Jo McNamara Rad Chat Host (00:00)
Hello everyone and welcome to Rad Chat, founded by me, Jo McNamara.

Naman Julka-Anderson (00:04)
And me, Naman Julka-Anderson. Rad Chat is a forward-thinking global knowledge hub where healthcare professionals can advance their expertise in therapeutic radiography and oncology. Unlike traditional academic resources, we blend real-world experience, expert insights, best practice, and patient perspectives.

Jo McNamara Rad Chat Host (00:21)
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Naman Julka-Anderson (00:38)
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Jo McNamara (00:47)
This is episode 201, which is part of the education and workforce development series, where we're going to be hearing not from one, not from two, but from three amazing guests, Hayley Gibson, Hayley Snowden, and Sue Ormesher, who will be talking about how they're tackling health inequalities in their region. So welcome all to Rad Chat. It's good to have all three of you join us today.

Hayley Snowden (01:10)
It's good to be here. Thank you for having us.

Jo McNamara (01:12)
Perfect. So let's do introductions one by one. So Hayley S, would you be so kind as to introduce yourself, please?

Hayley Snowden (01:20)
Yep, so my name is Hayley Snowden and I'm a Health Inequalities Programme Manager for the West Yorkshire and Harrogate Cancer Alliance.

Jo McNamara (01:27)
and Hayley G.

Hayley Gibson (01:29)
Hi, thank you for inviting me to the podcast. This is exciting. So I am Hayley Gibson and I am the lead radiographer in Leeds Teaching Hospital for breast imaging.

Jo McNamara (01:40)
and Sue.

Sue Ormesher (01:41)
Sue Ormesher, and I'm the Communications and Engagement Officer for the West Yorkshire and Harrogate Cancer Alliance.

Jo McNamara (01:48)
So Sue, how did you get to be in your role? What's your kind of career background?

Sue Ormesher (01:54)
⁓ it's quite long. I started out as a journalist 30 years ago and then after about 10 years doing that, I went into communications. So kind of over to the other side, really, working for a range of over the years, I've worked for a range of different public, private and third sector organisations, but latterly, largely the NHS. So it's all about, you know, getting messaging out there.

and raising the profile of the cancer alliance and increasing awareness about cancer symptoms, the importance of screening, that sort of thing.

Jo McNamara (02:28)
Thank you for sharing. Hayley ⁓ Gibson, would you be so kind as to tell us a little bit of background about your career and how you got into radiography?

Hayley Gibson (02:38)
you

Gosh, so I've been a radiographer for 21 years this year. And I started in Leeds University and did my student training in Leeds Teaching Hospital Trust and then stayed and worked clinically as a radiographer before I branched into management. And I still do bits of clinical now to keep my hand in. I joined the breast team.

12 months ago and became the lead radiographer over all breast services in Leeds and prior to that I had done other lead radiographer roles and roles specifically around quality. I come into breast with an interest in health inequalities having launched a self-request chest campaign and kind of learnt a lot about the backgrounds there.

So yeah, it's something that I'm generally interested and passionate about.

Jo McNamara (03:35)
Lastly, Hayley Snowden, what's kind of your career background? What's led you to kind of the role that you're currently doing now at the Cancer Alliance?

Hayley Snowden (03:45)
Yes, so my background is predominantly in operations and service management, a mixture of trust work and in the community. So I was responsible for the One New Leeds program, which is.

a community program which helps support patients lose weight, be more active, reduce our alcohol intake, etc. That really early prevention for health and cancer. And about just over four years ago, sort of mid pandemic, I took the role of Cancer Alliance and moved into this particular role for health inequalities nearly three years ago now. So I've not got a background in cancer. It was all new to me,

number of years ago so it's it was a steep learning curve but yeah I've never looked back.

Naman Julka-Anderson (04:30)
Talking about health inequalities, Hayley S, what are some of the health inequalities that people in your region face?

