Published on 17 February 2025
How our 123 Approach is helping to confront health inequalites in cancer care
By Helen Johnstone, Health Inequalities and Patient Experience Development Lead at Cheshire and Merseyside Cancer Alliance
Tackling health inequalities is a priority in the NHS Long Term Plan, with a national expectation that cancer alliances should engage in this agenda.
Priorities in this are maintaining a focus on patient experience and health inequalities at all stages of transformation, from prioritisation, planning and service design through to implementation and evaluation, to ensure that improvements are inclusive and aligned to the local populations needs.
Cancer is also included in the
Core20plus5 approach, which informs action to reduce healthcare inequalities at both national and system level.
Cheshire and Merseyside Cancer Alliance (CMCA) was the first cancer alliance in the country to establish a Health Inequalities and Patient Experience (HIPE) team, whose aim was to develop the infrastructure to support understanding and use of health inequalities and patient experience insights across their programmes and projects. The HIPE team have achieved this via their ‘123 Approach’.
The 123 Approach is a training and education package aimed at cancer care professionals to support them to reduce health inequalities in their organisation and own work.
The project was in a pilot phase for two years, during 2022 and 2023, developing into a successful and sustainable approach to tackling health inequality.
The learning was particularly impactful in helping CMCA staff to understand and use the HIPE insights themselves. The face-to-face training resulted in a 34.4% increase in knowledge and confidence in tackling health inequalities among its attendees; and one third of CMCA staff following the training then chose to become HIPE Champions. Furthermore, 50% of CMCA projects now have at least one patient representative involved, and patients experiencing inequality have been recruited to an advisory panel.
Our online resources were downloaded more than 1,500 times between 2022 and 2023; and the training has been expanded into several different formats following requests to be delivered to Cancer Support Workers as part of the Principles of Cancer Care Programme, Macmillan Partnership Leads and as a workshop at the Macmillan national conference.
Demand for the training, resources and support networks grew across Cheshire and Merseyside, and beyond, during this pilot phase, leading to the development of the 123 Approach standard and facilitator eLearning courses.
The purpose of this approach is to engage with NHS staff in cancer services at all levels and to streamline their approach to tackling health inequality.
By creating a comprehensive package of CPD-accredited training and support, our ambition is to empower NHS staff, at all levels, to see health inequalities as their own responsibility and support them to take action and improve patient experience across the cancer pathway.
What is the 123 Approach to Health Inequalities? There are three parts to the package...
1. Training
The 123 Approach is an innovative, e-Learning training course based on patient and staff voice, with a series of usable tools, which places action firmly at the feet of staff.
It is free of charge and aimed at all staff within cancer services, regardless of their level of practice (pre-registration to consultant level) or pillar of professional practice (clinical, leadership and management, research or education).
The programme has been designed in collaboration with people who have lived experience of cancer and NHS colleagues working across the cancer pathway. The course is fully funded, CPD accredited and aligned to the ACCEND framework. It should take between 60 and 90 minutes to complete.
The content of the training walks learners through what is a health inequality and the wider determinants of health. It discusses barriers to healthcare and how this may present in a cancer pathway. It explains intersectionality – how different factors that a person faces combine to create health inequality – and learners listen to patient and staff voice through this journey.
However, the training does not leave you with the barriers faced but supports learner s to consider how they can address the health inequalities faced within their own line of work. This is step 1 and what follows is an introduction to step 2: The resources, and step 3: The support.
The package gives practical steps and support on how to address health inequalities and improve patient experience.
2. Resources
Learners have access to a library of materials which are of an extremely high standard to support colleagues to identify and address health inequalities that can be referred to at any time.
An important aspect of the training is that staff are not left to face challenges on their own after completing the online module. Included in the resource section are checklists to support how an organisation can review a pathway or process and the potential use of the patient voice to support this.
Staff have access to factsheets containing information on specific protected characteristics, which can support policies and procedures to ensure they are in line with the information presented in the factsheets.
In addition, they demonstrate how to accommodate reasonable adjustments and personalise care in organisations.
Finally, there are step by step guides on how to identify and address health inequalities, from general barriers to specific considerations and legal requirements.
3. Support
Delegates gain access to internal and external peer support networks, in addition to tailored advice and support from our HIPE team. CMCA has set up a HIPE Staff Network that brings together NHS colleagues from across Cheshire and Merseyside who work in cancer services and have an interest in tackling health inequalities.
The network provides a platform to share updates and best practice in addressing health inequalities and improving patient experience within cancer services. It also offers support from the Cancer Alliance and enables colleagues to seek feedback from others. The network is open to all colleagues nationally but focuses on specific projects within the Cheshire and Merseyside region.
In addition, we have created step by step guidance on how to embed tackling health inequalities as part of organisational culture, with a how-to guide on creating a staff network and how-to guide on setting up a staff champion scheme.
Feedback has been amazing with 100% of our learners being highly motivated to make changes. Furthermore, 100% of respondents felt either extremely or somewhat confident in reducing health inequality within their role following completion of the training and 94% said it was either extremely or somewhat easy to access health inequality resources in the post-course survey.
A key aspect of the training is the ‘change one thing’ form. This form is the starting point in identifying a health inequality in the area of work you are involved in and considering how to tackle. The smallest change often makes the biggest difference, and everyone can ‘change one thing’.
In addition to the 123 Approach health inequalities training, the platform also offers a facilitator training package that enables students to deliver the training face to face, at a time convenient to their organisation, with the ability to make the training bespoke for their own setting and experience.
Any organisation or individual interested in accessing the 123 Approach training or resources can visit the Home page of this website and click on the ‘123 Approach Health Inequalities Training’ button. This will take you to a new page. If this is your first time you will be asked to create a new account.
Once set up, you will have full access to the e-Learning, resources and support. Alternatively, click on this link to take you there directly: 123 Approach
