community and a lack of representation of Roma Community in participation groups.

Previous work had focused on infection prevention, hydration awareness, AMR reduction; helping Roma people to recognise symptoms and live with infection in their homes; thus, reducing hospital admissions and improving patient safety and experience. However, we identified that for stewardship advice to be effective, we needed to help the community understand the importance of antibiotics; when they are required, and how these drugs can be accessed safely through prescription, addressing both medical needs and broader social health determinants.

A small project team enrolled on a New Citizen Project “Participation in Action” program to identify and develop skill on how to best work with people and communities to prevent infections, and ultimately, reduce AMR. Through this work we used tools and techniques to articulate the question we wanted to work with, learning steps of discovering, defining, developing and delivering in collaborative, truly participatory ways. After gaining insight from several health professionals and VSCE organisations, we developed a co-production group with three Roma community interest groups, building understanding and trust to work together on AMR reduction and reduce inequalities in antimicrobial stewardship.

Impact on tackling AMR

Engaging with communities and building strong relationships has fostered long-term collaboration and trusted networks across West Yorkshire to support AMS/IPC initiatives. This approach enabled enhanced Needs Assessment and Gap Analysis efforts with Migrant, Asylum Seeker, Gypsy, Roma, and Traveler communities, addressing barriers to screening and immunizations. Roma communities are now actively involved in all aspects of AMS/IPC engagement, from awareness days to educational activities tailored for families, including school events, pre-school sessions, and post-school drop-ins. These achievements celebrate the power of collaboration in creating inclusive, impactful health interactions. The Roma community emphasized the value of verbal translations and pictorial resources in improving message accessibility, reducing misunderstandings, and reaching a wider audience. Community members even brought medication boxes purchased locally without prescriptions, helping the project team identify antibiotics, explain their appropriate use, and stress the importance of taking them only when prescribed. Public awareness campaigns have been central to the Partnership’s AMR prevention strategy, including animation films on recognising UTIs, preventing infections through hydration and hygiene, and supporting carers’. Through co-production, community members enriched these resources with Eastern European translations, ensuring accessibility. The films have since been shared widely via social media and Romanian YouTube news channels, expanding impact. It was crucial to develop strategies to overcome stigma, language, and cultural barriers. With community support, we hosted “Health Awareness” days, enabling community pharmacy colleagues to inform attendees about Pharmacy First opportunities. They explained how infectious disease assessments could be conducted via telephone, with translators from community interest groups present. This familiar approach-built trust with local pharmacies, fostering meaningful behavioural change and improving access to safe antibiotics and healthcare. Additionally, Roma citizens were referred to the London School of Hygiene and Tropical Medicine, where they now contribute to a citizens’ forum on Pharmacy First and healthcare access alongside other PPIE representatives.

Future Development

We plan to co-produce AMS teaching packs with community leaders to address barriers and enhance healthcare practices for Roma communities. A Roma directory will be developed to support networking and strengthen connections across support networks. Additionally, we aim to establish a participation framework to engage other vulnerable communities in AMS/IPC prevention strategies. These initiatives will focus on fostering collaboration, improving access to healthcare, and driving meaningful behavioural change through shared learning and community-led solutions.

Organisation

Beacon House Primary Health Care for the Homeless

Project title: Moving Care Upstream

Project Overview

At Beacon House Clinic, we have long recognised the disproportionate use of antibiotics within the homeless population. Studies indicate that homeless individuals are at a higher risk for infections like pneumonia, urinary tract infections, and skin conditions, which often require antibiotic treatment. The difficulty in accessing timely healthcare exacerbates the situation, leading to more severe conditions and increased antibiotic use. Research shows that the homeless are more likely to be hospitalised for infections, with one study revealing that they are 3.5 times more likely to require hospital admission for such conditions compared to the general public.

MOVING HEALTH CARE UPSTREAM
In response to this challenge, Beacon House embarked on a project in collaboration with NHS England over the past 18 months to address the root causes of high antibiotic usage. Our initiative focused on moving care upstream through increased vaccination uptake to prevent infections in the first place. Vaccines, including those for pneumonia, influenza, and meningitis, have proven effective in reducing infections that typically require antibiotics. However, vaccination rates among the homeless population have historically been low. Public Health England has highlighted that homeless individuals are less likely to receive vaccinations compared to the general population.

To combat this, we introduced a comprehensive approach. On every first visit, patients are screened for vaccine status, and all recommended vaccines are offered. In addition, we implemented educational sessions, outreach activities, and promotions with giveaways to raise awareness about the importance of vaccinations. These initiatives have been designed to make vaccines more accessible and improve patient understanding.

Our efforts are actively contributing to reducing antibiotic use among this vulnerable group. By tracking our vaccination uptake and aiming for continued improvement, we are committed to both enhancing public health and supporting antimicrobial stewardship in the homeless community.

Impact on tackling AMR

The impact of Beacon House Clinic’s vaccination initiative has been significant in improving health outcomes for homeless individuals. Here are three key points reflecting the success of our project:

50% Vaccine Uptake: We have achieved a 50% vaccination acceptance rate among homeless patients, a significant improvement compared to national vaccine uptake rates. For instance, the flu vaccine uptake for the general population in the UK for the 2022-2023 season was 80.7%, indicating a gap but showing our success in a high-risk group.

Reduced Risk of Infections: By offering vaccinations such as the flu and pneumococcal vaccines, we have contributed to reducing the incidence of vaccine-preventable diseases among the homeless population. This not only helps prevent infections that typically require antibiotics but also supports overall health improvement, potentially reducing hospital admissions related to pneumonia and other preventable infections.

Increased Awareness of Preventive Care: Through our educational sessions, outreach, and on-site vaccine offerings, we have successfully raised awareness about the importance of preventive care. This approach has empowered homeless individuals to take proactive steps in managing their health, potentially reducing the reliance on emergency services and improving their long-term health outcomes.

These efforts have demonstrated positive results in reducing the need for antibiotics and increasing overall vaccine uptake within this vulnerable population. We are committed to further expanding these initiatives to improve health outcomes and support antimicrobial stewardship.

Future Development

To further develop and increase the impact of our vaccination initiative, we plan to expand outreach efforts by partnering with additional local organisations and community groups to raise awareness. We will also explore innovative digital platforms to engage with homeless individuals, ensuring better access to health information and vaccines. Additionally, we aim to increase our vaccination uptake by tailoring educational sessions to specific groups within the homeless population, addressing their unique needs. Sharing our good practice through national networks, such as NHS England and local health forums, will help extend the reach of our approach, promoting broader adoption across similar services.