Hayley Snowden (04:38)
Predominantly deprivation, I would say that's the biggest health inequality. We know that people, patients who live in more deprived areas, excuse me, have poorer health outcomes. We also have very varied demographics of patients in terms of those that come from ethnic minority backgrounds, again, generally have poorer health outcomes, whether that be because of access or...

They're not sure what signs or symptoms to recognise and hesitate coming forward to speak to their GP or other healthcare professionals. I would definitely say they're two of the most common. There are lots of others, severe mental illness, learning disabilities, right across the board really. And that's where these programmes are so important to help support those patients to feel empowered to come forward and get checked.

Jo McNamara (05:23)
from your clinical perspective, what do you see in your role that can kind of align to health inequalities and how that impacts on people's ability to go for screening?

Hayley Gibson (05:35)
I think probably the most obvious is when you look at the data.

So you've got to be able to, so for breast screening, we cover Leeds and Wakefield. And ⁓ drilling down to the data and understanding who is coming for their breast screening or who is not coming for their breast screening, it becomes quite a stark difference between areas around Leeds and Wakefield and our inner city areas, which we class as socially deprived, have got a much lower,

uptake compared to the more affluent areas. And then if you can drill down further into your stats and understand who this population is that aren't coming and why, we can then start thinking about what can we do to break down that barrier.

Jo McNamara (06:27)
How easy is it, Hayley, to actually access the statistics? Because I'm just thinking from my own clinical background, sometimes access to that data isn't as easy as you would like it to be. What do you do in your service to ensure that you can readily access that? Or is it because you work with Cancer Alliance that you have that capability and time to process that data?

Hayley Gibson (06:50)
It's not easy. And that was one of the steep learning curves I had coming into the service when I'm saying, where's the data? The data is a lot of us manually drilling down to understand postcodes linked then to the IMD number, to understand then what ethnicity our patients are that are using the service. It would be...

it would be a lot easier for us if we could have that readily available, but I appreciate why we can't. And actually you have a sense of satisfaction if you can do some of that yourself, which me and my colleague have spent a lot of time doing in some of the areas that we have been running pilots on to try and understand who is our population that we're screening.

Naman Julka-Anderson (07:38)
It's quite a big thing to be getting involved in isn't it if you think about it with health inequalities it changes per region and things like that. How have you found engaging with kind of the service users or patients if they even understand and know what region or area they live in and how it impacts their health?

Hayley Gibson (07:42)
Yeah.

Again, this has been something that we have learnt a lot along our journey. What I think we firstly thought was we were going to go out and engage with the population. What we've learnt as we've gone on is actually it is better for us wanting to increase our screening uptake is sometimes engage with key stakeholders in the community or link to GP surgeries.

We then provide the education or we'll go into an area that they suggest, but we normally try to be invited in rather than impose ourselves. And we have found that having that balance and working with people are much, much better results. And we've substantially increased screening uptake in areas around leads by modelling that. And that is now going to become the unit's preferred way of working.

But yes, it's often engaging with the right people rather than thinking we have got the answers.

Jo McNamara (08:53)
So we've talked a little bit about kind of the socioeconomic cohorts of patients that potentially may not be accessing screening. But why is it, when you've engaged with patients and service users, why is it specifically that demographic? Is it because they have lack of knowledge around the screening or lack of education, or is it because of things like cost? You know, public transport is not cheap here in the UK.

And so, that could be a factor, but have you actually been able to understand what it is that's kind of limiting the uptake?

Hayley Gibson (09:29)
So it's not one thing, it's a complex reason of why people don't engage. And that could be low health literacy and understanding. It could be the locations that we have our screening centres that don't then make it easy for people to travel. As you said, it's expensive to travel. And if your choice is you're going to work or you have a family or you have caring responsibility,

that is often put before people's health if they don't understand why it's so important to detect breast cancer ⁓ early.

Lots of our population don't engage in healthcare, they don't understand what it is. But also how we communicate can affect them people's understanding. So if we haven't got it in their language and we are sending a letter out in English and their first language, and that's not their first language, know, as a screening unit, how are we expecting people that may not have any understanding of what this programme is to then come? So I don't think it's one reason.

