Diagram of Core20Plus5 setting out the target population and the 5 key clinical areas of health inequalities

Core20PLUS Connectors

Exceptional quality healthcare for all through equitable access, excellent experience, and optimal outcomes is the NHS's goal for reducing healthcare inequalities. 


The Core20PLUS Connectors programme is part of the support framework for progressing the goals of Core20PLUS5, a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both a national and system level. The programme builds on many other community-based initiatives and experience from other volunteer roles which support health improvement and reducing inequalities. These include Community Champions, Vaccine Champions, Link Workers, Peer Advocates, and the extensive network of (salaried) Social Prescribing link workers.

Whilst healthcare services may only impact partially on wider health inequalities, it’s vital the NHS is doing all it can to narrow the gap in major clinical areas of disparity in healthcare outcomes for excluded and disadvantaged communities – especially in maternity care, severe mental illness, respiratory disease, cancer, and cardiovascular disease.  These conditions all have clear evidence of disparities in ill-health, healthy life expectancy and mortality – linked to social and economic deprivation and other aspects of exclusion and discrimination.  

We are pleased to be working with the Health Inequalities Improvement team at NHS England on one element of the strategic focus on reducing healthcare inequalities, the Core20PLUS Connectors programme. We are leading the design, set-up and support for the programme, working with a set of valued partners – Healthwatch England, National Voices, and The Health Creation Alliance

Update:

The programme funds Integrated Care System (ICS) and place-based initiatives to recruit, mobilise and support influential community connectors to take practical action to improve health and reduce inequalities across the five clinical priorities outlined in the Core20PLUS5 approach. We are now in the second year of this three year programme with 19 confirmed sites spread across two intake streams, they target a range of Core20PLUS5 focuses, and include a spread of different communities of focus and geography types.

Wave 2 (22/23)

Eight sites have been selected to implement local, community-based initiatives to support the reduction of healthcare inequalities in Wave 2 of the Core20PLUS Connectors Programme.  

Wave two successful sites include:

Black Country and West Birmingham ICS, Walsall (Midlands)

The project aims to remove barriers to access, build trust and create opportunities for connectors to shape services to better meet the needs of inclusion health communities and six deprived neighbourhoods. This also includes the provision of 'micro-grants'

• Cheshire and Merseyside Health and Care Partnership, Halton (North West)

Targeting six wards in Halton with high levels of deprivation, connectors will look to address all 5 clinical areas of focus within the Core20PLUS5 approach. A ‘Making Every Contact Count (MECC)’ model will also be used to target those with severe mental illness for annual health checks and those with Learning Disabilities to support hypertension case finding

• Hertfordshire and West Essex ICS (East of England)

Working in partnership with VCSE across 20% most deprived wards and inclusion health groups, to listen, involve & work with the community to co-design programmes and bridge between communities, link workers and health and care services, across all 5 clinical focuses.

• Kent and Medway ICS (South East)

Two projects - one focusing on Maternity with Black, Asian and Minority Ethnic populations in Thanet and South Kent Coast. The other focuses on bowel Cancer screening in Black, Asian and Minority Men aged 60-75, in Dartford and Gravesham.

• Leicester, Leicestershire & Rutland ICS (Midlands)

Working, with ethnic minority community organisations in the most deprived areas to achieve a culturally conducive community engagement strategy, focusing on Chronic Obstructive Pulmonary Disorder (COPD), Cancer and  Hypertension)

• Mid and South Essex HCP (East of England)

Focusing on COPD and working within the six most deprived wards in Southend. The project involves collecting local knowledge, offering patients support, engaging with decision-makers and co-designing services.

• Somerset (South West)

Building on the success of COVID Champions, the programme focuses on COPD in Bridgwater with a model to pay connectors to overcome the barriers to volunteering and impact on benefits.

• Staffordshire and Stoke-on-Trent ICS, Southwest Staffordshire (Midlands)

The Cannock Chase District project focuses on hypertension and cancer by enabling connectors into influencing positions.

Wave 1 (21/22)

A total of 26 EOIs were received to participate in the programme. A panel including members of VCSE organisations and partners with lived experience of healthcare inequalities reviewed these submissions and 11 were selected for Wave 1 of the programme.

