The medical scepticism remit of work was initially borne out of an interesting nuance from our research project on COVID insights in 2020. Alongside the distrust of institutions which persists among many BME communities, The Social Innovation Partnership along with its community research team (which would later develop into ‘Centric’) identified healthcare and medical scepticism. This strategy will be constantly informed by communities in South London who are seldom heard. This will be to ensure needs are met at the local level when it comes to health, wellbeing, gaps in service delivery and barriers when engaging with medical institutions.
The significance of an urban strategy of health for the urban locale and communities already mired by discrimination, racism and social injustice cannot be ignored. With this strategy, Centric are ushering in a fresh approach driven by the local community. It is also responsive to the serious health inequalities which often fall below the radar while at the same time, tapping into the local innovation which often gets missed. The components outlined in this document contribute to building fairer and equal health outcomes for those most disengaged.
After discussions with Impact on Urban Health, and with their valued support, we then embarked on an ambitious exploration into medical scepticism, focusing on healthcare distrust among diverse black and minority communities in South London. In turn, and eighteen months later, this approach has served as a basis for fresh and novel health outreach initiatives across the urban locale.
At the inception of the medical scepticism research, Centric investigated the significance of research ethics and why research ethics was relevant to medical scepticism – there is a historical context of ethical considerations towards black people. While out amongst South London communities, it was around this time Centric were approached by the NHS, King’s College London and Lambeth Council, and began liaising with academics such as Dr Caitjin Gainty from King’s College London, and also of the Healthy Scepticism initiative, and also Dr Maya Goldenberg in Canada, the author of the 2021 book Vaccine Hesitancy.
Centric also afforded due attention to the wellbeing of our community researchers and the sensitivities of researchers, as there are requirements for reflection for BME researchers when conducting sensitive research and the coping and managing of mental health. In this way, Centric realised the importance of decolonising the research process for community researchers. Centric then began building these teams, comprising individuals who were sceptical at the outset.
Here, Centric shifted behaviour via its cultural interface, familiarity, a shared sense of empathy and shared lived realities. Centric became an informal recourse for people to go to for a trusted and safe space for reflection, discussion and ideation, for both its community research team and the wider community who were gaining awareness of, and interest in, our work.
It was at this time we had extrapolated the seven key insights from the 2021 medical scepticism research. This was not easy, as it was at the peak of distrust, yet we were still able to conduct 120 interviews and unearth these nuances below the radar. The fact we were able to build the capacity and capability of the community researchers and feed that back into the medi-scape as a part of knowledge production, was significant. Centric then won the King’s Together Fund along with Dr Caitjin Gainty, from King’s College London, on the back of our previous research.
Centric’s own research alongside revealed a huge lack of trust between communities and health institutions which pre-existed prior to COVID-19 yet was further highlighted during the pandemic. A key finding in regard to this apparent distrust was communities in South London did not feel there were appropriate opportunities for engagement with statutory services and therefore are unable to participate in decision-making or the design of services which they use. Centric embarked on a project with Southwark Council exploring this further, plus conducting interviews with local residents. Centric is also currently working on a similar project with Hammersmith Council, a conurbation which has the highest rate of vaccine hesitancy in London.
Given where we are now, issues around the strain on staff, health messaging, consent, digital trust and communication in healthcare are even more important and that there is an awareness of consent and an understanding of medical jargon, language and communication. The research approach adopted by Centric means new knowledge is generated and feeds into new theories and then into new interventions and initiatives. This has been significant for the medical scepticism remit of work as it also aligns with the NHS Long-Term strategy, particularly in the areas of prevention, health equality, care quality, improvements, technology and workforce pressures on staff.
These are the areas of focus for this medical scepticism strategy:
Technology and Medical Scepticism
Centric has already been looking at conducting further research around digital technologies and how communities can engage with emerging technologies and the repercussions of this when it comes to eHealth adoption. Centric suggests, as supported by recent studies in the field, that many patients are informed and involved digital users who have the skills and knowledge to navigate themselves around platforms. Nevertheless, this does not apply to all communities and there is further work required. This indicates the importance of patient/user involvement to co-design eHealth platforms which are user-friendly. This is significant for the future of tech innovation within health services.
This is also where disaggregated data is relevant as a lack of it has maintained broad generalisations, stereotypes and confusion as sub-groups are not analysed against other demographic variables. Centric has discovered that this is relevant when working with communities such as the Somali community. Centric envisages merging data disaggregation with tech to improve the effectiveness of interventions, inform more equitable health initiatives, inform policy and promote a more holistic approach when engaging various ethnic groups.
Safe Spaces in Healthcare for both Patients and Staff
Safe and welcoming spaces for people, particularly for health-related domains, are important and can facilitate therapeutic talking, active listening, community engagement, strategic dialogue, recommendations and a place to offload. Although there is little research on the psycho-emotional impact of pandemics on medical and clinical staff, the pandemic has indicated the impact can be significant. This has particularly been the case for black and minoritised female nurses who have faced a pandemic, the deaths of colleagues and friends, burnout and then the prospect of losing their jobs with vaccine mandates.
In recent research conducted by Centric at a well-known London hospital, it came to light it was important for there to be safe, neutral and non-judgmental spaces for NHS staff to air frustrations and concerns. A culture of valuing staff, and considering their wellbeing, results in better staff engagement and in turn, better patient outcomes and financial performance. The contrary is also the case therefore, that poor staff engagement has the knock-on effect on poor patient outcomes.
Strategic Academic Partnerships for Equitable Co-Production
Contrary to the barriers and constraints experienced by external researchers from either the academy or institutions, we have found that unheard voices within the urban locale have been willing to participate in research. This has been without any anticipations or preconceived expectations their own views will merely be validated by the research. It is imperative to further build relationships between community and academia to ensure work is strategically aligned and that communities are learning from academia and the locale also feed into the knowledge production of academia, and to also embed community findings and knowledge.
Centric has built important academic relationships over the last two years and this has resulted in an equitable exchange of knowledge and learning which needs to be continued to help in processes of research, co-design and co-production of fresh initiatives and innovations. This has led us to collaborate on projects at King’s College London, the London School of Economics, Birkbeck, South Bank University and the University of Manchester.