You know, it's complex. There's lots of people doing research on this now. I think our role in the clinical is to educate people, educate the right people so that they are educating the population.

Naman Julka-Anderson (10:49)
Hayley Snowden, since coming into oncology, obviously you said you've kind of learnt and understood a bit more. Is there anything that's really surprised you within the health and equality space?

Hayley Snowden (10:59)
I think linking with what Hayley was saying earlier about data and the significant lack of it around health inequalities, it's, you health inequalities have always been there, I think. But with the recent, well, relatively recent launch of the Core 20 plus five program, which is the national program to target those 20% most deprived populations, I think there's still quite a lack of data to point us in the right direction. I think we know what the health inequalities are.

as you've just asked Jo, why I think is the really key point to that and the data helps us understand some of those barriers and the why that Hayley was just saying, but there's still lots more to look at and to share so that we can create those interventions and engage the patients to make sure they attend. It's getting better, but yeah, I think the lack of data and information was probably the biggest surprise to me coming into this field.

Jo McNamara (11:58)
So, Hayley Snowden, in terms of kind of the project and the work that's ongoing, you know, what is it that the region's doing and how can people get involved and support that?

Hayley Snowden (12:12)
So the main campaign we have running at the minute is called You Can Ask and this is a Leeds predominant campaign, although it is with a Leeds and Wakefield breast screening service,

came about off the back of a piece of work that public health teams in Leeds carried out looking at some of the barriers in three areas of health inequalities across the city. So learning disabilities, ethnic minority groups and patients with a severe mental illness. And those patients as part of that insight report said.

I'm happy to go, but I wasn't aware that I could have a longer appointment or I could take somebody with me. And basically about the reasonable adjustments that the Breast Screening team could offer to support those patients to attend. So we're targeting patients that are willing to go so they have that good knowledge of health literacy and the importance of a screening appointment. We're just supporting them to be able to attend with the adjustments that they require. So the campaign is basically to raise

awareness that you can ask for reasonable adjustments. Obviously within reason, I'm seeking some of the mobile units, not everything is possible but the team are there to make it as easy as possible really for you to attend if you wish to do so. And the campaign involves predominantly social media, we've also got some information going out into invite letters from the breast screening team and also some training and raising awareness of

prompting patients and asking them if they require any reasonable adjustments because often patients don't always feel confident or empowered to ask. They sometimes don't turn up because they didn't think that they could ask or didn't feel it was appropriate. it's a bit multifaceted, the campaign, to raise awareness and provide patients with confidence to ask for adjustments if they need them.

Naman Julka-Anderson (14:05)
There is always that worry, isn't it? Patients are, we don't want to put too much burden on the NHS, you know, you're busy, that kind of thing. But actually, yes we are, but there's so many things we can do for people. I think that's the crossover, isn't it? That sometimes people just don't know that they can do it.

Hayley Snowden (14:21)
Absolutely, I think there's a bit of a power imbalance often when you're, whether it's a GP or any kind of clinical appointment, so people don't want to feel like they are,

putting the service out or they've been a burden or they're asking for something that they shouldn't be when actually if it means that they're going to attend their appointment and potentially find a cancer at an earlier stage which would ultimately save their life in the long term then by offering it could be a double appointment or a letter in another language something that we have readily available to offer it really can make a difference.

Jo McNamara (15:03)
So Sue, what's your role been within the West Yorkshire ICB and Cancer Alliance specific to this project?

Sue Ormesher (15:10)
Well, as part of a communications team of two, we've worked really closely with Hayley and her colleagues and Hayley and people in partner organisations as well to help to develop the campaign really. We've also had ⁓ an external marketing agency who've been working very closely with us on

you know, the best ways to reach people. And one of the aspects of the campaign was to work with a group of women for each of the groups that are being targeted, women with a serious mental illness, with a learning disability, from predominantly South Asian ethnic minorities. So they worked with us to co-produce some of the resources and assets,

which we thought was really important. what they felt could work. We worked with the Hamara Center, which is a center in Leeds, and ⁓ a woman who works there, who is a trusted member of that community, also lent her support to the campaign as well. So she features on some of the leaflets and the social media assets.