These 11 successful sites are: 

• Devon (South West)

Focusing on two geographies, using two distinct communities, the ICS will employ a social research comparative method, to get under the skin of rural and coastal deprivation and the effect it has on health and happiness.

• Greater Manchester Health and Social Care Partnership (North West)

Working with the Caribbean & African Health Network (CAHN) across four areas, recruiting 30 Caribbean & African Connectors to co-deliver 8-12 sessions for PCNs to explore the elements of care pathways that matter to people.

• Joined Up Care Derbyshire (Midlands) 

The programme seeks to increase uptake of flu, pneumonia and COVID-19 vaccinations among people with COPD; hypertension case-finding; improve early cancer diagnosis and improve uptake of SMI and learning disability health checks across four wards across Derby City..

• Lancashire South Cumbria ICS (with North East /North Cumbria ICS) (North West and North East & Yorkshire)

The project with have particular focus will be on hypertension in Blackpool, to bring about more responsive, inclusive effective local governance, and a greater public trust and confidence in local services through the support of CORE20+. 

• North East and North Cumbria ICS (North East & Yorkshire) 

Utilising the range of active lived experience networks which are already engaged within the ICS. The long-term outcome is to embed the insight into the ICS approach and that local health decision makers made decisions informed by community experience. 

• North East London ICS (London)

Working in a specific ward, the core focus is to raise awareness of healthy behaviours and access to preventative interventions, including increases in over 50s health checks, cancer screenings and local resident GP registrations.

• Shropshire, Telford and Wrekin (STW) (Midlands)

Working to increase screening uptake and awareness of symptoms, the model builds on a body of, engaged and educated Cancer Champions who work within their own community and population groups with the highest cancer burden.

• South West London Health and Care Partnership (London)

The core focus will be on a community led delivery model; based on an asset-based community development (ABCD) methodology, building trust and confidence in public institutions, by offering support that is culturally sensitive or tailored to specific needs. 

• Suffolk and North East Essex (East of England)

Actively enabling links between grass roots black, Asian and ethnic minority community groups to coproduce projects around mental health, maternity by producing culturally appropriate advice, guidance and support.

• Sussex Health and Care Partnership (South East)

Working with communities within Hastings, St Leonard, Brighton and Hove and specifically focusing on cancer, blood pressure and hypertension. Utilising data and insight to co-design interventions to address the unmet needs of this population, including asset-based approaches to developing local solutions.

• West Yorkshire Health and Care Partnership (North East & Yorkshire) 

Splitting the project across two communities of interest to create a health and care system that understands the needs of the population. Gypsy & Traveller population: to reduce inequalities in cancer screening and hypertension diagnosis. Refugee & Asylum Seeker population: to connect with communities to improve access to maternity services and increase SMI Health Checks

Associate sites:

North Central London (London)

Connectors will raise awareness withing the Black African/Caribbean, South East Asian and Kurdish/Turkish communities, people with Learning Disabilities, people experiencing homelessness, asylum seekers and refugees. Hypertension will be of specific focus. 

• Hampshire and Isle of Wight (South East)

Focusing on the plus communities in East Hampshire, considering dimension of ethnicity, inclusion health groups, learning disabilities, SMI and protected characteristics. The project will apply a “see”, “feel” and “change” model to inform to influence decision makers. 

The chosen initiatives encompass the five clinical priority areas outlined in the Core20PLUS5 approach and target different communities and geographies.

More information about these projects in wave 1 of the Core20PLUS Connectors Programme can be found here

A third wave of the programme will be launched in autumn/winter 2022. If you would like to be added to our mailing list of stakeholders to receive a notification when wave three is launched, please email This email address is being protected from spambots. You need JavaScript enabled to view it..

Click here to access the Prior Information Pack

 

The Core20PLUS Connectors concept

  • Community connectors are people who are part of those communities who are often not well supported by existing services, experience health inequalities, and who then help change these services to support their community better. This approach recognises that people and communities often know what they need and what would work, and that the NHS needs to hear from these communities
  • The Connectors programme will develop and support community-based roles to impact on the goals of Core20PLUS5 - acting as a voice to focus on barriers and enablers to reduce health inequalities and connect people with decision-makers.
  • This will include taking practical steps locally for health improvement in excluded communities experiencing healthcare inequalities, with focus on the five priority areas (maternity care, severe mental illness, severe respiratory disease, cancer, and cardio-vascular disease) and other locally identified priorities. 

