Starting a ‘new conversation’ about blood pressure in south east London

Find out how the South East London Coalition for Better Health and Equity is bringing together partners across the healthcare system to tackle the burden of hypertension.

A raised blood pressure sits almost at the top of the global burden of disease. It is second only to tobacco dependence as a risk factor for deaths in all ages and genders in the UK, in 2019. It remains the leading risk factor for cardiovascular disease and related disability. High blood pressure affects more than one in four adults in England and having a high blood pressure is associated with half of heart attacks and strokes. This is why it is one of our ‘Vital 5’ - an initiative that advocates for people, communities and organisations to make improvements to five factors that have a major impact on health at an individual and population level.

Challenges of adherence remain despite the availability of quick, accurate and cheap ways of diagnosing a raised blood pressure, and safe, effective and evidence-based means to manage it, which have both been around for decades.

So why then is it so difficult to tackle high blood pressure and how is it impacting on health inequalities for people living in south east London?

This question is perhaps far too reductionist because this is also a challenge that other health systems globally continue to face, although this review of the Pan Canadian Hypertension Framework shows us what is possible.

This topic has become more pressing in the context of COVID-19, which has widened health inequalities further, and where having high blood pressure is a risk-factor for poorer outcomes. Even before the pandemic, people from the most deprived parts of England were already 30% more likely to have high blood pressure.

In July 2020 King’s Health Partners, along with South East London Integrated Care System (ICS), created a new joint programme - the South East London Coalition for Better Health and Equity. The coalition is a system-wide approach that creates the space for ‘new conversation’ and new thinking about enduring challenges such as blood pressure. Led by Shaun Danielli, Director of Population Health and Equity, this programme aims to address health inequalities and improve population health by focusing on prevention and the among two other strategic aims - population health management and data, and ‘health in all policies’. This programme also strongly supports two major themes from King’s Health Partners five-year plan, ‘transforming system-wide quality improvement and outcomes’ and ‘improving urban population health’.

Starting with blood pressure, the programme co-developed its approach with colleagues from public health, the ICS and the Clinical Commissioning Group (CCG), and within King’s Health Partners, using the Design Council’s framework for innovation. Together we hosted an online workshop on blood pressure in June 2021, bringing together 96 stakeholders from diverse backgrounds and across south east London, including those from community groups, primary care, secondary care, borough councils, public health and academia.

We had four key aims for the workshop:

• connecting people around blood pressure, i.e., making blood pressure everyone’s business;
• creating a shared understanding around the challenge, our assets and the opportunity in south east London;
• inspiring action by sharing examples of current related projects; and
• co-developing tangible ideas to pilot and evaluate in south east London.

A range of experts attended to kickstart building a shared narrative around blood pressure in south east London. Sian Martin, Health Systems Insight Manager at the British Heart Foundation, first described why there needs to be a continued focus on blood pressure, what our local data is telling us and shared learnings from their blood pressure award programmes.

We then heard from Prof Nicola Thomas, Professor of Kidney Care at London South Bank University, on her pilot, which started during COVID-19, where she is working with eight barber shops in Lambeth to provide on-the-spot blood pressure checks for customers who want them.

More experts within south east London also shared their work, including:

• On why blood pressure in pregnancy matters by Prof Lucy Chappell, Professor of Obstetrics/NIHR Senior Investigator King’s College London
• South east London Pharmacist led virtual clinics by Helen Williams, National Speciality Advisor for CVD Prevention, Consultant Pharmacist SEL CCG
• Bloop pressure at home pilot in Lewisham by Dr Georgina Thomas, GP, Morden Hill Surgery, One Health Lewisham fellow for BAME health inequalities
• Approach to mapping interventions/initiatives around blood pressure by Joanne Ferry, Senior Public Health Specialist, London borough of Bexley
• Clinical Effectiveness by Dr Rachna Chowla, Joint Director of Clinical Strategy King’s Health Partners and Clinical Lead, Clinical Effectiveness Bexley

These presentations were followed by smaller discussions, allowing attendees to share what was happening in their area of south east London. Conversations also took place on what else could be done to augment these projects or to fill in the gaps that haven’t been addressed.

Some of the themes that came up in the discussions are captured in the image on the right [illustration credit: Wenda Aitchison].

The feedback from the workshop made it very clear that working closely with local communities is key to making real impact and you can read some of the comments we received below.

This is a ‘new conversation’ that has only just begun, and on 1st September 2021 we joined local voluntary and community sector organisations at a community health and wellbeing event in south Southwark to ensure it continues.

Our joint programme is also working on the next steps, including further community engagement and developing its theory of change. The approach used in this workstream will be applied to the next 'Vital 5' area of focus, which is tobacco dependency. For more information contact wenda.aitchison@kcl.ac.uk and to view a recording of the workshop click here.

The next King’s Health Partners Primary Care webinar is taking place on 22^nd September. Prof Lucy Chappell will be speaking on Pre-conception and Health Inequalities. you can find out more here. 

Wenda Aitchison (Project Officer, King’s Health Partners), Karin Nilsson (Programme Manager, Prevention and Health Inequalities, King’s Health Partners & South East London Integrated Care System) and Dr Rachna Chowla (Joint Director of Clinical Strategy, King’s Health Partners)

Feedback from the blood pressure workshop

It is really positive to see the amount of interest and energy across the system to tackle health inequalities with a clear focus on local needs linked to the Vital 5. It genuinely feels like the conversations are different this time; there is clear recognition of the crucial role that communities must play in generating and delivering solutions and a commitment to co-create and build trust with local people and the voluntary and community sector (VCS).

This is a fantastic start but will only mean something if we now turn this talk into action. As a next step I would love to see this discussion being held in the community to begin the journey of building trust. We need to take time to listen to what local people and the VCS think about blood pressure and the Vital 5 and listen to their ideas for how we can work together to address this.

Will Nicholson, Programmes and Partnerships Lead at Health Foundry, co-founder of the Southwark Culture Health and Wellbeing Partnership and Thriving Communities Lead at Lambeth Together.

 Thank you so much for including me in what was one of the most inclusive, diverse, positive workshops, with a real sense of keenness to progress in this space. It’s too important not to keep moving on this.

Prof Lucy Chappell, Professor in Obstetrics, King’s College London.

Liked this article? Find out more about the Vital 5.