The agency we've worked with have done a very targeted social media campaign, mainly on Facebook, and sent emails out to lots and lots of community groups so we can try and spread the word as far as possible. And from the communications team, we have been trying to raise awareness through our own social media channels, but also in the press as well,

secured an interview with BBC Radio Leeds, Greatest Hits Radio have also featured ⁓ Hayley Snowden, that's been quite good. Oncology News Today, which is a national news website, also featured the story and then we've been just sending out social media on a regular basis with all the key messages that we've with our partners.

You know saying you did you know you can ask you know just trying to hammer that message across that did you know you you know reason and we don't tend to use reasonable adjustments because it's a little bit jargony so we're just trying to to put it in more simple language and say did you know you can ask for a longer appointment or you can take somebody with you or you can go and look at the the unit beforehand just so you have an idea of what to expect so it's that kind of thing really and it will be

ongoing, we're hoping to create a legacy page on our website just to show what's been achieved because the reach particularly with Facebook that our marketing agency have achieved has been really good, like well over a million at the last count, well over a million engagements and so yeah that's been quite impressive so we're hoping that we can use it in the future really as well.

and it'd be great to widen the campaign to other areas. But we really want to capture what's been achieved, yeah, that's it. Yeah, thanks.

Naman Julka-Anderson (18:10)
When you say widen it to other areas Sue, is that regions or other kind of backgrounds of people?

Sue Ormesher (18:15)
⁓ I think both, I'm in an ideal world and also would like to spread the word amongst cancer communications colleagues who I work with. sit on a cancer communications network group which is a monthly group and we all share campaigns that we've been working on so that it might give people in other areas an idea or if they're thinking of working on something similar.

they don't have to reinvent the wheel. We do that quite a lot. did it with another campaign that Hayley was led on called Remove the Doubt, which I think it was the Greater Manchester Cancer Alliance have since taken up. it's about sharing good practice as well and hopefully inspiring colleagues in other parts of the country to adopt similar campaigns.

Jo McNamara (19:10)
So, Hayley G, obviously from Sue's perspective, there's been lots of social media engagement, but from your perspective working clinically, have you seen lots of people now engaged and ask for these reasonable adjustments as a result of the campaign?

Hayley Gibson (19:27)
Yes, we are starting to see it coming through

and people starting to ask. The audit hasn't been complete yet, so you're a bit premature asking for the results. But we have managed to ingrain it into our admin stats, so when they're speaking on the phone, they are then used to saying, there any reasonable adjustments, or is there anything else you need? And then all our reminder text messages now have it as part of the text so that people know

they can pick up the phone and ask. And then it's about us promoting it as well. And we've spent some time educating the radiographers about the campaign with the support of the Cancer Alliance coming in. So they are now starting to talk about it with our ladies coming onto the screening sites.

Naman Julka-Anderson (20:19)
What's the feedback been from the radiographers?

Hayley Gibson (20:22)
⁓ Really positive.

They are as clinical staff working in a breast screening unit is kind of ingrained into them to do whatever is needed to get ladies to have their breast screening complete. But I think they've liked bringing it all together and then thinking about it as a campaign rather than something then that we perhaps would have normally just done if anyone had rung and said, can I have this?

Or can I need that? But it's really encouraged. It's really...

It's really made us kind of look about what we're doing. And so we've done work around our learning disability appointment invitation and we have easy reads now readily available that can be translated into any language. And they are then specifically linked to our screening center. So they've got our branding on them. So yeah, it's been good. Very, very welcomed by our radiographers.

