An #inclusivity story from NHS North Cumbria Clinical Commissioning Group (CCG) Communications Team...


The rollout of the vaccine programme brought into sharp focus the need for us to ensure we communicate with our whole community here in north Cumbria.

That meant challenging ourselves - do we reach all the groups of people who call our area their home? The answer was - we were trying, but we had to do better.

We took a countywide approach working with colleagues at Morecambe Bay CCG and in the public health team at Cumbria County Council, as well as those that had links into people living here who may have had English as a second, third or fourth language.

While we lived with covid restrictions, we initially focused on providing information online in a range of languages.

We have a very small ethnic minority population in Cumbria compared to some of our neighbouring counties and cities. We quickly agreed we should ensure we provided information and made it available on our website and promote the page widely. The webpage is here: https://northcumbriaccg.nhs.uk/covidvaccine/covid-vaccine-leaflets-alternative-languages-and-accessible-formats  

As new guidance became available in alternative languages, we posted it on social media and asked people to act as allies - ‘if you have friends or neighbours who would find this information helpful please share it with them’:


Despite our website appearing at number 3 in the Google rankings for alternative language information, we knew simply making the information available was nowhere near enough.

A small group of colleagues working in inclusion roles met and identified individuals who could help, and wider groups and networks who would be vital in sharing the information.

Naz was kind enough to allow us to film her receiving her vaccine, and her video has been shared in both English and Malay:


We reached out to the Multicultural Cumbria and Furness Multicultural Forums who have language and diaspora networks in our community, and provided information for them to share and offered to be a link for those asking questions, raising concerns and seeking support from those communities with trusted advice and guidance. More information is available here: https://multiculturalcumbria.org.uk/category/covid-19/ and https://www.facebook.com/FMCFyouthclub 

Colleagues at Cumbria County Council used their school census information to identify the top languages spoken, which were:

  • Polish
  • Romanian
  • Arabic
  • Turkish
  • Chinese
  • Bengali
  • Hungarian
  • Bulgarian
  • Portuguese 
  • Spanish

We prioritised these languages as the guidance developed and changed.

We then targeted those languages on social media. It picked up some queries from our community, which we used as an opportunity to reinforce the importance of reaching out to everyone in our local area:


We have also worked with Cumbria County Council to access some funding for our partner forums to enable them to reach out through their networks and plan to build stronger links between our diverse communities and health services. We are planning to offer drop-in sessions on health issues identified through those networks as we get used to living with covid. 

Huge thanks to Saj and Janine for their invaluable support.


This film from NHS England describes how Derby Teaching Hospitals have taken an inclusive approach to their feedback methods and improvement initiatives.

They want to make sure people of all backgrounds and disabilities can give feedback and have put in place easy read feedback cards for people with disabilities as well as translating their feedback cards into the 10 most used languages in Derbyshire:

Read more on the NHS England website...

More than 296 young people struggling with their emotional wellbeing have been helped by a new service designed by their peers.

The LINK service offers a ‘non-medical’ solution that provides a holistic approach to managing some of the issues young people face today – many of which have been heightened by the challenges faced as a result of the COVID-19 pandemic. Worries and anxiety about isolation, identity, school, exams, and parents and carers working on the frontline have all increased over the last 18 months.

The service is a collaboration between Barnardo’s and several local Primary Care Networks (PCNs), which are groups of GP Practices working together. 


One of the young people who has used LINK said: "If I’d not met [my worker], I don’t think I’d have the confidence to leave the house and I’d be anxious all the time. I’m less worried now, it’s like the weight of the world has been lifted off my shoulders…She has really guided me to a better place. She’s listened to me and got me back on the right path. Now I live more in the present rather than worrying all the time about the future and the past. Now the future looks a lot brighter.” 


LINK provides individuals with that much-needed support, but what is particularly special about this service is that children and young people have been actively involved in co-producing it from the very outset. They have formed interview panels, describing to health and care professionals what they would need from the service, what it should look like, and what they would want from the practitioners involved. 

This has resulted in a truly personalised offer, which includes the provision of one-to-one and group support, the use of assessment tools, school drop-ins, and connecting children and young people to appropriate resources in the wider community which are best suited to their needs, interests and circumstances. It ultimately empowers individuals to look after their own wellbeing, and recognise when they might need further help. 


Since its launch the service has received 296 referrals. 76% of these have been made by GPs, with the remainder coming from schools, colleges, police and other organisations who value this new service. 

Now, more than a year in, the co-production work continues, with a number of children and young people who have accessed the service getting involved in further influencing and shaping its future.