In the first stage this financial year, NHSE will fund and support around ten Integrated Care Systems to develop and mobilise the model of Core20PLUS Connectors locally, for example through partnership with a VCSE organisation or Local Healthwatch Group to fund local co-ordination to build a network of local Core20PLUS Connectors.  The programme is planned to sustain and grow in the following two years, with learning and evaluation being built into the design.  

The Connectors programme is part of the support framework for progressing the goals of Core20PLUS5, a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement as shown in the diagram at the top of the page

The Connectors programme is one of a number of funded initiatives that support focused action across ICSs to reduce healthcare inequalities across the five priority clinical themes and contribute to wider steps on health inequalities including upstream social determinants. 

 

 

The Connectors programme builds on and relates to many other community-based initiatives and extensive experience of largely volunteer roles that impact on health improvement and inequalities, including Community Champions, Vaccine champions, Link Workers, Peer Advocates, and the extensive network of (salaried) Social Prescribing link workers.  The co-design work to date for the programme has been informed by both people and organisations with experience of health inequalities and community-based programmes. 

Core20PLUS Connectors will play a role that contributes to improvement trajectories at ICS / Place level across the five health and care inequality priorities, and influence reduction in health inequalities across other locally identified priorities.  

The Connectors Approach

  • Community-centred

The model for taking forward the Connectors programme is based firmly on community-driven / assets-based Community Development.  The co-design work with people and organisations bringing direct experience of health inequalities and in community-based roles affirms several features of being community-driven: 

1. Co-design your local connector programme

  • Work with existing organisations with trust
  • Learn from what already exists/assets (and invest in it)
  • Speak to communities and ask them what will work
  • Define success in community terms not KPIs/targets

2. Recruit connectors

  • Community connectors must be local people (peer power)
  • Have recent lived experience of inequality
  • Have good current connections within their communities
  • Engage people with the right attributes/traits
  • Train and support connectors (to prevent harm and enable personal progression)

3. Share power with communities

  • Equal seats
  • Long term relationship
  • Accept responsibility
  • Listen, get behind and fund what they think the solutions are
  • Share anonymised data with them
  • Work with them to address the issues - in partnership

The approach emphasises the importance of connections and development of trusted relationships, both within local communities and between communities and the wider health and care system – with Connectors acting in vital ‘bridging’ roles.  

 

The dynamic, interactive relationship between the wider health and care system (ICS / Place / Provider Collaboratives / Primary Care Networks) and Connectors is key to the role – connecting both as a bridge between communities and health and care services and connecting within communities to improve health with focus on the five health inequalities priorities in Core20Plus5.  - 

From the co-design work, and engagement with ICSs to date, key features about the programme are recommended: 

  • There are likely to be many Connectors across an area – e.g. for different communities / neighbourhoods / and potentially relating to health conditions or services.  
  • The Core20PLUS Connectors focus can build on and enhance existing local community-based initiatives, as long as there is focus on the goals and outcomes of Core20PLUS5. 
  • The focus of activity is mainly at community level rather than direct support / referral for individuals and families.  
  • Connectors will need to work in coordination with other community roles and Social Prescribing Link Workers 
  • Hosting and support for the local network of Connectors will be via VCSE partner/s (e.g through the VCSE Alliance) and / or Local Healthwatch Groups. 
  • Connectors may be voluntary / unpaid roles, or through a combination of volunteer and salaried roles, according to the locally adopted model.  Identifying development pathways from voluntary to paid roles is recommended.  

 Logic Model

A high-level outline logic model for the programme approach is shown below, an indication of the approach to how outcomes and impact on narrowing health inequalities can be supported through the work of Connectors, and as a basis to support local programme design and models.  

  

 

Co-design

The content here builds on insights and ideas presented and discussed at a series of co-design workshops with people and organisations bringing direct experience of health inequalities and community-based roles.  Thank you to everyone who was able to attend the workshops and take part in the co-design process.  

Our partners on the programme compiled a set of reports from the co-design process, available here:

For PDF copies of these reports and for more information on the Core20PLUS Connectors programme please email This email address is being protected from spambots. You need JavaScript enabled to view it.