Jo McNamara (21:18)
I always think we are absolutely missing a easy win when you look at mammography and you think every time a woman is standing there getting a mammogram, like they could literally stand there and you could have an advertising board, couldn't you, with all these amazing messages on it. Exactly the same for us in radiotherapy, always think patients are typically lying on their back looking up. I'm like,

Or you could have a nice advertising board there talking about public health messages and things like that. So yeah, maybe in the future, company needs to design a mammography machine that essentially has an advertising screen on it. Hey, there you go. You can't look away. You're standing there having your mammogram. You could do some reading.

Hayley Gibson (21:53)
Hahaha

Naman Julka-Anderson (21:57)
We have this in your urinals Jo, you've got all the public messaging there above it now.

Jo McNamara (22:07)
It probably distracts the patients to be fair as well, wouldn't it?

So, Hayley Snowden, in terms of kind of the project and taking it forward, what do you hope to have achieved maybe within the next year?

Hayley Snowden (22:28)
The project finishes, I think we're in the last couple of weeks now, so we're hoping the results will show us that the proactiveness and the raising awareness of reasonable adjustments does improve the uptake of patients going and sharing that with other cancer alliances I think would be the main goal. We do have an intranet page called NHS Futures where all cancer alliances share their project information and the assets we've created. On some of them we purposefully don't have the

Yorkshire logo on them so that they can be what we could lifted and shifted or pinched with pride, other kinds of alignments call it. So yeah it's similar to what Hayley was saying about

creating best practice for other breast screening services. And more locally as well, the Pennine Breast Screening Service, which covers the other areas of West Yorkshire, have already been asking to say, this something that we could perhaps do? Because if the results show that it works, we'd love to support that after the campaign. And obviously I'd love the legacy page to be accessed by lots of different people, patients and professionals alike. Once that's up and running, that will remain there that we can continue.

to update. yeah, once the campaign's finished it's about that sustainability. you know, when ladies come for their breast screening, next time they're in round in three years time, they will remember the campaign, will plant that seed and they'll speak to their mums, daughters, sisters, nieces about reasonable adjustments and the word will spread that way and continue to do so.

Naman Julka-Anderson (23:54)
Hayley S. just as a follow up to that you sound very passionate about health inequalities why are you so passionate about health inequalities?

Hayley Snowden (24:01)
I think it's...

only right that everybody has the information to be able to make an informed decision about their health and screening being one of them. I if we give everybody the right platform and information to make a decision then that's all we can do as a cancer alliance really. We'd love everybody to go with all of the messaging that we're sharing but it's those patients that want to go but because of their health inequality can't access the services that they're wanting to. Obviously we have

patients that are, I don't want to say harder to reach because our reach perhaps isn't always appropriate, they don't engage with services, those patients are trickier to remove their barriers but if we have patients who have removable barriers then we should be doing that for them and having interventions in place to be able to remove that health inequality. It's not that easy for everybody but if it is then we should be our responsibility to do that.

Jo McNamara (25:02)
Is there anything from kind of the perspective of anyone listening thinking, ⁓ I'd actually quite like to do a project as part of health inequalities within my clinical field. Is there any advice that you would give them? Because obviously I'm just talking from someone who's clinical, sometimes Hayley S doing the work that you're doing, coordinating and the strategic management of projects, sometimes

you know, we wouldn't have that knowledge and skill. Is there any top tips that you would maybe give them?

Hayley Snowden (25:33)
Yeah, threefold. think the first one would be engage with your local cancer alliances. There are lots of us around the country and there will be a cancer alliance in your area that will be open to delivering projects similar to the one we're delivering here.

Secondly would be to use the data, look at the data that is available so that you are aware of which patient groups that perhaps need that additional support so you can then approach a cancer alignances with an idea of your patient demographic who isn't attending their breast screening. And then the third one would be to co-create with patients.

