Hard to reach? It’s time to change the language 

This Sexual Health Week we want to amplify the voices of those who face barriers as well as those who are working tirelessly to break barriers. GP Anne Connolly, a passionate women’s health advocate, illustrates here why we need to rethink the language we use when talking about underrepresented people.  

Too often we hear that certain groups and populations are ‘hard to reach’. But are those people really hard to reach? Or is it that they are just easy to ignore? 

People are not hard to reach, they are right there – and they have an opinion if we make the effort to listen.

It is ‘us’ as providers and commissioners who make the assumptions that we have collected all the necessary information without addressing in sufficient detail if the input reflects the populations served. If we are committed to reducing the current disparities or inequalities of care and outcomes, this has to change. 

Financial cuts and efficiency savings often lead to reduced access to sexual and reproductive health care. Alternative ways of delivering services which involve reducing numbers of clinics, clinic opening hours or in person appointments may work for the majority, but risk creating further barriers for those who already find it a challenge to access care. Failure to fundamentally understand how complex the hurdles can be for the many who do not have easy access to IT; the ability to attend the appointment in a new, more distant site; or the option of flexible work patterns inevitably increases disparities. 

In Bradford, where I work, the main young people’s clinic was moved from the city centre, half a kilometre with altered working hours which meant the young people did not have easy access on their way home from school or college. Footfall dropped significantly and confidence in the service took a long time to gain when a new city centre site was commissioned and established. 

What can we do better? 

We must gain trust with people who find mainstream services hard to access because of cultural, social or communication concerns: to really appreciate the needs of the diverse sectors of the communities for whom we provide care.

We need to offer the reassurance that everyone’s voice matters and will be heard and acknowledged…and show that we have listened. We can learn so much about developing and delivering appropriate care if we appreciate and understand the unique challenges that different communities face. 

We must optimise working with the voluntary sector to co-produce the messaging and methods that will enable the delivery of acceptable models of care. And we must use appropriate interpreters and engage peer advocates to test out the messages or plans to reduce the risk of making ineffective or counterproductive changes from incorrect assumptions. 

Having worked in inner city Bradford for the past 30 years with one of the most deprived and diverse populations in the country, I understand the challenges to providing appropriate care for those who we claim are ‘hard to reach’. To address the inequalities that exist for women, and within the population of women, patient and public involvement is essential. 

The Bradford Women’s Health Network (WHN) was established in 2016 and funded by a small grant from the CCG. The WHN is a collective of women living and working in Bradford District and Craven, with a mission ‘to improve the health and wellbeing of women and their families through effective partnership working, with a particular focus on seldom heard voices’. The WHN has reach into the different communities, is trusted and provides feedback which would not be possible otherwise. The valuable feedback gained from using advocates and co-production can be used to support commissioning decisions, engagement and improvements in patient care. The recent evaluation of the Network by Birmingham City University has been published and clearly demonstrates the benefit this has provided and this can be replicated in others towns and cities. 

The latest changes to the health and social care system in England which encourages closer working arrangements between health and local authority commissioners should provide an opportunity to get this right for all.

The key is the voluntary sector who can ‘reach the parts that others can’t reach’ and make sure that those seldom heard voices are truly heard. 

We must change the language – people are never hard to reach – it takes time, effort, desire, trust (and sometimes small financial costs) to hear even the quietest voices over the noise of the most vocal. 

Hard to reach? No – easy to ignore!