Dr Richard Massey, Clinical Director of the Keswick and Solway PCN, said: “We knew there was a gap and that young people who needed some emotional help weren’t getting the support required, or were on waiting lists for medical services that might not have actually met their needs. For me, it was important that the people using the service had a hand in shaping how it would work. It is clear to us that if you ask young people, they know exactly what they need and have helped us to design a service which feedback tells us is really effective."

A parent said: "This is such a fantastic service to have; just having someone for kids to talk to when they feel they can't tell a parent or teacher makes such a difference to a child's mental health. Massive thank you Barnardo’s & NHS!!"


The LINK service is available to those aged between 5 and 19, and who are registered to a GP practice and/or attend school within the Penrith and Eden, Keswick and Solway, Brampton and Longtown areas.

For further details about the LINK service or to make a request for support, please email linkcumbria@barnardos.org.uk or call 07874 795 426.

To find out more about co-production, please visit our Co-Production Toolkit at: www.northcumbriaccg.nhs.uk/get-involved/co-production-working-together-tool-kit


There are lots of great video resources out there that can help deepen our understanding of the inequality and injustices that people in our society face.

Here are just a few of our favourites...


Please see below for a video from North East Ambulance Service (NEAS) Proud staff network - 'Real things straight people say'.

Whether you realise it or not, everyday conversations can be filled with microaggressions. But what is a microaggression? And what would it sound like if a microaggression towards an LGBT+ person was reversed towards a straight person?!


The LGBT+ Staff Network and Executive Directors at Cumbria, Northumberland, Tyne and Wear NHS FT (CNTW) have developed a short video to explain what pronouns are, why they are important, and how we can all use them to be allies to trans and non-binary people:


5 tips for being an ally:


Are you racist? 'No' isn't a good enough answer. Most of us, says Marlon James, are non-racist. While that leaves us with a clear conscience, he argues, it does nothing to help fight injustice in the world:


Everyday racism: what should we do?


What is co-production?

Co-production is a way of working that involves people who use health and care services, carers and communities in equal partnership.

It engages groups of people at the earliest stages of service design, development and evaluation. Co-production helps to ground discussions in reality, and to maintain a person-centred perspective.


Why should we co-produce?

Local people often have ideas and solutions that would work better for their communities. Taking part can increase people’s confidence and self-worth. It also enables and empowers people to have ‘ownership’ of their local services and gives them a sense of purpose. 

As an organisation, it builds greater understanding of local health services and connects you to the community. 

The graph below shows the benefits of co-production when looking to improve and transform a service:

  • The red line, Stabilisation, is what happens when there is no focus on change of any kind
  • Transformation only, the gains tend to fade. Changes are implemented and make a difference but over time enthusiasm wanes, someone moves to another job and the change is not fully sustained, some gain is maintained but not all and then another bright idea comes along and the change trend is repeated
  • Improvement only, when small PDSA style change takes place routinely across the system consistently by staff. Progress is steady and always upwards towards improved quality but relatively slow for the pace of our system
  • Improvement and transformation, when the two previous methods are combined then change can happen more quickly and continuously in an upward trajectory
  • When we include co-production and involve those who use our services then improvement happens even quicker and quality is greater


So, where do I start?

Below are some suggestions of where to start co-producing:

  • Talk to your patients – this can be informally, even in the waiting room!
  • Contact colleagues who are involved in working with people and communities, and start to map community groups, people with expertise, community leaders e.g. local councillors, voluntary organisations, local authority neighbourhood panels and community development teams, etc.
  • Identify places to make connections where people meet already, e.g. community cafes, live at home schemes, libraries, community meeting places, food hubs, pubs, places of worship, farmers markets etc.
  • Connect with local engagement leads
  • Contact your local Healthwatch – find their details at: www.healthwatch.co.uk 


Useful principles

Below are some useful principles, to help guide you when looking at co-producing:

  • Get the community involved as soon as possible and maintain an ongoing conversation
  • Build on what already exists such as patient groups that are already established, community meetings already in place and use feedback from current surveys
  • Use community spaces such as community centres, libraries, community cafes, which are often more accessible and inclusive
  • Be open and honest with people, including the ‘tricky issues’
  • Value people’s time and input and ask what support they need
  • Focus on ‘doing things together’ – not just a tick box exercise
  • Listen more, broadcast less
  • Avoid jargon and acronyms
  • Involvement is messy and organic – develop it with people
  • Forethought not an afterthought!


To find out more about co-production, please visit our Co-Production Toolkit at: www.northcumbriaccg.nhs.uk/get-involved/co-production-working-together-tool-kit.

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Tools for Co-Production: Bitesize

6 April 2022 │ 9:30am - 10:30am │ Virtual: Microsoft Teams

A short, virtual workshop to get to know the key tools needed to start to build effective relationships with partners and service users for better patient outcomes.

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