It's one thing creating an idea of a campaign and taking it to patients, but actually if you start...

with stakeholders or voluntary organisations who engage with those patient groups and asking what do you want this campaign to look like? If you want us to read this message or hear this message, where do you want to see it? Where do you want to read it? And that's worked for us in the past with other campaigns and it's definitely worked for us this time again, hence why the lady from Hamara wanted to actually be in the campaign as a trusted member of the public. Messages coming from trusted community members resonate far,

more than it does coming from me or someone else in the Cancer Alliance. If you look like somebody on a poster in your local area and you trust them, you're more likely to listen to the messaging that they've got. So yeah, they're the three key things I would say to sort of have in mind if you're wanting to look at doing a piece of work.

Naman Julka-Anderson (26:58)
to you Hayley Gibson. I was just thinking I feel like we're on University Challenge by full naming you each time. Hayley Gibson, from your perspective as a lead, what kind of advice or top tips would you give to other leads considering campaigns or pieces of work like this?

Hayley Gibson (27:15)
Education, think. Go and educate yourself about what is health inequalities, what it means to reach out and listen to what people are going to tell you.

you don't have to do it yourself. There is plenty of people out there to help, the likes of Hayley and Sue and other key stakeholders. And I think by working with them, you get a much better result. And that's certainly what we've seen in our screening unit.

Jo McNamara (27:42)
And Sue from your perspective, any top tips for anyone listening that you think actually it'd be really good for you to do this, to be able to engage in a project or a campaign like this.

Sue Ormesher (27:54)
I think I'd echo really what Hayley said, Hayley Snowden, well both, but Hayley Snowden too in terms of

engaging right from the start with the people that you once you've identified the people that you want to target in the campaign, engage with them, don't work in isolation, but also work with your partner, closely with your partner organisations as well. So that everybody is is on message really that you know and you and

Develop three or four key messages of what you want to achieve. You don't need to over complicate it. And then work out how best to reach those people to go to where they are. So whether that is on Facebook community groups, Facebook forums, community centers, it might be groups for example with this campaign, people with learning disabilities who may go to a day space, spend some time at a day center.

It's about things like bus shelter advertising, which we did use a bit of as well, because people, and even to the point of mapping out routes of where people might get a bus from the particular area they live in to the breast screening unit that they're going to. So you bring together all of that detail and a really valuable campaign will take shape.

Jo McNamara (29:12)
Perfect. We don't usually do this and Naman's going to be like, no, she's going rogue. She's scaring me already. But Naman, you do a lot of work within the health inequalities space and lots of work that you've done recently out with communities. What advice would you give to people who are wanting to do research projects or campaigns in this space?

Naman Julka-Anderson (29:34)
Thanks, Jo. You didn't full name me though, University Challenge style. I think, as I think everyone's alluded to, it's about trust. So you can have an idea, but if you don't actually speak to the community you want to help. Sometimes there's almost no point because they won't engage with you. So for example, Black Women Rising is by the Leanne Pero Foundation. It took me three and a half years to start working with them, but now, yeah, they can't get rid of me. But it's just about building the trust and once you've got the trust...

Obviously maintaining it and not having like a colonial mindset of gonna take all your information and help and knowledge and then not kind of give back. So like you said about the legacy website, that's amazing because it's always gonna be there. No one's gonna be able to take it away from all the work and stuff you've done. yeah, thanks Jo.

Jo McNamara (30:16)
I'm sure he'll get me back in other episodes. But thank you all so much for joining us on Rad Chat. It was such an interesting conversation and we could probably go on for a lot longer. So thank you all for giving up your time. A huge thank you to our guests, Hayley Gibson, Hayley Snowden and Sue Ormesher for talking about how they're tackling health inequalities in their region. Thank you all for listening to Rad Chat with myself, Jo McNamara and Naman Julka-Anderson.

Jo McNamara Rad Chat Host (30:50)
So what do you do now? Well you can use this episode as part of our free continual professional development accredited content which offers flexible learning that fits your busy schedule. Just check out the show notes for the reflective questions, links to literature and resources and link to the completed form to receive your accredited certificate.

Naman Julka-Anderson (31:00)
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Jo McNamara Rad Chat Host (31:10)
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Naman Julka-Anderson (31:33)
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Jo McNamara Rad Chat Host (31:48)
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